Infant botulism results from intestinal colonization with a Clostridium-producing botulinum neuro-toxin. The precise source of clostridia causing infant botulism is usually not known. C. botulinum producing the same type of neurotoxin has been isolated both from affected infants and from soil and dust samples within their homes (53). Testing of food has been unable to identify a dietary vehicle for infant botulism with the prominent exception of honey, fed to a minority of infant botulism cases. Indigenous honey has been linked by epidemiology and microbiology to type A infant botulism in Japan (82) and Argentina (83), type B in Italy (84), and types A and B in the United States (53). These toxin types match the prevailing types causing foodborne botulism in these nations with the exception of Japan, where botulism is primarily caused by aquatic, not terrestrial food. Regional variations may become increasingly less relevant, as honey purchased in today's market is often a blend of product from multiple sites, even from one or more distant continents; two recent Scandinavian cases of infant botulism were fed honey imported from as far as Argentina (85,86). Because of this risk of contamination with spores, honey should not be given to infants under 1 year of age. The United Kingdom has set an admirable precedent by requiring this recommendation on the label of all honey sold within its borders.
Contaminated corn syrup has never been definitively linked to any case of infant botulism. Initial studies prior to 1982 by the U.S. Food and Drug Administration (FDA) found contamination with C. botulinum spores in 13 (1.3%) of 1001 market samples of corn syrups (87). The major producer of corn syrups in the United States intermittently detected low levels of spores in their corn syrups (88). In response, they initiated proprietary processing changes to avoid contamination. Subsequent studies by FDA (89) and by Health and Welfare Canada (90) did not detect C. botulinum in over 650 samples of corn syrups.
In many societies, herbal teas or infusions are given to infants for colic and other common ailments. No spores were detected in herbal teas given to some of the first cases of infant botulism recognized in California (91). Satorres et al. recently prepared infusions from 100 samples of medicinal herbs used in western Argentina (92). They isolated type A C. botulinum from one sample of Lippia turbinata (commonly poleo) and detected toxicity in mice suggestive of botulinum toxin from one sample each of three additional herbs.
When attempting to link an item from the baby's diet with the subsequent diagnosis of infant botulism, one must carefully compare the timing of feedings with the onset of symptoms. For instance, both corn syrup and honey have been given to treat constipation caused by infant botulism. Herbal teas have been given to infants believed to have colic, who instead were distraught from hunger caused by the feeding paralysis of early infant botulism.
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