title: Infant botulism: is there an association with thiamine deficiency?
abstract: Infant botulism is an acute life-threatening condition and diagnosis is frequently delayed. Therefore, the best time window to administer specific antibodies, at present the only etiology-based therapy, is often missed, entailing long periods of hospitalization in the PICU. Here we present a 3-month-old boy with infant botulism and respiratory failure, who quickly and favorably responded to thiamine supplementation. From the feces we isolated Clostridium botulinum serotype A2. In addition to producing botulinum neurotoxin A, this strain carried the thiaminase I gene and produced thiaminase I. Accordingly, the child's feces were positive for thiaminase I activity. Because C botulinum group I strains are capable of producing thiaminase I, we speculate that thiamine degradation might further aggravate the paralytic symptoms caused by botulinum neurotoxins in infant botulism. Thus, supportive supplementation with thiamine could be beneficial to speed up recovery and to shorten hospitalization in some patients with infant botulism.
authors.affiliation: Pediatric Intensive Care, and hannelore.ringe@charite.de.
authors.forename: Hannelore
authors.initials: H
authors.lastname: Ringe
authors.affiliation: Department of Neuropediatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany; and.
authors.forename: Markus
authors.initials: M
authors.lastname: Schuelke
authors.affiliation: Pediatric Intensive Care, and.
authors.forename: Sven
authors.initials: S
authors.lastname: Weber
authors.affiliation: Center for Biological Threats and Special Pathogens-Biological Toxins (ZBS3), Robert Koch-Institute, Berlin, Germany.
authors.forename: Brigitte G
authors.initials: BG
authors.lastname: Dorner
authors.affiliation: Center for Biological Threats and Special Pathogens-Biological Toxins (ZBS3), Robert Koch-Institute, Berlin, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kirchner
authors.affiliation: Center for Biological Threats and Special Pathogens-Biological Toxins (ZBS3), Robert Koch-Institute, Berlin, Germany.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Dorner
mesh_terms: D000818:Animals; D001906:Botulism / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D003014:Clostridium botulinum / Q000302:isolation & purification*; D003016:Clostridium perfringens / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D051379:Mice; D013832:Thiamine Deficiency / Q000097:blood* / Q000150:complications / Q000175:diagnosis*
keywords: Clostridium botulinum; Clostridium difficile; botulinum toxin antibody; infant botulism; metronidazole; neomycin; thiaminase; thiamine deficiency; vitamin B1 deficiency