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Paediatrics
Dry and dusty outback: infant botulism
  1. Patricia Grant1,
  2. Alexandra A Legge1,
  3. Aranzazu Gonzalez2 and
  4. Kathryn Browning Carmo1,3
  1. 1 NETS, New South Wales Newborn and Paediatric Emergency Transport Service, Bankstown, New South Wales, Australia
  2. 2 Paediatrics, Broken Hill Base Hospital, Broken Hill, New South Wales, Australia
  3. 3 Faculty of Medicine, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
  1. Correspondence to Dr Kathryn Browning Carmo; kathryn.carmo{at}health.nsw.gov.au

Abstract

Infant botulism is a rare but life-threatening neuroparalytic syndrome caused by intestinal colonisation of Clostridium botulinum resulting in a symmetrical descending flaccid paralysis. This gram-positive, rod-shaped anaerobic bacillus is universally found in soil with previous links to ingestion of honey and dust contaminated with C. botulinum spores. We present a case of a baby boy with this rare condition eventually linked to dust on a rural outback property. This young patient was ventilated for 90 days. Initial serology for botulism toxin was negative, although C. botulinum spores were eventually grown in the stool. The patient did not receive early treatment with Human Botulism Immune Globulin Intravenous (BIG-IV) as there was a low index of suspicion and a delay in obtaining a stool sample for nearly 6 weeks due to constipation. This case highlights the importance of early treatment with BIG-IV when clinical features and environmental conditions in the remote Australian outback favour persistence of C. botulinum spores in soil without awaiting confirmatory tests.

  • Botulinum toxin
  • Neonatal and paediatric intensive care

https://doi.org/10.1136/bcr-2024-262942

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    Footnotes

    • X @AlexandraLegge1, @kathryc4

    • Contributors PG, AAL, AG and KBC were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, critical revision for important intellectual content and gave the final approval of the manuscript. KBC is the guarantor of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.