Infant Botulism: Checklist for Timely Clinical Diagnosis and New Possible Risk Factors Originated from a Case Report and Literature Review
Robertino Dilena,
Mattia Pozzato,
Lucia Baselli,
Giovanna Chidini,
Sergio Barbieri,
Concetta Scalfaro,
Guido Finazzi,
Davide Lonati,
Carlo Alessandro Locatelli,
Alberto Cappellari,
Fabrizio Anniballi
Affiliations
Robertino Dilena
Unità di Neurofiopatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Mattia Pozzato
Neurology Unit & MS Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Lucia Baselli
Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Giovanna Chidini
Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Sergio Barbieri
Unità di Neurofiopatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Concetta Scalfaro
National Reference Centre for Botulism, Nutrition and Veterinary Public Health, Department of Food Safety, Istituto Superiore di Sanità, 00161 Rome, Italy
Guido Finazzi
Department of Food Control, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia-Romagna, 25124 Brescia, Italy
Davide Lonati
Toxicology Unit, Laboratory of Clinical and Experimental Toxicology, and Poison Control Centre and National Toxicology Information Centre, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
Carlo Alessandro Locatelli
Toxicology Unit, Laboratory of Clinical and Experimental Toxicology, and Poison Control Centre and National Toxicology Information Centre, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
Alberto Cappellari
Unità di Neurofiopatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Fabrizio Anniballi
National Reference Centre for Botulism, Nutrition and Veterinary Public Health, Department of Food Safety, Istituto Superiore di Sanità, 00161 Rome, Italy
Infant botulism is a rare and underdiagnosed disease caused by BoNT-producing clostridia that can temporarily colonize the intestinal lumen of infants less than one year of age. The diagnosis may be challenging because of its rareness, especially in patients showing atypical presentations or concomitant coinfections. In this paper, we report the first infant botulism case associated with Cytomegalovirus coinfection and transient hypogammaglobulinemia and discuss the meaning of these associations in terms of risk factors. Intending to help physicians perform the diagnosis, we also propose a practical clinical and diagnostic criteria checklist based on the revision of the literature.
