Infant botulism was confirmed by demonstration of toxin in the stool. The child most likely contracted this disease by which route?

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

Answer: (B)

Infant botulism happens when a baby ingests Clostridium botulinum spores that then germinate in the immature gut and produce toxin there. The infant’s gut flora isn’t fully developed, so spores can colonize and generate toxin inside the intestine, which is later excreted and detectable in stool. This in vivo toxin production in the gut is the hallmark of infant botulism.

Wound-related routes would involve toxin produced in a wound, not in the intestine, and ingestion of preformed toxin in spoiled food causes foodborne botulism from toxin already present in the food, not from intestinal colonization in an infant.