Wardinger Jaimie E, Darwish Nada, Amatya Shaili
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Health Children's Hospital, 500 University Dr, Hershey, PA, 17033, USA.
Matern Health Neonatol Perinatol. 2024 Jan 2;10(1):1. doi: 10.1186/s40748-023-00172-2.
Infantile botulism (IB) is a devastating and potentially life-threatening neuromuscular disorder resulting from intestinal colonization by Clostridium botulinum and the resultant toxin production. It can present with constipation, descending paralysis, and, potentially, respiratory failure. Botulism is a diagnosis that is more commonly seen in the pediatric intensive care unit (PICU) or on the general pediatric wards and would not typically be managed in the neonatal intensive care unit (NICU), and therefore requires high clinical suspicion to ensure prompt diagnosis and treatment.
We discuss a case where an infant from central Pennsylvania presented to a Level IV NICU rather than to the PICU for an evaluation for sepsis and was uniquely diagnosed with IB. The infant presented with poor oral feeding and reduced oral intake, hypothermia, and lethargy. His symptoms progressed into hypoxia and acute respiratory failure. Interestingly, this infant had no known exposure to honey or any other identifiable sources of botulism contact. The infant's twin brother and the other infants who attended the mother's in-home daycare remained asymptomatic. This infant was initially evaluated and managed for a potential infectious etiology. However, a diagnosis of IB was suspected, and was later confirmed through the detection of botulinum toxin in the infant's stools. A high level of suspicion allowed for timely treatment with Botulism Immune Globulin neutralizing antibodies (BabyBIG), even prior to confirmatory testing. We describe the process of obtaining BabyBIG, as well as the natural course of illness after treatment in our patient who ultimately made a complete recovery.
This case highlights the importance of considering infantile botulism as a diagnostic possibility even in the absence of risk factors, and the need for vigilance in diagnosing and treating this rare but potentially life-threatening condition. With timely recognition, subsequent treatment with BabyBIG, and supportive care, infants with infantile botulism can be expected to recover completely. This information is particularly important for neonatologists providing care for infants outside the neonatal period, especially during times of high patient census and resulting overflow of pediatric admissions in the NICU.
婴儿肉毒中毒（IB）是一种由肉毒梭菌在肠道定植并产生毒素导致的严重且可能危及生命的神经肌肉疾病。其症状包括便秘、下行性麻痹，甚至可能出现呼吸衰竭。肉毒中毒在儿科重症监护病房（PICU）或普通儿科病房更为常见，通常不在新生儿重症监护病房（NICU）进行治疗，因此需要高度的临床怀疑以确保及时诊断和治疗。
我们讨论了一例来自宾夕法尼亚州中部的婴儿病例，该婴儿因败血症评估被送往四级NICU而非PICU，并被独特地诊断为婴儿肉毒中毒。该婴儿出现经口喂养困难、摄入量减少、体温过低和嗜睡症状。其症状进展为缺氧和急性呼吸衰竭。有趣的是，该婴儿没有已知的蜂蜜接触史或任何其他可识别的肉毒中毒接触源。该婴儿的双胞胎兄弟以及在母亲家中日托所的其他婴儿均无症状。该婴儿最初因潜在的感染病因接受评估和治疗。然而，怀疑为婴儿肉毒中毒，随后通过在婴儿粪便中检测到肉毒毒素得到证实。即使在确诊测试之前，高度的怀疑也使得能够及时使用肉毒中毒免疫球蛋白中和抗体（BabyBIG）进行治疗。我们描述了获取BabyBIG的过程，以及我们的患者在治疗后疾病的自然病程，该患者最终完全康复。
该病例强调了即使在没有危险因素的情况下也应将婴儿肉毒中毒视为一种诊断可能性的重要性，以及在诊断和治疗这种罕见但可能危及生命的疾病时保持警惕的必要性。通过及时识别、随后使用BabyBIG进行治疗以及支持性护理，婴儿肉毒中毒患儿有望完全康复。这一信息对于为新生儿期以外的婴儿提供护理的新生儿科医生尤为重要，尤其是在患者数量众多且导致NICU儿科入院人数过多的时期。
