Centorbi H.J.,¹ Aliendro O.E.,¹ Demo N.O.,² Dutto R.,² Fernandez R.,³ Centorbi O.N.P*¹.
¹ Facultad de Química Bioquímica y Farmacia.Universidad Nacional de San Luis. Chacabuco y Pedernera (5700). San Luis. Argentina. ² Hospital Materno Infantil de San Luis. ³ Facultad de Ciencias Médicas. Universidad Nacional de Cuyo.

Infant botulism is caused by the absorption of toxin produced by toxigenic clostridios that colonize the intestinal tracts of infants under 1 year of age. Since 1984, when the first case was described in Argentina, about 150 cases of infant botulism have been reported. Two of the most recognized sources of Clostridium botulinum spores for infants are dust and honey. A case of infant botulism linked to honey consumption is described.
The patient, a girl of 3 months of age, was admitted to the hospital with a neuromuscular illness clinically consistent with infant botulism: constipation, difficulty in swallowing, a weak cry, a poor suck and generalized hypotonicity. She was exclusively breast-fed. Honey was used to sweeten the pacifier. A complete blood cell count and CSF were normal. Microbiological confirmation: i) the mouse bioassay was used to test for the presence of toxin in fecal samples (to demonstrate the presence of a substance that is toxic to mice, one aliquot of sample was inactivated by heating to a boiling waterbath temperature for 10 min) and subsequent demonstration of botulinal toxin by a specific monovalent botulinum antitoxin in a mouse toxin neutralization test. ii) Serum was tested in mice in the same manner as that used for testing fecal extracts (without heat inactivation). iii) Culturing stool specimen for isolation of C. botulinum was made by using anaerobe procedures and special enrichment techniques according to Hatheway et al. Isolation of C. botulinum from honey. We received only a little remain of the honey that was supplied to the patient. The method used for spore assay was the dilution- centrifugation reported by Midura et al.
Type A botulinal toxin was detected in stool sample but not in serum sample. C. botulinum spores type A were found in stool sample and also in honey sample. The treatment of the patient was symptomatic by means of nutritional and respiratory support. After 14 days of hospitalization she was discharged with only a persistent constipation. This is the first case of infant botulism in Argentina and perhaps in South America linked conclusively to honey.