Editing Botulism (section)

=== Infant botulism ===
[[File:Infant botulism patient.jpeg|thumb|upright|An infant with botulism. Despite not being asleep or sedated, he cannot open his eyes or move; he also has a weak cry.]]

Infant botulism (also referred to as [[floppy baby syndrome]]) was first recognized in 1976, and is the most common form of botulism in the United States. Infants are susceptible to infant botulism in the first year of life, with more than 90% of cases occurring in infants younger than six months.<ref name="SSAIBchap">{{cite book | vauthors = Arnon SS |chapter-url=http://www.infantbotulism.org/readings/ibchap.pdf |chapter=Infant Botulism | veditors = Feigin RD, Cherry JD, Demmler GJ, Kaplan SL |title=Textbook of Pediatric Infectious Diseases |edition=5th |location=Philadelphia |publisher=WB Saunders |date=2004 |pages=1758–66 |url-status=live |archive-url=https://web.archive.org/web/20110726180149/http://www.infantbotulism.org/readings/ibchap.pdf |archive-date=26 July 2011 }}</ref> Infant botulism results from the ingestion of the [[Clostridium botulinum|''C. botulinum'']] spores, and subsequent colonization of the small intestine. The infant gut may be colonized when the composition of the [[gut flora|intestinal microflora]] (normal flora) is insufficient to competitively inhibit the growth of ''C. botulinum'' and levels of bile acids (which normally inhibit [[Clostridia|clostridial]] growth) are lower than later in life.<ref name=Caya2004>{{cite journal |last1=Caya |first1=James G. |last2=Agni |first2=Rashmi |last3=Miller |first3=Joan E. |title=Clostridium botulinum and the Clinical Laboratorian: A Detailed Review of Botulism, Including Biological Warfare Ramifications of Botulinum Toxin |journal=Archives of Pathology & Laboratory Medicine |date=June 2004 |volume=128 |issue=6 |pages=653–662 |doi=10.5858/2004-128-653-CBATCL |pmid=15163234 }}</ref>

The growth of the spores releases [[botulinum toxin]], which is then absorbed into the bloodstream and taken throughout the body, causing paralysis by blocking the release of [[acetylcholine]] at the [[neuromuscular junction]]. Typical symptoms of infant botulism include constipation, lethargy, weakness, difficulty feeding, and an altered cry, often progressing to a complete descending [[flaccid paralysis]]. Although constipation is usually the first symptom of infant botulism, it is commonly overlooked.<ref name="Infant Botulism">{{cite web|url=http://kidshealth.org/en/parents/botulism.html|title=Infant Botulism|website=kidshealth.org|access-date=28 September 2016|url-status=live|archive-url=https://web.archive.org/web/20161007110000/http://kidshealth.org/en/parents/botulism.html|archive-date=7 October 2016}}</ref>

[[Honey]] is a known dietary reservoir of ''[[Clostridium botulinum|C. botulinum]]'' spores and has been linked to infant botulism. For this reason, honey is not recommended for infants less than one year of age.<ref name=Caya2004 /> Most cases of infant botulism, however, are thought to be caused by acquiring the spores from the natural environment. ''[[Clostridium botulinum]]'' is a ubiquitous soil-dwelling bacterium. Many infant botulism patients have been demonstrated to live near a construction site or an area of soil disturbance.<ref name="Infant botulism literature review">{{cite journal | vauthors = Domingo RM, Haller JS, Gruenthal M | title = Infant botulism: two recent cases and literature review | journal = Journal of Child Neurology | volume = 23 | issue = 11 | pages = 1336–46 | date = November 2008 | pmid = 18984848 | doi = 10.1177/0883073808318200 }}</ref>

Infant botulism has been reported in 49 of 50 US states (all except for Rhode Island),<ref name="SSAIBchap" /> and cases have been recognized in 26 countries on five continents.<ref name="globalIB">{{cite journal | vauthors = Koepke R, Sobel J, Arnon SS | title = Global occurrence of infant botulism, 1976-2006 | journal = Pediatrics | volume = 122 | issue = 1 | pages = e73-82 | date = July 2008 | pmid = 18595978 | doi = 10.1542/peds.2007-1827 }}</ref>