Occasionally, the onset of lethargy and weakness may be so abrupt as to mimic bacterial sepsis or meningitis, thus leading to a delayed diagnosis. The diagnosis is confirmed by the detection of the organism or its toxin in the infant s stool. Toxin isolation and identification are accomplished via mouse lethality testing, with typing confirmed by neutralization of toxin by specific sera. In addition, bacterial sepsis and meningitis must always be excluded in any infant presenting with fever, lethargy, and poor feeding. The absence of a gag reflex, profound hypotonia, and hyporeflexia help to differentiate infant botulism from bacterial sepsis.
Many infants require intubation and prolonged mechanical ventilation.
Continuous nasogastric feedings are preferred over bolus feedings to minimize the risk of aspiration. Small volumes increased over a few days are well tolerated and decrease the need for central hyperalimentation. Physical and occupational therapies are crucial in maintaining range of motion and functional positioning in patients. Antibiotics have not shown to ameliorate the course of the disease. Aminoglycosides such as gentamicin should be avoided for they may potentiate the neuromuscular blockade.