Pediatric Botulism Treatment & Management

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 9, 2012
 

Medical Care

In patients with botulism, supportive care, especially ventilatory support, is essential.[19]

  • Promptly initiate ventilatory support promptly because respiratory muscle weakness rapidly progresses and the gag reflex is frequently impaired, which predisposes patients to aspiration. Patients need continued suctioning and may require intubation or tracheostomy.
  • Antitoxin (see Medication) dramatically alters the course of the disease, especially if administered within the first 24 hours.
  • In general, antibiotic therapy to clear clostridial GI infection in infant botulism is contraindicated, because the treatment increases toxin release and worsens the condition. Antibiotics may be considered to treat secondary bacterial infections.
  • Aminoglycosides, such as gentamicin or tobramycin, may potentiate the neuromuscular blockade; therefore, they are contraindicated.
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Surgical Care

In patients with wound botulism, surgical debridement of the wound is indicated to remove the source of toxin production.

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Consultations

Consultations with an infectious diseases specialist and a neurologist are frequently beneficial.

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Diet

Tube feeding may be useful if GI tract motility is intact. If motility is not intact, consider parenteral feeding.

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Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Coauthor(s)

Daniel AC Frattarelli, MD, FAAP  Senior Staff, Departments of Pediatrics and Emergency Medicine, Henry Ford Hospital

Daniel AC Frattarelli, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Clinical Pharmacology, and American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

Nahed M Abdel-Haq, MD  Assistant Professor, Department of Pediatrics, Wayne State University School of Medicine

Nahed M Abdel-Haq, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Itzhak Brook, MD, MSc  Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Leslie L Barton, MD  Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

  1. Kerner CAJ. Das Fettgift oder die Fettsaure und ihre Wirkungen auf den thierischen Organismus, ein Beytrag zur Untersuchung des in verdorbenen Wursten giftig wirkenden Stoffes. 1822.

  2. Kerner CAJ. Neue Beobachtung uber die in Wurttemberg so haufig vorfallenden Verigiftungen durch den Genuss geraucherter Wurste. 1820.

  3. van Ermengem E. Ueber einen neuen Bacillus und seine Beziehungen zum Botulismus. Z Hyg Infektionskr. 1897;26:1-56.

  4. Merson MH, Dowell VR Jr. Epidemiologic, clinical and laboratory aspects of wound botulism. N Engl J Med. Nov 8 1973;289(19):1105-10. [Medline].

  5. Midura TF, Arnon SS. Infant botulism. Identification of Clostridium botulinum and its toxins in faeces. Lancet. Oct 30 1976;2(7992):934-6. [Medline].

  6. Pickett J, Berg B, Chaplin E, et al. Syndrome of botulism in infancy: clinical and electrophysiologic study. N Engl J Med. Sep 30 1976;295(14):770-2. [Medline].

  7. Shapiro RL, Hatheway C, Swerdlow DL. Botulism in the United States: a clinical and epidemiologic review. Ann Intern Med. Aug 1 1998;129(3):221-8. [Medline]. [Full Text].

  8. Horwitz MA, Hughes JM, Merson MH, Gangarosa EJ. Food-borne botulism in the United States, 1970-1975. J Infect Dis. Jul 1977;136(1):153-9. [Medline].

  9. Luquez C, Dykes JK, Yu PA, Raphael BH, Maslanka SE. First report worldwide of an infant botulism case due to Clostridium botulinum type E. J Clin Microbiol. Jan 2010;48(1):326-8. [Medline]. [Full Text].

  10. Zhang S, Wang Y, Qiu S, Dong Y, Xu Y, Jiang D. Multilocus outbreak of foodborne botulism linked to contaminated sausage in Hebei Province, China. Clin Infect Dis. Aug 1 2010;51(3):322-5. [Medline].

  11. May ML, Corkeron MA, Stretton M. Infant botulism in Australia: availability of human botulinum antitoxin for treatment. Med J Aust. Nov 15 2010;193(10):614-5. [Medline].

  12. Fagan RP, McLaughlin JB, Castrodale LJ, Gessner BD, Jenkerson SA, Funk EA, et al. Endemic foodborne botulism among Alaska Native persons--Alaska, 1947-2007. Clin Infect Dis. Mar 2011;52(5):585-92. [Medline].

  13. Fagan RP, McLaughlin JB, Middaugh JP. Persistence of botulinum toxin in patients' serum: Alaska, 1959-2007. J Infect Dis. Apr 1 2009;199(7):1029-31. [Medline].

  14. Yuan J, Inami G, Mohle-Boetani J, Vugia DJ. Recurrent wound botulism among injection drug users in California. Clin Infect Dis. Apr 1 2011;52(7):862-6. [Medline].

