From the Guidelines
Infant botulism in a 3-month-old typically presents with constipation, followed by progressive descending paralysis, and early signs include poor feeding, weak cry, reduced facial expression, and decreased movement, as reported in the 2021 clinical guidelines for diagnosis and treatment of botulism 1. The symptoms of botulism intoxication in a 3-month-old infant can be subtle and may not be immediately apparent. However, some common signs and symptoms include:
- Constipation, which is often reported as an early symptom among children 1
- Poor feeding, weak cry, and reduced facial expression, which are common signs in infants with botulism 1
- Decreased movement and a "floppy" appearance due to generalized muscle weakness
- Difficulty swallowing and reduced gag reflex
- Respiratory difficulties, which can be life-threatening if left untreated
- Cranial nerve involvement, causing ptosis (drooping eyelids), fixed or dilated pupils, and ophthalmoplegia (eye muscle weakness) These symptoms result from botulinum toxin blocking acetylcholine release at neuromuscular junctions, causing muscle paralysis. It is essential to seek prompt medical attention if botulism is suspected, as respiratory failure can occur. Treatment involves supportive care and may include Botulism Immune Globulin Intravenous (BIG-IV or BabyBIG), which can significantly reduce illness duration and severity if administered early 1.
From the Research
Common Symptoms and Signs of Botulism Intoxication in 3-Month-Old Infant
- Constipation 2, 3
- Weakness 2, 3
- Hypotonia 2, 3
- Lethargy 3
- Weak cry 3
- Poor feeding 3
- Dehydration 3
- Bulbar and spinal nerve abnormalities 3
- Flaccid paralysis 2, 3
- Descending motor weakness 2
- Respiratory failure 2, 3
Clinical Presentation
The infant with botulism becomes progressively weak, hypotonic, and hyporeflexic, showing bulbar and spinal nerve abnormalities 3. The disease presents with symptoms such as constipation, weakness, and hypotonia and can lead to respiratory failure 2.
Diagnosis and Treatment
Diagnosis is confirmed by isolating the organism or toxin in the stool and finding a classic electromyogram pattern 3. Treatment consists of nutritional and respiratory support until new motor endplates are regenerated, which results in spontaneous recovery 3. Botulism immune globulin (BIG) is also used to treat infant botulism, which functions by neutralizing all systemically circulating botulism toxins 2, 4, 5.