First case of infant botulism in Portugal

Costa Bonito, Maria Conceição

http://hdl.handle.net/10400.18/2525

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Authors

Costa Bonito, Maria Conceição

Abstract(s)

Infant botulism is a very rare neuroparalytic disease that can occur in babies under two years of age, caused by ingestion of Clostridium botulinum, an ubiquitous gram positive bacilli that grows better under anaerobic, low salt and low acid conditions. The spores formed by this bacterium are not inactivated, unless the food is heated under high pressure to 121ºC, for at least 20 minutes. This rare occurrence is due to the toxin produced by the bacteria, after ingestion of the spores and their germination in the infant’s intestine. Those neurotoxins interfere with the presynaptic release of acetylcholine at the neuromuscular junction. The first case detected in Portugal occurred in 2009. The patient was a boy aged one month. The child was breastfed, but sometimes his parents used to give him wild herbal chamomile infusion and honey. After refusing to eat for three days, the boy was taken to the Hospital, with the symptoms overlapping with botulism. The laboratory identification was performed using mouse bioassay, according to standard procedures issued by the Center for Disease Control (CDC), Atlanta, USA. Type B botulinum toxin was detected in the infant´s faeces sample. Clostridium botulinum type B was isolated from the faeces as well as from honey and chamomile herbs samples. In contrast to foodborne botulism, associated to the ingestion of botulinum toxin pre-formed in foods, infant botulism occurs after ingestion of the spores and subsequent production of the toxin in the children’s intestine because of their still weak defences. One way to prevent this disease is not to give honey and wild herbal tea to the infants under two years of age.