  15. Wheeler C, Inami G, Mohle-Boetani J, Vugia D. Sensitivity of mouse bioassay in clinical wound botulism. Clin Infect Dis. Jun 15 2009;48(12):1669-73. [Medline].

  16. Sobel J. Diagnosis and treatment of botulism: a century later, clinical suspicion remains the cornerstone. Clin Infect Dis. Jun 15 2009;48(12):1674-5. [Medline].

  17. Umeda K, Seto Y, Kohda T, Mukamoto M, Kozaki S. A novel multiplex PCR method for Clostridium botulinum neurotoxin type A gene cluster typing. Microbiol Immunol. May 2010;54(5):308-12. [Medline].

  18. Kirchner S, Kramer KM, Schulze M, et al. Pentaplexed quantitative real-time PCR assay for the simultaneous detection and quantification of botulinum neurotoxin-producing clostridia in food and clinical samples. Appl Environ Microbiol. Jul 2010;76(13):4387-95. [Medline]. [Full Text].

  19. Chalk C, Benstead TJ, Keezer M. Medical treatment for botulism. Cochrane Database Syst Rev. Mar 16 2011;CD008123. [Medline].

  20. Centers for Disease Control and Prevention. Investigational Heptavalent Botulinum Antitoxin (HBAT) to Replace Licensed Botulinum Antitoxin AB and Investigational Botulinum Antitoxin E. MMWR Morb Mortal Wkly Rep. Mar 19 2010;59(10):299. [Medline].

  21. Arnon SS. Creation and development of the public service orphan drug Human Botulism Immune Globulin. Pediatrics. Apr 2007;119(4):785-9. [Medline].

  22. [Best Evidence] Arnon SS, Schechter R, Maslanka SE, et al. Human botulism immune globulin for the treatment of infant botulism. N Engl J Med. 2006;354:462-71. [Medline].

  23. Al-Sayyed B. A 3-day-old boy with acute flaccid paralysis. Pediatr Ann. Sep 2009;38(9):479-82. [Medline].

  24. Albanese A. Terminology for preparations of botulinum neurotoxins: what a difference a name makes. JAMA. Jan 5 2011;305(1):89-90. [Medline].

  25. American Academy of Pediatrics. Botulism and infant botulism (Clostridium botulinum). In: Red Book: 2009 Report of the Committee on Infectious Diseases. 28th. Elk Grove Village, IL: American Academy of Pediatrics; 2009:259-52.

  26. Artin I, Bjorkman P, Cronqvist J, Radstrom P, Holst E. First case of type E wound botulism diagnosed using real-time PCR. J Clin Microbiol. Nov 2007;45(11):3589-94. [Medline].

  27. Attree O, Guglielmo-Viret V, Gros V, Thullier P. Development and comparison of two immunoassay formats for rapid detection of botulinum neurotoxin type A. J Immunol Methods. Aug 31 2007;325(1-2):78-87. [Medline].

  28. Austin JW, Leclair D. Botulism in the North: a disease without borders. Clin Infect Dis. Mar 2011;52(5):593-4. [Medline].

  29. Baldwin MR, Tepp WH, Przedpelski A, et al. Subunit vaccine against the seven serotypes of botulism. Infect Immun. Mar 2008;76(3):1314-8. [Medline].

  30. Baron J, Greenberg D, Shorer Z, Hershkovitz E, Melamed R, Lifshitz M. Infant botulism: be aware of this rare disease. Isr Med Assoc J. Sep 2007;9(9):682-3. [Medline].

  31. Botulism associated with commercially canned chili sauce--Texas and Indiana, July 2007. MMWR Morb Mortal Wkly Rep. Aug 3 2007;56(30):767-9. [Medline].

  32. Boyanova L, Kolarov R, Mitov I. Antimicrobial resistance and the management of anaerobic infections. Expert Rev Anti Infect Ther. Aug 2007;5(4):685-701. [Medline].

  33. Brent RL. Immunization of pregnant women: reproductive, medical and societal risks. Vaccine. Jul 28 2003;21(24):3413-21. [Medline].

  34. Brook I. Anaerobic infections in children. Adv Exp Med Biol. 2011;697:117-52. [Medline].

  35. Cai S, Singh BR, Sharma S. Botulism diagnostics: from clinical symptoms to in vitro assays. Crit Rev Microbiol. Apr-Jun 2007;33(2):109-25. [Medline].

  36. Centers for Disease Control and Prevention (CDC). Botulism associated with commercial carrot juice--Georgia and Florida, September 2006. MMWR Morb Mortal Wkly Rep. Oct 13 2006;55(40):1098-9. [Medline].

