Keywords
Intensive care
mouse bioassay
Categories
How to Cite
Abstract
Introduction. Infant botulism presents with potentially severe flaccid paralysis. Argentina has an incidence of 2.41 cases/100,000 live births.
Objective. To describe the clinical characteristics of patients with Infant botulism hospitalized in Pediatric Intensive Care Units.
Material and Methods. Retrospective, observational, multicentric study conducted between 01-01-2013 and 31/12/2019.
Results. A total of sixty patients were included, all diagnosed with the mouse bioassay. Conventional mechanical ventilation was administered to 80%, Non-Invasive Ventilation to 27%; 30% received antitoxin. The median Intensive Care stay was 25 days (IRD: +-18.5) and median conventional mechanical ventilation was 27 days (IRD +-14.5). Delay in diagnostic confirmation: median 16 days (IQR 13-18.5).
Conclusions. Infant botulism presented prolonged periods of hospitalization and mechanical ventilation; only 30% of patients received antitoxin. The diagnostic confirmation delay time exceeded the recommended antitoxin administration window.
References
Koepke R, Sobel J, Arnon SS. Global occurrence of infant botulism, 1976-2006. Pediatrics 2008; 122(1): e73-82. https://doi.org/10.1542/peds.2007-1827
Lúquez C, Bianco M, Sagua M, et al. Relationship between the incidence of infant botulism and the presence of botulinum-toxin producing Clostridia in the soil of Argentina from 1982–2005. J Pediatr Neurol 2007; 5: 279-286. https://doi.org/10.1055/S-0035-1557408
Johnson EA, Tepp WH, Bradshaw M, Gilbert RJ, Cook PE, McIntosh DG. Characterization of Clostridium botulinum strains associated with an infant botulism case in the United Kingdom. J Clin Microbiol 2005; 43(6): 2602-2607. https://doi.org/10.1128/JCM.43.6.2602-2607.2005
Drivenes B, Krause T, Andersson M, Müller L, et al. Infant botulism in Denmark from 1995 to 2015. Dan Med J 2017; 64(9): A5404. PMID: 28874241
Ministerio de Salud de la Nación. Guía de Prevención, Diagnóstico, Tratamiento y Vigilancia Epidemiológica del Botulismo del Lactante. Buenos Aires, 2012. (Consulta: 21 de marzo 2021). Disponible en: https://www.toxicologia.org.ar
Centers for Disease Control. Infant Botulism: information for clinicians. (Consulta: 1 de junio 2021). Disponible en: https://www.cdc.gov/botulism/infant-botulism.html
Hobbs R, Thomas C, Halliwell J, et al. Rapid detection of botulinum neurotoxins-A review. Toxins (Basel) 2019; 11(7): 418. https://doi.org/10.3390/toxins11070418
Jackson KA, Mahon BE, Copeland J, Fagan RP. Botulism mortality in the USA, 1975-2009. Botulinum J 2015; 3(1): 6-17. https://doi.org/10.1504/TBJ.2015.078132
Arnon SS, Schechter R, Maslanka SE, Jewell NP, Hatheway CL. Human botulism immune globulin for the treatment of infant botulism. N Engl J Med 2006; 2: 354(5): 462-471. https://doi.org/10.1056/NEJMoa051926
Chalk CH, Benstead TJ, Pound JD, Keezer M. Medical treatment for botulism. Cochrane Database Syst Rev 2019; 4(4): CD008123. https://doi.org/10.1002/14651858.CD008123.pub4
Moneim J. Question 1: In infant botulism, is equine-derived botulinum antitoxin (EqBA) an effective alternative therapy to human-derived botulinum immune globulin (BIG)? Arch Dis Child 2018; 103(9): 907-909. https://doi.org/10.1136/archdischild-2018-315498
Ministerio de Salud de la Nación. Boletín Integrado de Vigilancia Epidemiológica. (Consulta: 21 de julio 2021). Disponible en: https://bancos.salud.gob.ar/bancos/materiales-para-equipos-de-salud/soporte/boletines-epidemiologicos/
Dilena R, Pozzato M, Baselli L, et al. Infant botulism: checklist for timely clinical diagnosis and new possible risk factors originated from a case report and literature review. Toxins 2021; 13(12): 860. https://doi.org/10.3390/toxins13120860
Vanella de Cuetos EE, Fernández RA, Bianco MI, et al. Equine botulinum antitoxin for the treatment of infant botulism. Clin Vaccine Immunol 2011; 18(11): 1845-1849. https://doi.org/10.1128/CVI.05261-11
Khouri, JM, Payne JR, Arnon SS. More clinical mimics of infant botulism. J Pediatr 2018; 193: 178-182. https://doi.org/10.1016/j.jpeds.2017.09.044
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2022 German Hugo Kaltenbach, Carla Ávila, María Cárdenas, Viviana Arias, Pablo Llarenas, Karina Palacio, Marcelo Moyano, Juan Martinez, Patricia Rust