Infant botulism is confirmed by detection of toxin in stool. How is the child most likely infected?

• A. Ingestion of spores that germinate in the intestine
• B. A scratch wound caused by a cat
• C. A puncture wound with contaminated item
• D. Ingestion of preformed toxin found in a contaminated jar of pureed vegetables

Answer: (A)

Infant botulism happens when Clostridium botulinum spores are swallowed and then colonize the baby’s immature gut, where they germinate and produce toxin in the intestines. The infant’s gut lacks fully established normal flora to keep these spores in check, so toxin is generated in vivo rather than being ingested as a preformed toxin. This is why the most likely route is ingestion of spores that germinate in the intestine. In contrast, preformed toxin in food causes foodborne botulism (more typical in older children or adults), and toxin production in a wound leads to wound botulism. Honey and environmental dust are common sources of spores for infants.