By Eva Briggs, MD
Recently the New York State Department of Health issued an advisory about cases of infant botulism linked to two batches of powdered infant formula from a small brand called ByHeart.
The FDA recalled the formula after 10 different states recorded a total of 13 cases of infant botulism. (Update: All lots of infant formula from ByHeart, in all sizes of canisters and pouches, have been recalled.)
Botulism is a disease caused by a toxin produced by the bacterium Clostridium botulinum. It can be deadly but fortunately it’s rare. I’ve never seen a case in my career. Botulinum toxin is one of the most powerful toxins known. Inhaling just one microgram can kill a person. A microgram is tiny; there are roughly 30 million micrograms in an ounce.
Botulinum toxin blocks the chemical acetylcholine that transmits messages from nerves to muscles. When muscles can’t receive nerve signals, muscles become weak or paralyzed. Initial symptoms are weakness, blurry vision, fatigue and speech difficulty. This can progress to weakness of the chest muscles impairing breathing, as well as arm and leg weakness. Patients remain conscious. They may have vomiting and diarrhea but typically don’t have a fever.
Clostridium botulinum occurs naturally in the environment. It produces spores and most people who contact these spores have no ill effects. But under certain rare circumstances the spores can start to produce toxins and cause disease.
There are five forms of botulism. The most common form affects infants. When people older than 1 year swallow botulism spores, the spores don’t start to grow. But spores can live, grow and produce toxin in infants under 1 year of age. Most commonly this occurs when infants are given honey or karo syrup. The spores are not killed by cooking so even cooked products with these ingredients are not safe for babies.
Infant botulism can come on gradually. Signs include constipation, trouble sucking, choking on feeds, droopy eyelids and floppiness from low muscle tone. Treatment is hospitalization for administration of an antitoxin called botulism immune globulin. Fortunately, the prognosis is good and 99% of infants make a full recovery.
Wound botulism occurs when Clostridium spores grow in a contaminated wound and produce toxin. Risks include injectable drugs, dirty wounds such as from a motor vehicle accident and (very rarely) surgery.
Foodborne botulism occurs when someone eats foods containing botulinum toxin. This can happen with improper home canning and rarely from commercial foods. Because multiple people often consume the same contaminated food, several people may become sick at the same time. Foodborne botulism can start within six hours of eating the food or as long as six to 10 days after exposure.
Small amounts of botulinum toxin are used cosmetically and medically. You’ve probably heard of it as the commercially available brand Botox. Iatrogenic botulism happens if too much is injected, if the Botox is accidentally injected into a vein or if the product is contaminated. Symptoms include droopy eyelids, trouble breathing and swallowing and paralysis. Treatment includes antitoxin, supportive care such as a ventilator and treatment of any complications.
A fifth and very rare form of botulism is adult intestinal toxemia. As in infant botulism, the spores actually start growing within an adult’s intestine. Why this happens isn’t known, although people with serious intestinal illness may be at higher risk.
The FDA recommends that people throw away formula from the two recalled lots of ByHeart Whole Nutrition Infant formula (Lot: 206VABP/251261P2 and Lot: 206VABP/251131P2). Since infant botulism can develop weeks after consuming after contaminated food, parents should record the information on the bottom of the package in case it is needed. Of course, if an infant develops symptoms of botulism, seek immediate medical care.
Eva Briggs is a retired medical doctor who practiced in Central New York for several decades. She lives in Marcellus.