Smith and colleagues present a fine piece of detective work around a 2 month old infant with an initially puzzling neurological presentation. They unearth valuable learning points:
- Young infants are particularly vulnerable due to the susceptibility of their gut to colonisation due to immature intestinal flora and lack of clostridium-inhibiting bile acids. This is in contrast to botulism in adults, which follows the ingestion of preformed toxin.
- Symptoms present insidiously and are classically described as constipation, cranial nerve palsies and progressive generalised weakness.
- Stool samples for clostridium botulinum PCR confirm the diagnosis easily and should be sent early as a basic investigation
- Food sourcing is possible and in this case eliciting the honey-soother history proved invaluable. Such questions ought to be part of routine questioning of carers in such cases
- Labelling of honey has been a requirement since 1996 in the UK but clearly this is not always enough to prevent administration of honey to infants under the age of one year.
Rakesh Biswas
Deputy Editor