The following text was automatically extracted from the image on this page using optical character recognition software:
Teas Preventa le Disease
contents:
Infant Bot
Malignant
Frank Bryant, Jr, MD, FAAFP Robert Bernstein, MD, FACP
Chairman Commissioner
Texas Board of Health
Bureau of Disease Control and Epidemiology,
1100 West 49th Street, Austin, Texas 78756 (512-458-7455)
Vol. 49, No. 24
Junc 17, 1989
TEXAS STATE
ulism in TexaDOCUMENTS COLLETi
Melanoma
INFANT BOTULISM IN TEXAS
Botulism is generally regarded as a food
poisoning which results from ingestion of pre-
formed toxin produced by the bacteria Clostrid-
ium hotulitum. Infant botulism is an illness
caused by the production of botulinal toxin in an
infant's intestinal tract. The first symptom of
infant botulism is usually constipation. The
infants generally appear lethargic and listless.
The child exhibits poor feeding because of
diminished suck reflexes and crying becomes
weak and feeble. Weakness progresses in a
symmetrical, descending fashion over hours or
days. The baby appears "floppy" with loss of
head control and loss of extremity control.
Clostridium hotidinum produce one of seven
serologically distinct toxins designated by the
letters A-G. Type A and type B organisms are
responsible for over 90% of infant botulism
cases in the United States. Type A generally is
found in areas west of the Rocky Mountains.
Type B organisms are distributed throughout the
United States. Spores of C. boti/inum are
widespread in soil and dust throughout the
world. Consumption of honey or corn syrup
represents an important risk factor for infant
botulism. These food items are not, however,
the source of infection for most infant botulism
cases. In most cases, the source of infection
remains unidentified. Recent infant botulism
cases in Texas are described below.
A total of 29 infant botulism cases was reported
in Texas from 1979 through 1988. The annual
number of reported cases ranged from zero in
1980 to six in 1984. No overall secular trend
is apparent. The infants ranged in age from I
to 27 weeks; 54% were 6 weeks of age or
younger. A majority (59%) were female. Race
and ethnicity were reported for 28 cases; 14
infants were white, and eight were Hispanic. The
other six infants were black or Asian. The
infants resided in 16 counties throughout Texas
(Figure 1). Over half the cases resided in two
geographic areas. Seven infants (24%) resided in
El Paso County, and nine infants (31%) resided
in northeastern Texas. Infants had onset of
illness in all months except October. No seasonal
distribution is apparent.
Thirteen of the infants were vaginally delivered.
Only two were considered premature. At birth,
the infants weighed from 5 lb 12 oz to 81b 10oz,
with a median weight of 7 lb 7 oz. Four of the
infants had been exclusively breast fed, and ten
had been exclusively formula fed. Eighteen of
the infants had been breast fed during some time
before onset of illness.
The clinical features of the infant botulism cases
are presented in Table 1. Poor feeding was noted
for all infants. All infants were described as
"floppy," with poor head control and weak ex-
tremities. A majority of infants were reported to
have constipation (81%), an altered cry (85%),
loss of facial expressions (83%), irritability (73%),
and ptosis (59%). Eighteen infants required
respiratory assistance. A feeding tube was
required for 95% of the infants. All were
hospitalized. Duration of hospitalization ranged
from seven to 75 days with a median of 29 days.
None received botulinum antitoxin. Outcome of
illness was reported for 27 infants; none died.
Seventeen infants had illness caused by C.
botliinum type A; 12 had illness caused by type
B. The diagnosis for 21 infants was confirmed by
the identification of C. holulinium organism and
botulinum toxin in stool specimens. C. hotulinum
organisms only were cultured from stool
specimens of seven infants, and toxin only was
demonstrated in the stool specimen of one
infant.
All thirteen cases from Bexar, El Paso, Dallas,
Ochiltree, Randall, and Tarrant counties were
type A. One case in Midland County and three
cases in Harris County were also type A. Cases
Texas Department of Health
, . _c &rr 1 ihrnrimc 7R7rA