Rapid diagnosis of a case of infant botulism by enzyme immunoassay

Infant botulism is a disease of infancy which results from the intestinal replication of Clostridium botulinum organisms. The disease was initially described in 19761 and has subsequently been recognized as the most frequent form of botulism in the United States.2 There is considerable variation in the clinical features of this disease. The most frequently recognized form is the “floppy baby syndrome,” but the range of symptoms includes irritability, lethargy or constipation at one end of the spectrum to sudden infant death syndrome at the other.3,4 A major impediment to establishing this diagnosis is that the standard tests usually require the resources of a reference or research laboratory. Methods to submit specimens are cumbersome, the standard mouse bioassay for toxin detection requires animal facilities and the test is usually concluded 4 days after animal inoculation.5 We recently developed an enzyme-linked immunosorbent assay (ELISA) as an alternative to mouse bioassay for detecting C. botulinum toxins A6 and B7 and subsequently assessed its diagnostic accuracy in cases of suspected botulism.8 This report illustrates the use of the assay to establish the diagnosis of a case of infant botulism.