  37. Cherington M. Botulism: update and review. Semin Neurol. Jun 2004;24(2):155-63. [Medline].

  38. Clemmens MR, Bell L. Infant botulism presenting with poor feeding and lethargy: a review of 4 cases. Pediatr Emerg Care. Jul 2007;23(7):492-4. [Medline].

  39. Dembek ZF, Smith LA, Rusnak JM. Botulism: cause, effects, diagnosis, clinical and laboratory identification, and treatment modalities. Disaster Med Public Health Prep. Nov 2007;1(2):122-34. [Medline].

  40. Domingo RM, Haller JS, Gruenthal M. Infant botulism: two recent cases and literature review. J Child Neurol. Nov 2008;23(11):1336-46. [Medline].

  41. Fenicia L, Anniballi F. Infant botulism. Ann Ist Super Sanita. 2009;45(2):134-46. [Medline].

  42. Fox CK, Keet CA, Strober JB. Recent advances in infant botulism. Pediatr Neurol. Mar 2005;32(3):149-54. [Medline].

  43. Francisco AM, Arnon SS. Clinical mimics of infant botulism. Pediatrics. Apr 2007;119(4):826-8. [Medline].

  44. Gottlieb SL, Kretsinger K, Tarkhashvili N, et al. Long-term outcomes of 217 botulism cases in the Republic of Georgia. Clin Infect Dis. Jul 15 2007;45(2):174-80. [Medline].

  45. Hatheway CL. Botulism: the present status of the disease. Curr Top Microbiol Immunol. 1995;195:55-75. [Medline].

  46. Jones RG, Corbel MJ, Sesardic D. A review of WHO International Standards for botulinum antitoxins. Biologicals. Feb 17 2006;[Medline].

  47. Kalka-Moll WM, Aurbach U, Schaumann R, Schwarz R, Seifert H. Wound botulism in injection drug users. Emerg Infect Dis. Jun 2007;13(6):942-3. [Medline].

  48. Kessler KR, Benecke R. Botulinum toxin: from poison to remedy. Neurotoxicology. 1997;18(3):761-70. [Medline].

  49. Koepke R, Sobel J, Arnon SS. Global occurrence of infant botulism, 1976-2006. Pediatrics. Jul 2008;122(1):e73-82. [Medline].

  50. Kongsaengdao S, Samintarapanya K, Rusmeechan S, et al. An outbreak of botulism in Thailand: clinical manifestations and management of severe respiratory failure. Clin Infect Dis. Nov 15 2006;43(10):1247-56. [Medline].

  51. Kongsaengdao S, Samintarapanya K, Rusmeechan S, Sithinamsuwan P, Tanprawate S. Electrophysiological diagnosis and patterns of response to treatment of botulism with neuromuscular respiratory failure. Muscle Nerve. Aug 2009;40(2):271-8. [Medline].

  52. Kumaran D, Rawat R, Ahmed SA, Swaminathan S. Substrate binding mode and its implication on drug design for botulinum neurotoxin A. PLoS Pathog. Sep 26 2008;4(9):e1000165. [Medline].

  53. Leggiadro RJ. Bioterrorism: a clinical reality. Pediatr Ann. Jun 2007;36(6):352-8. [Medline].

  54. Lindstrom M, Korkeala H. Laboratory diagnostics of botulism. Clin Microbiol Rev. Apr 2006;19(2):298-314. [Medline].

  55. Linial M. Bacterial neurotoxins--a thousand years later. Isr J Med Sci. Oct 1995;31(10):591-5. [Medline].

  56. Long SS. Botulism in infancy. Pediatr Infect Dis. May-Jun 1984;3(3):266-71. [Medline].

  57. Long SS. Epidemiologic study of infant botulism in Pennsylvania: Report of the Infant Botulism Study group. Pediatrics. May 1985;75(5):928-34. [Medline].

  58. Long SS. Infant botulism and treatment with BIG-IV (BabyBIG). Pediatr Infect Dis J. Mar 2007;26(3):261-2. [Medline].

  59. Long SS. Infant botulism. Pediatr Infect Dis J. Jul 2001;20(7):707-9. [Medline].

  60. Long SS, Gajewski JL, Brown LW, Gilligan PH. Clinical, laboratory, and environmental features of infant botulism in Southeastern Pennsylvania. Pediatrics. May 1985;75(5):935-41. [Medline].

  61. Mechem CC, Walter FG. Wound botulism. Vet Hum Toxicol. Jun 1994;36(3):233-7. [Medline].

  62. Mitchell WG, Tseng-Ong L. Reviews of infant botulism at childrens hospital los angeles. J Child Neurol. Aug 2008;23(8):968. [Medline].

