Infantile botulism is a rare condition that primarily affects infants under the age of 6 months. This disease is caused by ingestion of Clostridium Botulinum spores that are found in soil or honey. Once ingested, the spores germinate into bacteria that colonize the infant’s immature intestinal tract and synthesize a toxin. This toxin irreversibly binds acetylcholine receptors, leading to the clinical presentation of progressively worsening constipation, weakness, hypotonia, poor feeding, weak cry, and decreased activity. If enough toxins are released, life-threatening flaccid paralysis with respiratory failure can ensue. Fortunately, with high clinical suspicion, a physician can gain access to life-saving Botulism Immune Globulin Intravenously (BIG-IV) prior to laboratory confirmation. Early administration of Botulism Immune Globulin Intravenous (BIG-IV) can significantly improve outcomes by neutralizing any systemically circulating botulinum toxin. With early diagnosis and treatment, full recovery without neurologic sequelae is likely. Here we present two infants from Southwest Virginia who were admitted to a children’s hospital. These cases illustrate the typical presentation of infantile botulism, an approach to management, the possible clinical course, and opportunities for prevention.



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