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Wednesday, July 02, 2008
Botulism a Possibility, Even if Patient Not Fed Honey Global Occurrence
of Infant Botulism, 1976-2006 PEDIATRICS, Vol. 122 No. 1 July 2008, pp.
e73-e82
Objective. To summarize the worldwide occurrence of reported infant
(intestinal toxemia) botulism cases since first recognition of the
disease in 1976.
Patients And Methods. We collected information on infant botulism cases
by active and passive surveillance, by provision of therapeutic Human
Botulism Immune Globulin to suspected cases, and by searching the
medical literature. We defined a case as laboratory-confirmed botulism
that occurred in an infant 12 months of age that was not caused by the
ingestion of botulinum toxin in food.
Results. Twenty-six countries representing 5 continents reported the
occurrence of at least 1 case of infant botulism among their residents.
The United States, Argentina, Australia, Canada, Italy, and Japan, in
this order, reported the largest number of cases. A history of honey
exposure was significantly more common among case subjects hospitalized
outside of the United States than among those who were recently
hospitalized in California.
Conclusions. Most countries have not yet reported cases of infant
botulism. This limited reporting of the disease to date contrasts with
the known global occurrence of Clostridium botulinum spores in soils and
dust and suggests that infant botulism may be underrecognized,
underreported, or both. When bulbar palsies, hypotonia, and weakness are
present, physicians should consider the possibility of infant botulism
even if the patient has not been fed honey. Publication of additional
case reports and surveillance summaries will enhance understanding of
the occurrence and extent of this underrecognized disease.
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