NP-007 Infant botulism – experience of three case reports in a paediatric hospital

<h3>Background and Importance</h3> Infant botulism (IB) is a potentially life-threatening disorder that is caused by the ingestion of Clostridium botulinum spores, that consequently colonise and produce neurotoxins in the colon. IB occurs in children younger than 12 months, being more frequent in children younger than 6 months. The initial symptoms are constipation in 90%of cases, followed by neuromuscular paralysis, which begins with the cranial nerves and progresses to the peripheral and respiratory muscles. Clinical diagnosis is made through laboratory identification of the toxin or microorganisms in the faeces. Treatment is carried out after hospitalisation, with supportive measures, and should begin as soon as the diagnosis is suspected. Specific treatment is carried out with human botulism immune globulin (BIG-IV) and the earlier it is administered, the more effective it is and the lower the mortality rate. <h3>Aim and Objectives</h3> Presentation of three cases of IB in a paediatric hospital and description of the procedures leading to their resolution. <h3>Materials and Methods</h3> Admission of three infants with IB in three different years (2009, 2022 and 2023), aged less than or equal to 6 months. During the respective hospitalisations and after clinical suspicion of IB, the California Department of Health Services world reference centre was contacted to obtain guidelines for acquiring BIG-IV, since botulinum antitoxin from the national strategic reserve (RENAB) is only indicated from 12 months of age. After obtaining the appropriate authorisations from the Pharmacy and Therapeutics Committee, the hospital’s Board of Directors and INFARMED, as well as finalising the administrative procedures, the process of sending the medication to Portugal was set in motion. <h3>Results</h3> Clinical improvement in all three cases after the administration BIG-IV. <h3>Conclusion and Relevance</h3> The administration of BIG-IV should be carried out as early as possible, as soon as there is clinical suspicion of infant botulism. Although RENAB has been set up to provide equine botulinum antitoxin (DGS Guideline 001/2020 of 16/01/2020), it is not indicated for children under 1 year of age, so it is essential to create a National Reserve that includes BIG-IV indicated for this age group. <h3>References and/or Acknowledgements</h3> DGS Guideline 001/2020 of 16/01/2020 Rao AK, <i>et al.</i> Clinical guidelines for diagnosis and treatment of botulism, 2021. Centres for Disease Control and Prevention, Recommendations and Reports, Vol. 70, No. 2, May 7. Antonucci L, <i>et al</i>. Infant botulism: an underestimated threat. <i>Infectious Diseases</i>, 2021;<b>53</b>:9, 647–660. https://doi.org/10.1080/23744235.2021.1919753 Fox, CK, Keet, CA, Strober, JB. Recent advances in Infant Botulism. <i>Pediatr Neurol</i> 2005;<b>32</b>:149–154. Monography BAT, 9 May 2007. Monography BabyBIG, June 2021.