title: Infant botulism intoxication and autonomic nervous system dysfunction.
abstract: Three infants presenting with severe cases of infantile botulism, occurring at 17, 30, and 180 days of life, respectively, are described in this report. All three infants presented with areflexive flaccid coma or apnoeas requiring prolonged ventilation. In serum, type B botulinum neurotoxin (BoNT/B) was detected in two cases and BoNT/A in the third case, confirming the diagnosis of infantile botulism. Despite constant nursing and monitoring, the recovery of motility was progressive, but finally complete. Dysautonomia, measured by recording heart rate variability (HRV), persisted beyond observable physical recovery. Dysautonomia was assessed using a time-domain analysis of the continuous electrocardiogram response (via non-invasive weekly 24h Holters), which included sympathetic (SDNN) and parasympathetic indices (RMS-SD, pNN50). In all three of our patients, we observed an initial hypotonic period and a major decrease in all HRV indices. Despite observable recovery shortly after extubation, HRV time domain indices remained altered for many weeks. Because of the close monitoring afforded by hospitalization, this change in autonomic function was not accompanied by syncope, complications arising from ventricular arrhythmia, or sudden death. Our observations have important clinical implications since they emphasize the importance of pursuing cardiopulmonary monitoring following apparent functional recovery from the BoNTs.
authors.affiliation: Paediatric Department, Intensive care and Neonatology unit, University Hospital of Saint-Etienne, 42055 Saint-Etienne, Cedex 02, France. hugues.patural@chu-st-etienne.fr
authors.forename: Hugues
authors.initials: H
authors.lastname: Patural
authors.forename: Philippe
authors.initials: P
authors.lastname: Goffaux
authors.forename: Caroline
authors.initials: C
authors.lastname: Paricio
authors.forename: Guillaume
authors.initials: G
authors.lastname: Emeriaud
authors.forename: Georges
authors.initials: G
authors.lastname: Teyssier
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Barthelemy
authors.forename: Vincent
authors.initials: V
authors.lastname: Pichot
authors.forename: Frédéric
authors.initials: F
authors.lastname: Roche