In infant botulism, spores of Clostridium botulinum colonize the gastrointestinal tract after accidental ingestion and start producing toxin type A. The toxin makes its way into nerve cells and cleaves a critical protein complex necessary for the release of the neurotransmitter acetylcholine, halting nerve signaling. Upon further investigation, the family revealed the baby seemed to have abdominal discomfort prior to falling ill and they had soothed him with honey—a known source of C. botulinum spores and botulism in infants. //

With the strong possibility that the boy had botulism, the doctors immediately ordered BabyBIG (Botulism Immune Globulin Intravenous), the only FDA-approved anti-botulism toxin antibodies used to treat infant botulism. It was developed by and is distributed from a unique program run by the California Department of Public Health. The faster infants with botulism get BabyBIG, the better, because the antibodies cannot get into nerve cells—they can only prevent the toxin from going into them. Once the toxin is in the nerve cell and cleaves its target protein complex, it takes four weeks for that protein complex to regenerate and reverse the toxin's actions.

The BabyBIG arrived from California, and doctors administered it to the baby 31 hours after he first went to the emergency room. About six days later, stool tests confirmed the presence of C. botulinum toxin type A. With the antibody blocking the toxin, the baby boy spent 10 days intubated until he started moving again on his own. He opened his eyes and could cough. He was discharged after 21 days and spent eight days in a rehabilitation facility. Three months later, he had fully recovered and was developmentally on track. And at his recent three-year checkup, he continued to do well.

In this case, the boy's exposure to honey gave a tidy explanation for why he developed botulism—the diagnosis that finally solved the riddle of his crying. But in most cases, the exposure isn't so obvious. Infant botulism is rare in the US, with an average of around 80 cases each year, according to the Centers for Disease Control and Prevention. Clear exposure to honey or corn syrup only occurs in a minority of the cases, the doctors of the case report note. Instead, the condition is often linked to environmental exposures, such as rural living, dust production, or nearby soil perturbation. Its sporadic nature can make it yet more difficult to spot.