Tuesday, December 14, 2010

Infant With Weakness after Honey Ingestion

A 4-month-old infant presents with failure to thrive, progressive muscular weakness, and poor head control. On questioning, the mother states that she typically feeds the baby soy-based formula sweetened with honey. Which of the following organisms is most likely to be responsible for the child's presentation?

          A. Clostridium botulinum

          B. Clostridium difficile

          C. Clostridium perfringens

          D. Clostridium tetani

          E. Corynebacterium diphtheriae



      The correct answer is A. The baby has infant botulism (floppy baby syndrome), which is due to germination of Clostridium botulinum spores (found in honey) in the baby's gastrointestinal tract. Patients improve when honey is removed from the diet. This disorder is most common in children under the age of six months; older children and adults do not appear to be vulnerable to this form of botulism, but are susceptible to botulism caused by ingestion of preformed toxin.

      Clostridium difficile(choice B) causes pseudomembranous colitis, especially after antibiotic therapy.
      Clostridium perfringens(choice C) causes gas gangrene and gastroenteritis, and it is not associated with
      ingestion of honey.

      Clostridium tetani (choice D) causes tetanus, and does not cause a food-borne illness in infants.

      Corynebacterium diphtheriae(choice E) causes diphtheria in susceptible individuals.