Annaliese is eight months old and has been achieving all of the early developmen

Question

Annaliese is eight months old and has been achieving all of the early developmental milestones right on schedule. Having been breast-fed exclusively for her first six months, her parents, who are major advocates of eating locally grown organic foods, have recently introduced solid foods to her diet. Her parents brought her to your pediatric clinic and expressed concern that Annaliese has not been her cheerful self for the last 36 hours. Although she had been sitting up in her high chair for the last couple of months, when she was placed in her high chair today she just leaned over the tray and was unable to sit up. She has had little appetite and has not had a bowel movement in 72 hours. As you examine her, you note that she has very little muscle tone and cannot hold her head up. Her parents indicate that Annaliese is up-to-date with all of her immunizations. You question her parents about what they have fed Annaliese for the past several days. Her mom reported that they had made her oatmeal with organically grown oats, and her father added that he had collected and processed raw honey to sweeten the oatmeal. Based on this information, what is the patient's most likely diagnosis? Select the best answer. Variant Creutzfeldt-Jakob disease Cryptococcal meningitis Polio West Nile encephalitis Rabies Tetanus Infant botulism

Explanation / Answer

According to the symptoms of the infant, it can be clearly noticed that she suffers from disturbed bowel movements, loss of appetite, mood fluctuations and difficulty in maintaining posture. These are the typical symptoms of infant botulism primarily occuring from sudden changes in eating habits. It must be carefully noted here that the infant has been recently shifted on a semi-solid diet which is organic in nature. This might be the cause of botulism infection in this infant and caused irriability, muscle fatigue, constipation/diet chagnes as well.

The other diseases such as cryptococcal meningitis, polio, West Nile encephalitis etc are exclusively associated with initial high fever. Rabies occurs due to an animal-bite source or fluid transfer whereas tetanus shows locked muscles. Thus, the correct answer is : infant botulism.

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