Infant botulism in Andalusia (Southern Spain).
BACKGROUND
Infant botulism (IB) is caused by the intestinal colonization by Clostridium botulinum in the first year of life and its subsequent production of neurotoxins. Traditionally, IB has been associated to honey consumption. IB cases tend to cluster in geographic regions. In Europe, IB is a rare disorder. From 1976 through 2006, 65 cases were identified in 13 European countries. In Spain, in the last 15 years, most of the cases have been reported in one region, Andalusia (Southern Spain). A specific treatment for IB type A and type B (BabyBIG) is available outside of the United States since 2005.


METHODS
and aims: We performed a retrospective review of IB cases detected in Andalusia since 1997 and compare them with the cases of IB reported in Europe.


RESULTS
We identified 11 confirmed cases of IB in Andalusia since 1997, and 14 cases in Spain. Nine out of 11 cases were detected since 2007; none of these infants had been exposed to honey consumption. One case in 1997 and another in 2000 were associated to honey. Two cases were treated with BabyBIG in 2007. In the period 2006-2012 the cases of IB reported in Europe were 54.


CONCLUSIONS
We identified a considerable increase in the incidence of IB since 2006. A tendency to a reduction in the number of cases of IB linked to honey consumption has also been identified. An increase in the exposure to these bacteria from the environment could be presumed. Clinicians should maintain a high index of suspicion for this treatable disorder.
Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, Córdoba, Spain; Maimónides Institute for Biomedical Research of Córdoba, Córdoba, Spain. Electronic address: eduardo.lopez.sspa@juntadeandalucia.es.
Eduardo
E
López-Laso
Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, Córdoba, Spain.
Inés
I
Roncero-Sánchez-Cano
Pediatric Neurology Unit, Department of Pediatrics, University Hospital Virgen del Rocío, Sevilla, Spain.
Elena
E
Arce-Portillo
Pediatric Neurology Unit, Department of Pediatrics, University Hospital Puerta del Mar, Cádiz, Spain.
Myriam
M
Ley-Martos
Pediatric Neurology Unit, Department of Pediatrics, University Hospital Torre Cárdenas, Almería, Spain.
Javier
J
Aguirre-Rodríguez
Pediatric Neurology Unit, Department of Pediatrics, University Hospital Juan Ramón Jiménez, Huelva, Spain.
Adrián
A
García-Ron
Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital Juan Ramón Jiménez, Huelva, Spain.
David
D
Mora-Navarro
Department of Neurophysiology, University Hospital Reina Sofía, Córdoba, Spain.
Mario
M
Méndez-García
Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, Córdoba, Spain.
Rafael
R
Camino-León
D001906:Botulism / Q000175:diagnosis / Q000453:epidemiology*; D003014:Clostridium botulinum / Q000302:isolation & purification*; D005260:Female; D006722:Honey / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology
BabyBIG; Clostridium botulinum; Epidemiology; Human botulism immune globulin; Infant botulism