Infantile Botulism in a developed country: a non-extinct disease - a national study in Israel

Background: Infantile botulism (IB) caused by Botulinum Neurotoxins (BoNTs) secreted by anaerobic bacteria Clostridium botulinum , manifests by descending paralysis, constipation and possibly respiratory failure and death in infants.

Recent data on infant botulism in developed countries are scarce.

A national multicenter retrospective study included all IB patients diagnosed between 2007 and 2021 in Israel. Diagnosis was made in the National Reference Laboratory for Botulism. Epidemiological, clinical and laboratory data was extracted for analysis.

Cases description: During the study period there were 8 cases of IB (5 males). BoNT A was found in 3 patients and BoNT B in 5. The incidence of IB in Israel increased from 0.14/100,000 to 0.9/100,000 during the study period. Median age was 6.5 months (range 2.5-8 months). Median time to final diagnosis was 9.5 days (range 4-35 days).

Most of the cases (87.5%) occurred between March-July. The most common clinical signs and symptoms were hypotonia , poor feeding and weak cry. The "classical" descending paralysis was observed in 6 (75%) of the patients.

Honey consumption was reported in only one patient. Possible environmental risk factors were found in additional 3 patients. Anti-toxin treatment was given in 4 (50%) patients.

Discussion: Despite the rarity of IB, it appears that over the last 3 years (2019-2021), there has been a relative increase in the occurrence of IB in Israel. IB patients were older and without history of honey consumption compared to previous studies. Environmental exposure may be a source of infections and should not be overruled.