Just over a week ago the national Health Protection Surveillance Centre warned that reptiles are not appropriate pets for children under the age of five after an infant picked up a potentially life-threatening infection from a turtle. EITHNE DONNELLAN, Health Correspondent, finds out more
OLIVER GIBSON will be three months old next Monday. His mum and dad took him home from Dublin’s Rotunda Hospital on December 18th a happy healthy baby boy. Seven days later – on Christmas morning – after a night of irritability he had a weak cry, was lethargic and wasn’t feeding well.
He lay down with his mum Kris for a nap in the early afternoon and when her husband Kevin checked on them a short time later he noticed the baby was having difficulty breathing and was turning blue in the face.
They immediately rushed him through the snow and ice back to the Rotunda and within an hour he was on life support. Doctors told his parents he was extremely ill. Tests for meningitis were carried out and he was put on a range of antibiotics. He remained “floppy” for a number of days, showing no muscle tone, no reflexes and very little pupil dilation.
After being seen by a neurologist, his parents were told his problem was most likely neurological, muscular or metabolic. But an ECG test performed to monitor his brain activity seemed normal.
He was transferred, still on a ventilator, to the intensive care unit of Temple Street Children’s Hospital where further testing including an MRI scan was performed. It was normal. A range of possible causes for his symptoms was ruled out and the thinking was he probably had a neuromuscular disorder, which came as a devastating blow to his parents. “They had us believing we’d be going home with an invalid,” Kris recalls.
But over a number of days Oliver went from floppy to responsive and gradually recovered. On New Year’s Eve he was out of intensive care, a range of viral tests came back negative and it seemed he had fought off the mystery illness that had afflicted him. He was well enough to be sent home on January 5th, but his parents were still none the wiser as to what had actually happened to him.
That evening though, a paediatrician from Temple Street rang them at home to say they had finally obtained a positive result from all the testing they had done on Oliver.
He had contracted infant botulism, which is rare and life-threatening, and his stools had tested positive for type E botulism toxin in only the seventh such case reported in an infant worldwide. It was also the first case of any type of infant botulism reported in the Republic.
The hunt began to find the source of the infection. At first Kris was asked to stop breastfeeding in case that was the source. Public health officials visited their house off the Navan Road in Dublin and took a range of samples, including specimens of the supplements Kris took while pregnant, and samples of foam used in a recording booth Kevin had just constructed.
Reading up on botulism on the internet Kris discovered the toxin can be found in soil and felt sure it emanated from their Christmas tree.
However, testing carried out by the HSE, and sent to the UK for analysis, eventually found the source – the toxin was in water in a tank housing two pet turtles in their home as well as in food bought for the pets, which Kevin had accepted from a work colleague for three older children in the family.
The turtles had to be put down, the walls and furniture in the room where they were kept disinfected and the carpet ripped up and replaced.
But the nightmare didn’t end there. Two days after he had been discharged from Temple Street, Oliver showed “all the same terrifying symptoms all over again” and had to be rushed back to the hospital where he was put on life support for a second time. At least this time the doctors knew what they were dealing with.
The toxic spores which he had inhaled were still in his system but their effect had temporarily been halted by him being on oxygen. Now that he was off oxygen they were attacking his nerve endings again, causing paralysis.
Doctors at Temple Street consulted with experts in the UK and US who had previously treated cases of infant botulism. It was decided he needed to be given an antitoxin by IV infusion and the only one approved in Ireland for treating type E botulism toxin was not recommended for use in children, but it was given to him on the basis that the benefits outweighed the risks.
Consultation with a world leader on infant botulism at the California Department of Public Health though indicated that the type of antitoxin given to Oliver would be effective for only a couple of weeks and further doses in an infant could cause anaphylaxis.
A different antitoxin, which would cover him for several months until the toxin was cleared from his system, was required. One which had been tested and found to be effective by the US government in anti-terrorism research, but which had only been approved by the FDA for use in infants with type A and B botulism, was agreed upon by the experts as the best possible treatment available.
Kris and Kevin were amazed at the speed at which it could be flown to Temple Street for their son. They say the hospital, the HSE and the Irish Medicines Board agreed on its use, its purchase and importation on a Saturday and it was given to Oliver on a Sunday. The antitoxin cost about €35,000, his parents were told, but a few days after receiving it Oliver was well enough to go home, having completed another 10-day stint in hospital.
He hasn’t relapsed since but continues to undergo weekly tests. If three in a row are negative for the toxin, he will get the all-clear. So far, two have been negative.
While many criticise the state of the Irish public health system, Kris, who is originally from Chicago, says the service she and her Irish-born husband received in their hour of need was fantastic. “In the US we would have been treated, but we would have been left bankrupt,” she says.
“We will forever feel grateful to the doctor who was astute enough to suggest testing for this obscure, rare disease,” she adds.
The baby is now in great form, apart from “keeping unsocial hours”, Kevin observes.
The infant’s parents are more than happy now to endorse the warning issued by the national Health Protection Surveillance Centre just over a week ago when it said reptiles such as snakes, lizards, tortoises, turtles and terrapins are not appropriate pets for children under the age of five, because they carry a risk of botulism infection and also salmonella.
“Err on the safe side if you’re wondering whether or not you should keep that pet because no pet was worth what we went through . . . it was the most painful situation in my life. It was truly just a waking nightmare,” Kris says.
The reason botulism toxins are so hazardous to infants is because they haven’t yet built up defences to fight them. They are also a risk for adults with weakened immune systems including those who are pregnant or those with diseases such as cancer.
Over the past two years, a very small number of cases of infant botulism have also been diagnosed in the UK in babies with a history of having consumed honey. As a result, parents are now warned that honey should not be given to children under 12 months of age but Oliver’s mum, Kris Edlund Gibson, an actress who has starred in several TV dramas including Judging Amy and Frasier, says that in one of those UK cases the honey didn’t test positive for botulism toxin.
“So it was sort of a mystery how that baby got it. Well after Oliver, the HSE called them over there and said, ‘Hey, by any chance did you guys have turtles at home?’ and they did, the exact same kind of turtles as us and the exact same manufacturer of the turtle food.”
It seems those treating little Oliver Gibson may have finally solved a riddle for more than one family.
