Human botulism immunoglobulin intravenous (BIG-IV) is safe and effective for infant botulism, but the equine botulism antitoxin has not been used to treat patients with infantbotulism in the United States
Human botulism immunoglobulin intravenous (BIG-IV) is safe and effective for infant botulism, but the equine botulism antitoxin has not been used to treat patients with infantbotulism in the United States: Excerpt from Avoiding Common Pediatric Errors
Author:
Cynthia Gibson, MD
What to Do - Make a Decision, Take Action
Infant botulism causes acute bulbar dysfunction, weakness, and respiratory
failure in infants infected with the neurotoxin-producing Clostridium botulinum spores.Commonclinicalpresentingsymptomsincludeconstipation,
weak cry, poor feeding, ptosis, inactivity, and respiratory distress. Physical
findings consist of hypotonia, weakness, diminished or absent gag reflex,
ptosis, mydriasis, weak suck, and weak cry. The diagnosis is made by a high
clinical suspicion and detection of the botulinum toxin and isolation of the
spores from stool samples.
Clinicalmanagementisprimarilysupportive.Historically,anequineantitoxin was used for therapy that neutralized toxin molecules not yet bound
to nerve endings. However, side effects occurred in 20% of patients, including hypersensitivity reactions, anaphylaxis, and serum sickness. This
was commonly used in adult patients but was never recommended for infant botulism because of the side effects seen in the adult population. The
equine antitoxin is no longer considered beneficial, especially in the face of
a self-limited disease.
A human-derived antitoxin, human botulism immunoglobulin (BIG)
is now available for treatment of infant botulism, and has been shown to
reducelengthofstayandseverityofillness,includingtheneedformechanical
ventilation and tube feedings. BIG-IV was approved by the U.S. Food and
Drug Administration in 2003. It consists of immunoglobulin prepared from
the plasma of donors immunized with pentavalent botulinum toxoid. Side
effects are usually minor (flushing during infusion) although hypotension
and anaphylaxis can occur, as with any immunoglobulin product. Prompt
treatment of infant botulism with BIG-IV is safe and effective, and reduces
hospital stay.
Suggested Readings
ArnonSS,SchechterR,MaslankaSE,etal.Humanbotulismimmuneglobulinforthetreatment
of infant botulism. N Engl J Med. 2006;354:462–471.
Cox N, Hinkle R. Infant botulism. Am Fam Physician. 2002;65:1388–1392.
Shapiro RL, Hatheway C, Swerdlow DL. Botulism in the United States: a clinical and epidemiologic review. Ann Internal Med. 1998:129(3):221–228.
Thompson JA, Filloux FM, Van Orman CB, et al. Infant botulism in the age of botulism
immune globulin. Neurology. 2005;64:2029–2032.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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