Infantile Botulism

Infants with botulism usually present between 10 days to 6 months, with an acute onset of hypotonia, dys­phagia, constipation, weak cry, and respiratory insuf­ficiency. The neurologic examination shows diffuse hypotonia and weakness, ptosis, ophthalmoplegia with pupillary dilation, reduced gag reflex, and rel­ative preservation of deep tendon reflexes. The diag­nosis may be made by electrodiagnostic studies (see Chapter 7) or by measuring Clostridium botulinum toxin in a rectal aspirate containing stool.