A 4-month-old exclusively breastfed infant develops constipation, poor feeding, hypotonia and weak cry over several days. The mother reports adding honey to the feeds. The pathogenesis of this condition differs from adult botulism because:

• A Preformed toxin in honey is absorbed directly from the gut
• B The organism invades colonic mucosa and spreads haematogenously
• C The toxin reaches the central nervous system through the bloodstream
• D Spores ingested in honey germinate and produce toxin inside the infant intestine ✓

Explanation

Infant botulism results from colonisation of the immature gut by Clostridium botulinum spores, commonly from honey, which then germinate and elaborate toxin in situ; adults have competing flora that prevent colonisation, so adult disease follows preformed toxin. The toxin acts at peripheral cholinergic nerve endings after retrograde axonal transport, not directly in the CNS, and the organism does not invade tissue. Honey should never be given before one year of age.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.