Section: Saint Barnabas Medical Center News

Botulism: A Danger to Babies

08/12/2015

The baby was in trouble, but it wasn't clear why. On July 1 this year, three-month-old Tyler Roig of Livingston was irritable and seemed to have trouble swallowing. "The next day he was worse, his cry was weak, he was constipated and seemed out of it," recalls his mother, special education teacher Meredith Roig, 31. While her husband, Daniel, 29, a physical therapist, watched their 2-year-old son Cameron, she took Tyler to the pediatrician. Curiously, Tyler's blood work was normal and he had no fever. The pediatrician didn't discover what was wrong with him, but made the right call anyway—sending him to the Emergency Department at Saint Barnabas Medical Center.

There Tyler was found to be losing muscle tone and growing weaker, so he was admitted into the hospital. X-ray and ultrasound scans didn't solve the mystery. That's when Uzma Hasan, M.D., a pediatric infectious disease specialist, was called in. "She pretty much knew right away what it was," says Roig, still amazed at the quick diagnosis. "She was right on top of it."

Tyler had botulism. It's a rare paralytic illness that strikes only about 145 people each year, according to the Centers for Disease Control and Prevention (CDC). Most of us associate the word with food poisoning, but traditional foodborne botulism, which can occur in adults or children, accounts for only about 15 percent of cases. Somewhat more common—65 percent of instances, the CDC says—is infant botulism, which occurs when spores of a rod-shaped bacterium called Clostridium botulinum are ingested and colonize in the intestines of a baby who, for reasons not yet fully understood, is susceptible. Babies are thought to be vulnerable due to an age-related scarcity of normal bacteria that reside in the gut, allowing for an overgrowth of clostridium spores.

"We've seen cases here at Saint Barnabas before," says the doctor. "New Jersey is one of the top states in the country with botulism," says Dr. Hasan. Soil in certain states is much richer in spores, and ours is one of those states. Bacteria live in soil and apparently can be spread as a result of soil disruption—for example, from construction, which is widespread in the Garden State.

Tyler's symptoms were typical, Dr. Hasan says, and clued her in to the diagnosis. (See "Symptoms of Infant Botulism," at right.) They all stemmed from muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the respiratory muscles, arms, legs and trunk, and the condition can be fatal.

Treatment comes in an injection of baby botulism immunoglobulin—babyBIG, as it's known commercially. But this drug is only made in California. Because time was of the essence in this case, Dr. Hasan and Saint Barnabas coordinated with the California Department of Health to have the medication flown in overnight.

Tyler got the onetime injection and slowly began to recover. "By the third day we saw real progress, and after six days he was out of the intensive care unit and back in the regular pediatric wing," says Roig. He was discharged after eight days. "Tyler will be perfectly fine," Dr. Hasan says.

And he was very lucky. "Typically if infant botulism is treated within four days of onset, patients do well," says Dr. Hasan. "After a week or so it becomes much more serious. These babies still usually make a complete recovery, but it takes a few weeks." Some infants need physical therapy to regain muscle tone and sucking ability.

It took a few days at home to get Tyler to feed normally, Roig says, but he's now gaining weight again and has reached all his developmental markers. She's determined to alert other parents about this hidden danger. "Few people are aware that botulism can come from the soil, and with all the construction around here we have to get the word out," she insists.

Dr. Hasan agrees, and she extends that alert to area pediatricians, who may not quickly consider this rare but dangerous possibility. "Be educated about the symptoms, and know it is possible," she says.

Symptoms of Infant Botulism

There are five classic symptoms of botulism in infants:

> Lethargy

> Constipation

> Poor Feeding

> A Weak Cry

> Poor Muscle Tone ("Floppy" Muscles)

"All of these can be caused by other conditions too," says Uzma Hasan, M.D., a pediatric infectious disease specialist at Saint Barnabas Medical Center. "But most of those conditions also produce a fever, and botulism usually does not."

The doctor says parents should also be alert to the possibility of botulism if a baby "wants to feed but cannot swallow, has droopy eyelids and drools more than usual." Infants up to 6 months of age are most at risk, but the condition can occur in babies up to a year old.

"Most parents now know not to give infants honey because of the danger of botulism," she says. "But they also need to understand that construction and its attendant soil disruption near a baby's home can increase the risk."

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