Clostridial spores in powdered infant formula

Article Outline

• Copyright

Infant botulism, the intestinal toxemia form of botulism, most commonly follows unavoidable exposure to spores in the environment, such as through contact with dust or soil. During a transient period in infancy, gut flora may not inhibit intestinal outgrowth of ingested clostridial spores. Clostridia then can replicate and produce toxin that is absorbed and causes neuromuscular blockade. Until the practice of avoiding the feeding of honey to infants under 1 year of age, infant botulism in California was highly associated with infants consuming honey that contained clostridial spores.

In this issue of The Journal, Barash et al warn that powdered infant formula may pose a risk for infant botulism. Following report of a case of infant botulism in the United Kingdom that was linked to Clostridium botulinum spores recovered from the patient's powdered formula, California investigators sought to identify clostridial organisms in powdered infant formula. Seventeen percent of 30 samples ingested by patients with infant botulism and 78% of 9 market-purchased unopened powdered formula contained clostridial spores; none was C botulinum but the Clostridium species recovered have similar environmental distribution as C botulinum.

Contamination of powdered infant formula with Salmonella and Cronobacter (formerly Enterobacter) sakazakii previously has led to infection in infants; the US Food and Drug Administration mandates monitoring for these organisms. The report by Barash et al suggests that a large sampling study of powdered infant formula for neurotoxin-producing Clostridium species should be performed to assess whether formula poses a health risk for infants.