Botulism, honey

Tanzi, M.G. and Gabay, M.P., Association between honey consumption and infant botulism. Pharmacotherapy, 22, 1479-1483, 2002. 

Infantile botulism involves the ingestion of botulism spores. The most common identified vehicle for this ingestion in several case series was honey, involving approximately 20% of cases. In the majority of cases of infantile botulism, however, ingestion of honey was not reported. Other possible sources of botulism spores include foods and household dust. Because of the association between the ingestion of honey and infantile botulism, CDC recommends that honey not be fed to infants (CDC, 1998). 

Infantile Botulism—Ingestion ot botulism spores, often in honey, produces flaccid paralysis, poor feeding and suck reflexes, floppy baby syndrome. Wound Botulism—Contamination of wounds with C. botulinum spores can produce systemic symptoms. THERAPY Ventilatory support (often for weeks) Trivalent botulinum antitoxin Enemas and cathartics... 

Unexpectedly, care must be exercised in the use of honey. For honey, and indeed the very soils beneath us, contain botulinuses, the bacteria that produce the toxins leading to botulism. In most cases, the acidity of the human digestive system renders these microorganisms harmless. The digestive systems of infants and toddlers, however, are more or less neutral, which is why, in their case, honey is on the forbidden list. It has been advanced that botulism may be responsible for crib deaths. 

The digestive system of children under one year old has not formed enough to protect itself from botulism organisms sometimes found in raw, uncooked honey. The Centers for Disease Control recommends that raw honey not be given to children under one year old as it can cause a sometimes fatal diarrhea. 

Two types of illness are associated with the botulinum toxin, infant and adult botulism. An adult becomes iU by eating spoiled food that contains the toxin. Infants become ill from eating the spores of the botulinum bacterium. One source of these spores comes from the ingestion of honey. Spores are not normally toxic to adults. Botulinum toxins work by binding to the presynaptic nerve terminal at the neuromuscular junction and at cholinergic autononuc sites. They then act to stop the release of acetylchloline presynaptically, thus blocking neurotransmission. 

Infant botulism Form of botulism in infants associated with ingestion of honey. 

It may not be wise to feed honey to infants under 1 year of age, since infant botulism— botulism resulting from the production of toxins after the ingestion of Colostridium botuli-num—may result from the ingestion of raw agricultural products. Honey has been implicated as a source in a very few cases. This type of botulism does not occur in older children and adults. 

Spores of Clostridium botulinum, responsible for infant botulism, are often contained in honey, which may germinate in adults without adverse effects, but may cause serious illness in infants. In 1976, of 43 cases of infant botulism in California, 13 involved honey (C. botulinum found in 13% of 60 tested samples). It has been recommended that honey not be given to infants under 1 year old. ... 

The characteristic symptoms of infant botulism are poor sucking, constipation, generalized weakness, floppy appearance, and respiratory insufficiency (Cox and Hinkle, 2002). Infant botulism may quickly progress to respiratory failure if not treated. The development of the intestinal flora has been demonstrated to suppress the germination and growth of Clostridium botulinum spores in mice (Sugiyama and Mills, 1978). Ingestion of honey by infants is the classic scenario cited in infant botulism therefore, honey is not recommended in this susceptible population (Amon, 1998). 

---