Botulism diagnosis surprises baby's parents, who fed no honey

July 28--Infant botulism, a disease that is hardly ever seen in Frederick County, gave the family of 7-month-old Asiyah Yacouba a terrible scare and kept her in the hospital for a month.

She came home to Frederick from Children's National Medical CenterJuly 11 to continue recovering with help from therapists and her family, said her mother Aimee Yacouba. A full recovery may take months.

"She'll have to receive a lot of physical therapy," Yacouba said. "It just takes time."

Botulism is a muscle-paralyzing disease caused by a toxin made by the bacterium Clostridium botulinum. Most cases involve adults who have come into contact with foodborne botulism, most often from improperly canned foods, according to the Centers for Disease Control and Prevention.

Foodborne cases come from food in which botulism spores have produced the toxin. Infants under the age of 1 are susceptible to the spores activating in the large intestine and producing the toxin, according to Darlene Armacost, health department program manager. Infants usually get exposed by swallowing microscopic dust particles that carry the spores.

The source of Asiyah's botulism is still being investigated, but the strain was confirmed to be one usually found on the West Coast, Yacouba said. She suspects dates from California, a small portion of which Asiyah ate as she was being introduced to some solid foods.

While the case is under investigation, there is no laboratory evidence that dates have caused any cases of infant botulism, Armacost wrote in email.

Raw honey can contain botulism spores and is not recommended for infants for that reason. Asiyah had not eaten honey, and at the hospital, Yacouba learned that dirt can be a source of the spores.

"I want families to be aware of the signs, especially since it obviously doesn't only come from honey," Yacouba wrote in email.

Asiyah was 6 months old when she got sick, and she had reached milestones for her age: able to push herself up, hold her head upright. When she came home from Children's, she was like a newborn from the effects of the paralysis, Yacouba said.

When Asiyah was released to go home, lingering muscle weakness prevented her from nursing effectively, and she still needed a feeding tube. By July 20, she made enough progress to have that removed.

"It's been quite a scary month for us," Yacouba said.

"It is not something that we see a lot of," said Lisa Gudmundson, with the health department.

In eight years, the county has reported two cases of infant botulism.

Asiyah had mild symptoms that first sent the family to Frederick Memorial Hospital. Asiyah had slight listlessness that made the family wonder if she had hit her head in a fall the day before. She had no fever.

"She ... just wasn't herself with general weakness, and could not nurse or suck on her pacifier," Yacouba said. "She was still smiling; she was a little weak ... eyes a little droopy; her neck was floppy."

Dr. Robert Wack, the pediatrician at FMH who first had Asiyah's case, suspected it might be infant botulism, although it is rare and preliminary tests did not indicate it.

"We were thinking we would go home (to wait), and his gut said go to Children's," Yacouba said. "As we're there (at Children's), she starts to go downhill really fast."

Asiyah stopped moving her legs, her arms became floppy, her tongue swelled, and then came full body paralysis.

"It was ... horrible, really dramatic," Yacouba said.

Asiyah stopped breathing and required resuscitation. When medical staff's optimism faltered, Yacouba felt her own heart sink.

"They stopped saying everything is going to be OK," Yacouba said. "There was a point I asked myself, 'Is this how we lose a child?' I felt completely out of control.'"

It took two days in the hospital before Asiyah showed improvement, Yacouba said.

"The damage is unstoppable; you basically have to ride it out," she said.

A week after getting out of the hospital, Asiyah still lacked the muscle strength she had a month earlier, but she had recovered to the level of a 3-month-old, Yacouba said. Asiyah coos and sings happily, as her mother recalls the nightmarish weeks behind them.

"The most humbling and the most ... life changing," Yacouba said.

"I think it is important to warn families of this life-threatening bacteria," she wrote in email.

While the expectation is that Asiyah will make a full recovery, Yacouba will not soon recover from the experience, she said.

"Four short weeks that felt like forever."

Follow Patti Borda Mullins on Twitter @FNP_Patti

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