Infant botulism. Epidemiological, clinical, and laboratory aspects
S. S. Arnon, T. F. Midura, S. A. Clay, R. M. Wood and J. Chin
Clostridium botulinum organisms and toxin were identified in the feces of
six infants, aged 5 to 20 weeks, who had illnesses clinically consistent
with botulism. Five of the infants lived in California and became ill
within a six-month period in 1976; one infant became ill in New Jersey in
1975. Three cases were type A botulism, and three were type B. No source of
ingested botulinal toxin could be found in any case. However, one infant
with type B botulism had ingested a food containing C botulinum type B
organisms, and no toxin was found in it. The clinical findings in these
cases include constipation, weak sucking and crying ability, pooled oral
secretions, cranial nerve deficits, generalized weakness, and, on occasion,
sudden apnea. A characteristic electromyographic pattern termed "brief,
small, abundant, motor-unit action potentials" (BSAP) was observed. The
sources of C botulinum toxin for these six infants is thought to have been
in vivo (gastrointestinal) production following ingestion of C botulinum
organisms. Studies are underway to determine the full clinical spectrum,
incidence, and potential public health importance of this infectious
disease newly recognized in infants.
