A Case of Infant Botulism Caused by Clostridium baratii type F: Evaluation and Experience with Administration of Equine-derived Heptavalent Botulism Antitoxin

nfant botulism is the most common form of human botulism in the United States. Most cases are caused by toxin types A and B, which are treated with Human Botulism Immune Globulin Intravenous (BIG-IV; BabyBIG ® ). We present the case of a 10-day-old male with rapidly progressive paralysis and respiratory failure who was diagnosed with botulism caused by Clostridium baratii toxin type F, a rare form of botulism with poorly defined sources. BIG-IV has no demonstrated efficacy against this serotype of botulism. While the young age, rapid onset of symptoms, and severe presentation are consistent with other reported cases of toxin type F infant botulism, this case is interesting due to improvement with the administration of pyridostigmine and treatment with equine-derived heptavalent botulism antitoxin (HBAT), which has been rarely used in the treatment of infant botulism. This report adds to the literature on the efficacy and safety profile of HBAT administration in infants. Furthermore, this case report suggests that healthcare providers should be aware of the possibility of botulism caused by Clostridium baratii toxin type F in an infant presenting with sudden onset of paralysis and consider early treatment with equine-derived HBAT.