Palomino-Fernandez Laura, Villarejo-Perez Alvaro, Fernandez-Fuentes Cecilia, Sanchez-Codez Maria I, Del Valle-De Leon Noorelain, Gallego-Gutierrez Silvia, Peromingo-Matute Estrella, Carazo-Gallego Begoña, López-Laso Eduardo, Cano-Cabrera Marta, Falcon-Neyra Lola, Neth Olaf, Ruiz-Sáez Beatriz
From the Paediatric Infectious Diseases Unit, Reina Sofia University Hospital, Cordoba.
Paediatric Infectious Rheumatology and Immunology and Unit, Virgen del Rocio University Hospital, IBIS, Seville.
Pediatr Infect Dis J. 2025 Jun 1;44(6):e193-e198. doi: 10.1097/INF.0000000000004727. Epub 2025 Jan 17.
Infant botulism (IB) affects infants under 1 year of age, caused by the ingestion of Clostridium botulinum spores and subsequent neurotoxin production. IB is rare in Europe. This study aimed to analyze the epidemiology and management of IB over the past 25 years in Southern Spain.
This is a retrospective, multicenter study of IB cases detected in Andalusia since 1997. Epidemiologic, clinical, diagnostic and outcome variables were analyzed.
Twenty-three patients from 7 different hospitals were included, with a median age of 3 months. Most of these patients presented with weak crying, constipation, arreactive mydriasis and loss of myotatic reflexes. Neurophysiological studies showed alterations in 74% of the cases at diagnosis. The diagnosis was confirmed in all cases by stool sample analysis. Only 4 patients received human botulism immunoglobulin (HBIG) and 10 received empirically intravenous immunoglobulin (IVIG). The median time to improvement in patients who received IVIG and HBIG was slightly shorter; however, no differences were observed. Significant differences were observed when IVIG was administered within the first 72 hours (14 vs. 25 days, P = 0.035). In addition, patients who received empirical antimicrobial therapy required longer hospitalization times secondary to observed exacerbated paralysis (20 vs. 12 days, P = 0.033).
IVIG may be an effective treatment for shortening the duration of illness in regions that are not readily accessible for HBIG, but further studies are needed. Although IB is rare, when it is suspected, antimicrobial therapy should be avoided as it may exacerbate paralysis by increasing the availability of neurotoxin for absorption.
婴儿肉毒中毒（IB）影响1岁以下婴儿，由摄入肉毒梭菌孢子并随后产生神经毒素所致。IB在欧洲较为罕见。本研究旨在分析西班牙南部过去25年中IB的流行病学及治疗情况。
这是一项对自1997年以来在安达卢西亚发现的IB病例进行的回顾性多中心研究。分析了流行病学、临床、诊断及转归变量。
纳入了来自7家不同医院的23例患者，中位年龄为3个月。这些患者大多表现为哭声微弱、便秘、瞳孔反应迟钝及肌伸张反射消失。神经生理学研究显示，74%的病例在诊断时存在异常。所有病例均通过粪便样本分析确诊。仅4例患者接受了人抗肉毒中毒免疫球蛋白（HBIG），10例接受了经验性静脉注射免疫球蛋白（IVIG）。接受IVIG和HBIG的患者病情改善的中位时间略短；然而，未观察到差异。在首72小时内给予IVIG时观察到显著差异（14天对25天，P = 0.035）。此外，接受经验性抗菌治疗的患者因观察到麻痹加重而需要更长的住院时间（20天对12天，P = 0.033）。
在无法轻易获得HBIG的地区，IVIG可能是缩短病程的有效治疗方法，但仍需进一步研究。尽管IB罕见，但一旦怀疑，应避免使用抗菌治疗，因为它可能通过增加神经毒素的吸收可用性而加重麻痹。
