Infant botulism syndrome

Introduction to infant botulism syndrome Infant botulism syndrome refers to a group of syndromes that resemble botulism in clinical processes and electrophysiology. The main feature is that infants are acutely weak and weak. Mainly due to the acute poisoning disease caused by eating food contaminated with exotoxin of Clostridium botulinum (C. botulinum), if the disease is not rescued in time, the mortality rate is high. basic knowledge Sickness ratio: 0.0004% Susceptible people: children Mode of infection: non-infectious Complications: sudden infant death syndrome

Causes of infant botulism syndrome

(1) Causes of the disease

The etiology of this disease is related to botulinum and botulinum toxin. Although the botulinum toxin is not found in the serum of the sick baby, botulinum toxin can be found in the feces of the child or botulism can be isolated. Bacillus, which is likely to be caused by the ingestion of widespread botulinum spores in infants, is currently recognized as an important mediator of this condition, and many scholars have tried to feed honey to infants under 1 year of age.

(two) pathogenesis

In 1979, the Centers for Disease Control (CDC) classified botulism into 4 types, food botulism, infant botulism, traumatic botulism, and adult botulism in adult.

1. Food-type botulism is caused by Clostridium botulinum exotoxin such as BAT contaminated food, which is digested into the digestive tract by the mouth, and is decomposed into small molecules such as Aa, Ab in the stomach and small intestine, and then absorbed into the bloodstream. It mainly acts on the cranial nerves, motor synapses and cholinergic nerve endings. Aa binds to the presynaptic membrane receptors, prevents ion exchange inside and outside the nerve cells, and then enters the synaptic membrane to prevent Ca2-induced vesicle secretion. It blocks the release of the acetylcholine, a neurotransmitter, which causes muscle contraction and dyskinesia, showing muscle paralysis.

2. The age of onset of infantile botulism is less than 6 months. The age of the report is 6 days to 11 months. The pathogenesis is different from the above. The botulinum toxin is not detected in the baby food, but the meat can be found in the stool of the child. Clostridium botulinum and its toxins, which are caused by the absorption of exotoxin in the intestines after ingestion of Clostridium botulinum, the intestinal tract of infants is different from the intestinal flora of adults, and the inhibitory bacteria of Clostridium botulinum are lacking. Such as Bacteroides, Lactobacillus, inoculated spores of Clostridium botulinum can be a propagule and multiply, breast-fed infants account for 66% to 100% of the incidence of the disease, this disease is more common in breast-fed infants after adding complementary food for about 1 month The habit of the habitual constipation baby is prone to colonization by Clostridium botulinum, less than 2 months and living in the countryside. The baby in the farm is prone to disease when the food is contaminated with Clostridium botulinum in the soil, and the contaminated honey is eaten. 15%, in 1981, the American Academy of Pediatrics and the CDC recommended that infants under 12 months should not eat honey.

3. Traumatic botulism is infected with Clostridium botulinum in the lesion and produces exotoxin. The wound absorbs exotoxin locally and causes poisoning.

4. Infant botulism in adults When adult intestinal surgery, gastric acid deficiency causes intestinal pH changes, application of antibiotics causes intestinal flora imbalance, etc., intestinal tract lacks Clostridium botulinum inhibitory bacteria, eats meat The spores of Clostridium botulinum can cause disease by breeding in the intestine and producing exotoxin.

Although the etiology and pathogenesis of the above 4 types are different, the clinical manifestations are mainly neurological symptoms. The pathological changes are mainly the degeneration of the cerebral nucleus and the anterior horn of the spinal cord, brain and meningeal congestion, edema, and extensive punctiform hemorrhage. And small thrombosis and so on.

Infant botulism syndrome prevention

Infants should try to eat less honey foods. Honey itself does not have Clostridium botulinum. It is contaminated with Clostridium botulinum during collection, processing and packaging. If honey has been autoclaved for more than 30 minutes before consumption, it is safe to eat. .

Complications of infant botulism syndrome Complications sudden infant death syndrome

A small number of children have respiratory arrest due to respiratory muscle paralysis, and even sudden death, this disease is one of the causes of sudden infant death syndrome.

Symptoms of infant botulism syndrome Common symptoms Sucking reflex disappears dysphagia Dysphagia Reflex Reflex disappears paralysis weakness constipation

This symptom occurs mostly in infants within 6 months. The common clinical manifestation is constipation (which can last for several days). It can't suck and swallow difficulties. The whole body is obviously weak and weak. The crying is low, the head can't be vertical or the head can't be lifted. Attenuation, etc., symptoms of cranial nerve palsy include drooping eyelids, decreased eye and facial activity, slow response of pupil to light, and decreased mouth opening reflex and increased oral secretions when autonomic nerve is damaged.

Examination of infant botulism syndrome

1. Fecal examination In infantile and adult infantile botulism, fecal microscopic examination showed Gram-positive Bacillus.

2. Bacterial culture Suspicious food, vomit or excrement is heated and boiled for 20 minutes, and then inoculated on blood agar medium for anaerobic culture to isolate Clostridium botulinum.

3. Toxin test

(1) Animal test: The test specimen leaching solution is fed to the animal, or used as a guinea pig. The intraperitoneal injection of the white mouse can cause the animal to die rapidly in the quadriplegia, and the infant type can be used as an animal test for the baby fecal extract.

(2) Neutralization test: 0.5 ml of each type of antitoxin serum was injected into the peritoneal cavity of the mouse, and then 0.5 ml of the specimen was inoculated, and a control group was set at the same time to judge the toxin and the stereotype.

(3) Avian eyelid inoculation test: 0.1 to 0.3 ml of the toxin containing toxin is injected into the eyelid under the angle of the eye of the poultry, and the eyelids are closed, or paralytic sputum and dyspnea appear. After tens of minutes to several hours of death, it can be used as Quick diagnosis.

4. Toxin detection The anti-botulinum toxin antibody is used for neutralization test to check the botulinum toxin in the patient's serum, which can be used to classify toxins.

EMG examination has muscle fiber fibrillation, single stimulation response is reduced, multiple stimulation potentials are increased, short-term multi-wave motion, multi-phase motion, potential increase, etc., can be used as an auxiliary diagnosis.

Diagnosis and diagnosis of infant botulism syndrome

The diagnosis of this disease can be based on strict age of onset, special clinical weakness and other symptoms and other symptoms to make a preliminary diagnosis, EMG examination is helpful for diagnosis, often a short small amplitude and dense motor unit action potential The appearance of this pattern is consistent with the duration of nerve damage.

It is necessary to detect botulinum toxin in food and fecal samples, and to detect botulinum toxin and botulinum by fluorescent antibody staining. In addition, anaerobic culture method and special enrichment technology can be used to separate pathogens and identify strains. .

The symptoms should be associated with botulism, Lambert-Eaton syndrome, certain antibiotic poisoning, high magnesium, high manganese and hypocalcemia or snake bite, myasthenia gravis, poliomyelitis, acute infantile polyneuritis, etc. .

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.