Infant's 'inconsolable,' day-long crying fits tied to botulism from honey

A healthy, happy baby suddenly became "inconsolable" and cried for hours on end. The infant's irritability turned out to be an early sign of botulism, a relatively uncommon illness caused by dangerous, bacteria-made toxins, his doctors discovered.

The likely source of the toxin-making bacteria was honey. A new report describing the case underscores the potential danger of feeding infants honey.

According to the report, published Wednesday (Jan. 24) in The New England Journal of Medicine, the 8-week-old grew increasingly irritable and had frequent crying fits for a week leading up to his diagnosis. His grandmother noticed that his crying intensified when his abdomen was touched, and at an initial doctor's visit, a clinician determined that the infant just had gas.

However, back at home, the baby's lengthy crying episodes continued, and he had trouble sleeping and latching onto the nipple while breastfeeding. When his movements appeared to be growing weaker, his doctor advised the family to go to the emergency room.

Related: 4 infant botulism cases linked to honey-dipped pacifiers

In the ER, the baby "cried weakly and could not be soothed" and had a fast heart rate, but his other tests largely came back normal. Within hours, though, he grew lethargic and had to expend more effort to breathe, to the point that he began to grunt. His eyelids became droopy as his muscle tone decreased, and his heart rate rose.

These symptoms pointed to infant botulism as a likely diagnosis.

There are several types of botulism, but they're all caused by bacteria-made toxins that block nerves from firing, causing muscle weakness that makes it difficult to move, swallow and breathe. (A modified version of these toxins are used to make Botox, the muscle-freezing injectable drug that prevents wrinkles and treats spasms and migraines.)

Infants can get botulism when they ingest the spores of bacteria that make botulinum toxin. Once in a baby's gut, these spores can turn into toxin-producing bacteria. The toxin can then be detected in the infant's feces — and this is how doctors confirmed the baby's botulism diagnosis.

While awaiting the results of the fecal analysis, the team began treating the infant with anti-botulism toxin antibodies. When doctors suspect botulism, treatment should be started immediately even if the diagnosis isn't confirmed, because the diagnostic test is typically only available through public health departments and takes days to turn around, the doctors noted in their report.

The infant's breathing and movement improved with treatment, but by the time he was fit for discharge, he'd spent nearly a month in the hospital and its associated rehabilitation facility. At a check-up three months later, he had fully recovered, and at a recent check-up, he was still doing well.

In a given infant botulism case, the source of the bacterial spores isn't always clear — that's because they can be accidentally inhaled along with dust and soil in the environment. However, roughly 20% of cases are tied to the child consuming corn syrup or honey contaminated with spores. Because of this well-established risk, experts advise against feeding children honey before their first birthdays.

In the new case, the infant's family reported feeding him honey shortly before he was admitted to the hospital. They'd given it to him because he appeared to have abdominal discomfort caused by constipation or gas, and they hoped the honey would help soothe him.

After age 1, children's immune systems mature, their gastrointestinal systems grow more acidic and their gut microbiomes diversify — these factors are thought to essentially eliminate the risk of getting botulism from honey, according to the medical resource StatPearls.

Very rarely, the bacteria behind botulism can colonize the guts of adults in a similar way to what's seen in infant botulism. This unusual illness is often tied to an adult's gut bacteria being disrupted as a result of surgical procedures or antibiotic therapy, which gives the spores a chance to grow, according to the World Health Organization.

This article is for informational purposes only and is not meant to offer medical advice.

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