A 10-week-old breastfed infant presents with constipation, weak cry, poor feeding and descending hypotonia. There is no fever. The mother reports regularly sweetening the baby's gripe water with honey. Why does the infant develop disease while adults consuming the same honey do not?
- A The infant gut lacks competing flora, allowing ingested spores to germinate and produce toxin in vivo ✓
- B Adults have a receptor variant that prevents toxin binding at the neuromuscular junction
- C Maternal IgG secreted in breast milk neutralises the preformed toxin in adults only
- D Infant gastric acid destroys the toxin, forcing the organism to multiply and invade gut mucosa
Correct answer: A. The infant gut lacks competing flora, allowing ingested spores to germinate and produce toxin in vivo
Explanation
In infant botulism, Clostridium botulinum spores ingested through contaminated honey germinate in the immature gut because normal competitive microbiota have not yet established, and toxin is produced in vivo. Adults ingest preformed toxin in classic botulism, and their mature colonic flora prevents colonisation. The organism does not invade mucosa, ruling out option D.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.