Clinical manifestations and early recognition of infant botulism in 14 cases
10.3760/cma.j.cn101070-20230814-00087
- VernacularTitle:婴儿肉毒中毒14例临床表现及早期识别
- Author:
Yimu FAN
1
;
Jie WU
;
Feng HUO
;
Zhezhe ZHANG
;
Shuangjun LIU
;
Shuo WANG
;
Quan WANG
Author Information
1. 国家儿童医学中心，首都医科大学附属北京儿童医院急诊内科，北京 100045
- Keywords:
Infants;
Botulism;
Clostridium botulinum;
Early recognition
- From:
Chinese Journal of Applied Clinical Pediatrics
2024;39(7):533-536
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical presentations and early recognition features of infant botulism(IB).Methods:Retrospective case analysis.The clinical data of 14 patients with IB admitted to the Department of Emergency of Beijing Children′s Hospital Affiliated to Capital Medical University between January 2019 and June 2023 were retrospectively analyzed.Results:The age of onset was 4.2(1.9-8.6) months.Ten cases(71.4%) were under 6 months, 9 of whom had a toxic trigger.The median time of first visit was 1(0-8) day.Thirteen cases(92.9%) complained of poor feeding/milk refusal, of whom pupillary light reflex was sluggish/absent in 12(85.7%) infants, 11(78.6%) had constipation, 10(71.4%) had weakness and/or lethargy, and 9(64.3%) had myasthenia of limbs and/or reduced movement of the extremities, decreased muscle tone and strength of the extremities occurred in all infants, and bowel sounds were diminished or vanished in 10 infants(71.4%).Only 2 infants were suspected of IB at the first visit.The mouse bioassay showed positive fecal specimens in all 14 infants, with a time of diagnosis of 3(1-10) days.Eleven cases(84.6%) had varying degrees of intestinal stasis, and 1 case had reduced physiologic pneumatosis in the small intestine.Ten infants underwent the neostigmine test: one was positive, and one was suspiciously positive.Ten cases(71.4%) required mechanical ventilation, 7(50.0%) of whom used invasive respiratory support.The median length of hospital stay was 26(11-61) days.All the infants were essentially cured by the time they left the hospital.Conclusions:If infants are previously fit and conscious but have an acute onset of illness with parental complaints of poor appetite, weak reactions, and weakness of the extremities and are found to have cranial nerve palsy, signs of acute flaccid paralysis, abdominal distension, and diminished bowel sounds during the examination, the possibility of IB should be considered, and a fecal specimen should be sent for botulinum toxin assay as soon as possible.
