Réanimation

, Volume 21, Issue 3, pp 344–350 | Cite as

Formes graves de botulisme du nouveau-né et du nourrisson : trois observations récentes et algorithme de prise en charge

  • Ph. Sachs
  • S. Prot-Labarthe
  • L. A. King
  • R. Blondé
  • A. Papon
  • M. Popoff
  • O. Brissaud
  • J. Naudin
  • S. Dauger
Mise au Point / Update
  • 84 Downloads

Résumé

Le botulisme est une maladie rare chez le jeune enfant, responsable comme chez l’adulte de paralysies flasques par blocage présynaptique de la jonction neuromusculaire. Une intoxination alimentaire après ingestion d’un produit contenant de la toxine préformée comme de la charcuterie ou des conserves de fabrication artisanale est évoquée chez un patient en âge de consommer ces produits, a fortiori lorsqu’il existe un foyer géographique d’intoxination, mais peut également concerner le nourrisson. Le botulisme infantile survenant après colonisation intestinale par Clostridium botulinum, s’observe exclusivement chez l’enfant de moins d’un an. Le traitement symptomatique nécessite dans les situations les plus graves une phase prolongée de soutien ventilatoire et nutritionnel en attendant une récupération spontanée, souvent ad integrum, mais pendant laquelle les patients sont exposés aux complications de la réanimation. L’administration précoce de sérum antitoxinique permet d’accélérer cette récupération, ce qui suppose que le diagnostic soit évoqué rapidement à un âge a priori inhabituel. Nous présentons trois observations récentes illustrant cette maladie, et proposons un protocole pratique facilitant pour le réanimateur les démarches diagnostiques et thérapeutiques.

Mots clés

Botulisme infantile Botulisme alimentaire Paralysie Mydriase Sérothérapie 

Severe forms of newborn and infant botulism: three recent case reports and guidelines for management

Abstract

Botulism rarely involves young children. Food borne botulism is a direct toxin contamination that can affect infants following the ingestion of a food product contaminated by botulinum toxin. Infant botulism occurs after intestinal colonisation by Clostridium botulinium and secondary toxin production in children less than 12 months of age. Both forms lead to a presynaptic blockage of the neuromuscular junction. In its natural course, the disease ultimately resolves completely, but some patients will require ventilatory and nutritional support, thus experiencing intensive care complications. Early administration of intravenous antitoxin has been proved to accelerate recovery, which requires physicians to be aware of this rare disease. Here we report three recent cases of botulism in young children that are especially relevant, and propose guidelines to optimise diagnosis and treatment.

Keywords

Infantile botulism Food borne botulism Paralysis Mydriasis Antitoxin 

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Copyright information

© Société de réanimation de langue française (SRLF) and Springer-Verlag France 2012

Authors and Affiliations

  • Ph. Sachs
    • 1
    • 2
  • S. Prot-Labarthe
    • 1
    • 3
  • L. A. King
    • 4
  • R. Blondé
    • 1
    • 5
  • A. Papon
    • 1
    • 3
  • M. Popoff
    • 6
  • O. Brissaud
    • 7
  • J. Naudin
    • 1
    • 2
  • S. Dauger
    • 1
    • 2
  1. 1.AP-HPhôpital Robert-Debré et Université Paris Diderot-Paris VIIParisFrance
  2. 2.Service de réanimation et surveillance continue pédiatriqueshôpital Robert-DebréParisFrance
  3. 3.Pharmacie, pôle de biologiehôpital Robert DebréParisFrance
  4. 4.Institut national de veille sanitaireSaint-Maurice cedexFrance
  5. 5.Service de pédiatrie générale, pôle de pédiatrie médicalehôpital Robert DebréParisFrance
  6. 6.Institut PasteurCentre national de référence des bactéries anaérobiesParisFrance
  7. 7.Service de réanimation néonatale et pédiatrique, CHU PellegrinUniversité Bordeaux IIBordeauxFrance

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