Update: Infant botulism

This article summarizes what is known about the clinical features, epidemiology, pathogenesis, laboratory diagnosis, management, and environmental aspects of infant botulism in the past two decades since it was recognized as a clinical entity. The pathogenesis of infant botulism is distinct from food-borne or wound botulism. The infant ingests clostridial spores, which then germinate and colonize in the infant's intestine. The toxin is produced, absorbed, and carried to the cholinergic synapses, where it binds irreversibly. The diagnosis of infant botulism is established by the identification of botulinum toxin in and the isolation of Clostridium botulinum fr om stool specimens of the affected infants. In recent years, a completely different history is evident for the causative bacterial species associated with the production of botulinum neurotoxin. Infant botulism has become the most common form of botulism confirmed in the United States. Although infant botulism has been reported from the more developed countries of the world, the incidence of this disease is probably greater, as Clostridium botulinum spores are found in soils and on agricultural products worldwide. The most prevalent source of spores appears to be the general environment. Therefore, infant botulism is still an uncommon and often unrecognized illness that may be underdiagnosed in parts of the world where the disease is thought to be uncommon.