  63. Morefield GL, Tammariello RF, Purcell BK, et al. An alternative approach to combination vaccines: intradermal administration of isolated components for control of anthrax, botulism, plague and staphylococcal toxic shock. J Immune Based Ther Vaccines. Sep 3 2008;6:5. [Medline].

  64. Neghina AM, Neghina R. Epidemiology of foodborne botulism in Romania 1980-2009. Foodborne Pathog Dis. Aug 2011;8(8):907-11. [Medline].

  65. Osborne SL, Latham CF, Wen PJ, et al. The Janus faces of botulinum neurotoxin: sensational medicine and deadly biological weapon. J Neurosci Res. May 1 2007;85(6):1149-58. [Medline].

  66. Outbreak news. Botulism, Canada and United States. Wkly Epidemiol Rec. Oct 13 2006;81(41):386. [Medline].

  67. Paerregaard A, Angen O, Lisby M, et al. Denmark: botulism in an infant or infant botulism?. Euro Surveill. Dec 18 2008;13(51):[Medline].

  68. Peck MW. Biology and genomic analysis of Clostridium botulinum. Adv Microb Physiol. 2009;55:183-265, 320. [Medline].

  69. Risko W. Infant botulism. Pediatr Rev. Jan 2006;27(1):36-7. [Medline].

  70. Schiavo G, Rossetto O, Tonello F, Montecucco C. Intracellular targets and metalloprotease activity of tetanus and botulism neurotoxins. Curr Top Microbiol Immunol. 1995;195:257-74. [Medline].

  71. Shneerson JM. Botulism: a potentially common problem. Thorax. Nov 1989;44(11):901-2. [Medline].

  72. Shukla HD, Sharma SK. Clostridium botulinum: a bug with beauty and weapon. Crit Rev Microbiol. 2005;31(1):11-8. [Medline].

  73. Thompson CM, Gilligan PH, Fisher MC, Long SS. Clostridium difficile cytotoxin in a pediatric population. Am J Dis Child. Mar 1983;137(3):271-4. [Medline].

  74. Thompson JA, Filloux FM, Van Orman CB, et al. Infant botulism in the age of botulism immune globulin. Neurology. Jun 28 2005;64(12):2029-32. [Medline].

  75. Tseng-Ong L, Mitchell WG. Infant botulism: 20 years' experience at a single institution. J Child Neurol. Dec 2007;22(12):1333-7. [Medline].

  76. Umeda K, Seto Y, Kohda T, Mukamoto M, Kozaki S. Genetic characterization of Clostridium botulinum associated with type B infant botulism in Japan. J Clin Microbiol. Sep 2009;47(9):2720-8. [Medline].

  77. Underwood K, Rubin S, Deakers T, Newth C. Infant botulism: a 30-year experience spanning the introduction of botulism immune globulin intravenous in the intensive care unit at Childrens Hospital Los Angeles. Pediatrics. Dec 2007;120(6):e1380-5. [Medline].

  78. Ungchusak K, Chunsuttiwat S, Braden C, et al. The need for global planned mobilization of essential medicine: lessons from a massive Thai botulism outbreak. Bull World Health Organ. Mar 2007;85(3):238-40. [Medline].

  79. Villar RG, Elliott SP, Davenport KM. Botulism: the many faces of botulinum toxin and its potential for bioterrorism. Infect Dis Clin North Am. Jun 2006;20(2):313-27, ix. [Medline].

  80. Wigginton JM, Thill P. Infant botulism. A review of the literature. Clin Pediatr (Phila). Nov 1993;32(11):669-74. [Medline].

  81. Witoonpanich R, Vichayanrat E, Tantisiriwit K, et al. Survival analysis for respiratory failure in patients with food-borne botulism. Clin Toxicol (Phila). Mar 2010;48(3):177-83. [Medline].

  82. Witoonpanich R, Vichayanrat E, Tantisiriwit K, Rattanasiri S, Ingsathit A. Electrodiagnosis of botulism and clinico-electrophysiological correlation. Clin Neurophysiol. Jun 2009;120(6):1135-8. [Medline].

  83. Wongtanate M, Sucharitchan N, Tantisiriwit K, et al. Signs and symptoms predictive of respiratory failure in patients with foodborne botulism in Thailand. Am J Trop Med Hyg. Aug 2007;77(2):386-9. [Medline].

 
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This is a photomicrograph of Clostridium botulinum stained with Gentian violet. The bacterium, C botulinum, produces a neurotoxin which causes the rare, but serious, paralytic illness, botulism.
 
 
 
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