title: Flaccid paralysis in an infant associated with a dirty wound and application of honey.
abstract: An infant, who was born preterm at 36 weeks, presented with fever and ulcer at umbilical region which progressed to necrotising fasciitis of anterior abdominal wall. He was treated with intravenous penicillin, intravenous cloxacillin and local application of medicated honey. Subsequently, he required wound debridement. Postoperatively, he required prolonged invasive ventilation due to poor respiratory effort which was associated with hypotonia and areflexia. Nerve conduction study revealed absent responses. The diagnosis of infant botulism was made based on the clinical presentation, nerve conduction study and his clinical progress. Botulinum immunoglobulin was not available. He was treated with intravenous immunoglobulin and oral pyridostigmine. He was successfully extubated after 37 days, and currently the patient is doing well.
authors.affiliation: Paediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
authors.forename: Charlotte Jane
authors.initials: CJ
authors.lastname: Joseph
authors.affiliation: Paediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
authors.forename: Teik Beng
authors.initials: TB
authors.lastname: Khoo
authors.affiliation: National Clinical Research Center, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
authors.forename: Keng Yee
authors.identifier: http://orcid.org/0000-0002-0022-5539
authors.initials: KY
authors.lastname: Lee
mesh_terms: D001906:Botulism / Q000175:diagnosis / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003646:Debridement / Q000379:methods; D019115:Fasciitis, Necrotizing / Q000382:microbiology / Q000628:therapy*; D006722:Honey; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D010243:Paralysis / Q000382:microbiology; D011729:Pyridostigmine Bromide / Q000627:therapeutic use*; D016896:Treatment Outcome; D014456:Ulcer / Q000382:microbiology / Q000628:therapy; D014472:Umbilicus; D014946:Wound Infection / Q000628:therapy
chemical_list: D002800:Cholinesterase Inhibitors; D016756:Immunoglobulins, Intravenous; D011729:Pyridostigmine Bromide