Infant botulism treatment

Gastrointestinal colonization in adults or children by clostridial bacteria does not typically take place except under circumstances where the normal flora has been altered by antibiotic treatment (Cheiington, 1998). Botulism results from in vivo production of toxin, analogous to the pathogenesis of infant botulism (McCroskey and Hatheway, 1988 Chia et al, 1986). Support for this form of botulism is provided by demonstration of prolonged excretion of toxin and C. botulinum in stool and/or by the demonstration of C. botulinum spores but not preformed toxin in suspected foods. 

The purpose of this chapter is to use the insights gained in our understanding of the mechanism of BoNT action during the past decade to establish a conceptual framework within which to develop effective treatment strategies for intoxication. The chapter is organized into three major topics consisting of (1) an overview of BoNT action, (2) a description of foodbome, wound, and infant botulism, and (3) a discussion of possible treatment options. 

Although infant botulism was not recognized until a large outbreak occurred in California in 1976, it is currently the most prevalent form of botulism in the United States, accounting for approximately 70% of aU cases. Because infant botulism results from a continual elaboration of BoNT, it is more effectively treated by antitoxin than is foodbome botulism. Recently concluded clinical trials carried out with a human botulinum immune globulin (BIG) has revealed a greater than two-fold reduction in the mean duration of hospitalization in infants treated with BIG treatment was effective even when infusion was initiated several days after the onset of symptoms (Amon, personal communication). 

Botulism is an immune globulin. Botulism immune globulin contains IgG antibodies representative of the immunized donors who contribute to the plasma pool of the derived product. It is indicated in the treatment of patients younger than 1 year of age with infant botulism caused by type A or B. 

II. Indications. Botulinum antitoxin is used to treat clinical botulism (see page 136) to prevent progression of neurologic manifestations. It is generally not recommended for treatment of infant botulism however, open-label clinical trials have been under way in California with human-derived botulism immune globulin (BIG) and have been extended nationwide. For information, call the California Department of Health Services at (510) 231-7600. 

The data about fields of application of Silics in clinics for treatment for infectious diseases are presented in Table 4. From Table 4 it is evident that the field of application of Silics is rather large and covers both intestinal infections and toxicoses which victimize infants, as well as viral hepatitis, and botulism. It is appropriate to mention here that inclusion of Silics into the complex treatment of patients suffering from salmonellosis, dysentery, and intestinal toxicoses accelerates normalization of clinic manifestations of these diseases by a factor of two and more. In the case of botulism the normalization of symptoms characteristic of lesions of the nervous system is shortened by almost 4 days. If intestinal infections are not severe, Silics can be recommended as a single therapeutic agent. In the case of a considerable diarrheal syndrome it is more expedient to use it together with rehydration substances. Inclusion of Silics into a complex of therapeutic agents for patients suffering from viral hepatitis substantially accelerates recovery rates of patients, so that their normal level of bilirubin and activity of alanine aminotranspherase are recovered within shorter periods of time. 

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