Document Detail


Infant botulism intoxication and autonomic nervous system dysfunction.
MedLine Citation:
PMID:  19327405     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Three infants presenting with severe cases of infantile botulism, occurring at 17, 30, and 180 days of life, respectively, are described in this report. All three infants presented with areflexive flaccid coma or apnoeas requiring prolonged ventilation. In serum, type B botulinum neurotoxin (BoNT/B) was detected in two cases and BoNT/A in the third case, confirming the diagnosis of infantile botulism. Despite constant nursing and monitoring, the recovery of motility was progressive, but finally complete. Dysautonomia, measured by recording heart rate variability (HRV), persisted beyond observable physical recovery. Dysautonomia was assessed using a time-domain analysis of the continuous electrocardiogram response (via non-invasive weekly 24h Holters), which included sympathetic (SDNN) and parasympathetic indices (RMS-SD, pNN50). In all three of our patients, we observed an initial hypotonic period and a major decrease in all HRV indices. Despite observable recovery shortly after extubation, HRV time domain indices remained altered for many weeks. Because of the close monitoring afforded by hospitalization, this change in autonomic function was not accompanied by syncope, complications arising from ventricular arrhythmia, or sudden death. Our observations have important clinical implications since they emphasize the importance of pursuing cardiopulmonary monitoring following apparent functional recovery from the BoNTs.
Authors:
Hugues Patural; Philippe Goffaux; Caroline Paricio; Guillaume Emeriaud; Georges Teyssier; Jean-Claude Barthelemy; Vincent Pichot; Frédéric Roche
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-03-25
Journal Detail:
Title:  Anaerobe     Volume:  15     ISSN:  1095-8274     ISO Abbreviation:  Anaerobe     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-30     Completed Date:  2009-12-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9505216     Medline TA:  Anaerobe     Country:  England    
Other Details:
Languages:  eng     Pagination:  197-200     Citation Subset:  IM    
Affiliation:
Paediatric Department, Intensive care and Neonatology unit, University Hospital of Saint-Etienne, 42055 Saint-Etienne, Cedex 02, France. hugues.patural@chu-st-etienne.fr
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MeSH Terms
Descriptor/Qualifier:
Apnea / chemically induced
Autonomic Nervous System / drug effects*
Botulinum Toxins / toxicity*
Botulism / diagnosis*,  physiopathology*
Coma / chemically induced
Female
Humans
Hypotension / chemically induced
Infant
Infant, Newborn
Muscle Hypotonia / chemically induced
Nervous System Diseases / physiopathology*
Chemical
Reg. No./Substance:
0/Botulinum Toxins

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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