Could Intravenous Immunoglobulin Be an Alternative Therapy for Treating Infant Botulism in Areas Where Human Botulism Immunoglobulin Is Not Easily Available?: Our Experience in Andalusia, Spain.

BACKGROUND

Infant botulism (IB) affects infants under 1 year of age, caused by the ingestion of Clostridium botulinum spores and subsequent neurotoxin production. IB is rare in Europe. This study aimed to analyze the epidemiology and management of IB over the past 25 years in Southern Spain.

METHODS

This is a retrospective, multicenter study of IB cases detected in Andalusia since 1997. Epidemiologic, clinical, diagnostic and outcome variables were analyzed.

RESULTS

Twenty-three patients from 7 different hospitals were included, with a median age of 3 months. Most of these patients presented with weak crying, constipation, arreactive mydriasis and loss of myotatic reflexes. Neurophysiological studies showed alterations in 74% of the cases at diagnosis. The diagnosis was confirmed in all cases by stool sample analysis. Only 4 patients received human botulism immunoglobulin (HBIG) and 10 received empirically intravenous immunoglobulin (IVIG). The median time to improvement in patients who received IVIG and HBIG was slightly shorter; however, no differences were observed. Significant differences were observed when IVIG was administered within the first 72 hours (14 vs. 25 days, P = 0.035). In addition, patients who received empirical antimicrobial therapy required longer hospitalization times secondary to observed exacerbated paralysis (20 vs. 12 days, P = 0.033).

CONCLUSIONS

IVIG may be an effective treatment for shortening the duration of illness in regions that are not readily accessible for HBIG, but further studies are needed. Although IB is rare, when it is suspected, antimicrobial therapy should be avoided as it may exacerbate paralysis by increasing the availability of neurotoxin for absorption.