- acute weakness in previously well infant < 6 months of age
- due to intestinal colonization by Clostridium botulinum, which produces neurotoxin
- spores found in soil, agricultural products and honey
Presentation:
initial constipation, followed by lethargy and feeding difficulties
Physical:
hypoactive deep tendon reflexes, decreased suck and gag, poorly reactive pupils, bilateral ptosis, oculomotor palsies, and facial weakness.
Diagnosis:
C. botulinum toxin in feces or isolation in stool culture (less sensitive)
Management:
supportive, admission to observe for respiratory compromise (77% require eventual intubation), antitoxin has resulted in anaphylaxis in infants, no additional benefit with antibiotics (although often used)
