Dry and dusty outback: infant botulism

Infant botulism is a rare but life-threatening neuroparalytic syndrome caused by intestinal colonisation of <i>Clostridium botulinum</i> resulting in a symmetrical descending flaccid paralysis. This gram-positive, rod-shaped anaerobic bacillus is universally found in soil with previous links to ingestion of honey and dust contaminated with <i>C. botulinum</i> spores. We present a case of a baby boy with this rare condition eventually linked to dust on a rural outback property. This young patient was ventilated for 90 days. Initial serology for botulism toxin was negative, although <i>C. botulinum</i> spores were eventually grown in the stool. The patient did not receive early treatment with Human Botulism Immune Globulin Intravenous (BIG-IV) as there was a low index of suspicion and a delay in obtaining a stool sample for nearly 6 weeks due to constipation. This case highlights the importance of early treatment with BIG-IV when clinical features and environmental conditions in the remote Australian outback favour persistence of <i>C. botulinum</i> spores in soil without awaiting confirmatory tests.