Infant botulism: is there an association with thiamine deficiency?

Infant botulism is an acute life-threatening condition and diagnosis is frequently delayed. Therefore, the best time window to administer specific antibodies, at present the only etiology-based therapy, is often missed, entailing long periods of hospitalization in the PICU. Here we present a 3-month...

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Published in:Pediatrics (Evanston) 2014-11, Vol.134 (5), p.e1436-e1440
Main Authors: Ringe, Hannelore, Schuelke, Markus, Weber, Sven, Dorner, Brigitte G, Kirchner, Sebastian, Dorner, Martin B
Format: Article
Language:English
Subjects:
Animals
Babies
Botulism
Botulism - blood
Botulism - complications
Botulism - diagnosis
Boys
Clostridium botulinum
Clostridium botulinum - isolation & purification
Clostridium perfringens - isolation & purification
Complications and side effects
Diagnosis
Humans
Infant
Male
Mice
Pediatrics
Risk factors
Thiamine deficiency
Thiamine Deficiency - blood
Thiamine Deficiency - complications
Thiamine Deficiency - diagnosis
Vitamin B
Vitamin B1 deficiency
Vitamin deficiency
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Summary:Infant botulism is an acute life-threatening condition and diagnosis is frequently delayed. Therefore, the best time window to administer specific antibodies, at present the only etiology-based therapy, is often missed, entailing long periods of hospitalization in the PICU. Here we present a 3-month-old boy with infant botulism and respiratory failure, who quickly and favorably responded to thiamine supplementation. From the feces we isolated Clostridium botulinum serotype A2. In addition to producing botulinum neurotoxin A, this strain carried the thiaminase I gene and produced thiaminase I. Accordingly, the child's feces were positive for thiaminase I activity. Because C botulinum group I strains are capable of producing thiaminase I, we speculate that thiamine degradation might further aggravate the paralytic symptoms caused by botulinum neurotoxins in infant botulism. Thus, supportive supplementation with thiamine could be beneficial to speed up recovery and to shorten hospitalization in some patients with infant botulism.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2013-3378