title: Fatal course of foodborne botulism in an eight-month old infant.
abstract: An 8-month old girl, weighing 9 kg, was brought by her parents at 8.15 am to the Emergency Department (ED) for a progressive worsening of weakness and acute respiratory failure. On admission, the baby presented with poor oral intake, a weak cry and extremely weak muscular body control. Poor gag and suck, unreactive mydriasis, hypotonia, lethargy and absence of peristalsis were noted. Laboratory data showed severe respiratory acidosis. Chest X-ray, electroencephalography, encephalic CT scan and MRI were all normal, as were cerebrospinal fluid analysis and viral tests. Orotracheal intubation and continuous mechanical ventilation were applied. The patient received fluids, corticosteroids, aerosol therapy, large-spectrum antibiotics and enteral-nutrition. Further investigation revealed ingestion of an improperly prepared home-canned homogenized turkey meal. Type A botulinum neurotoxin was identified. Trivalent botulinum antitoxin, prostigmine and oral activated charcoal were administered. Generalized flaccid paralysis, areflexic bilateral mydriasis, gastric stasis and deep coma persisted for the duration of the hospital stay, and the patient died of severe respiratory failure and cardiac arrest 12 days after ED admission. Botulism poisoning should be suspected in any infant presenting with feeding difficulties, constipation, descendent paralysis or acute respiratory failure. Supportive treatment and antidotal therapy should be performed as soon as a clinical diagnosis is made. We describe a case of foodborne botulism in an 8-month old infant caused by ingestion of an improperly prepared home-canned homogenized turkey meal, representing the youngest fatal case reported in medical literature.
authors.affiliation: Pavia Poison Center and National Toxicology Information Centre -Toxicology Unit IRCCS Maugeri Foundation and University of Pavia;
authors.forename: Davide
authors.initials: D
authors.lastname: Lonati
authors.forename: Carlo Alessandro
authors.initials: CA
authors.lastname: Locatelli
authors.forename: Lucia
authors.initials: L
authors.lastname: Fenicia
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Anniballi
authors.forename: Paolo
authors.initials: P
authors.lastname: Landri
authors.forename: Andrea
authors.initials: A
authors.lastname: Giampreti
authors.forename: Valeria Margherita
authors.initials: VM
authors.lastname: Petrolini
authors.forename: Sarah
authors.initials: S
authors.lastname: Vecchio
authors.forename: Luigi
authors.initials: L
authors.lastname: Manzo