EARTHQUAKE: THE ROAD TO RECOVERY : Quake Dust Linked to Infants’ Ills : Health: Doctors suspect that bacteria-rich particles kicked up by the temblor are the reason three L.A.-area babies have contracted a rare, life-threatening illness.
In an unusual side effect of the Northridge earthquake, three Los Angeles-area babies have contracted infant botulism, a rare, life-threatening illness that health officials believe may have been caused by bacteria-rich dust kicked up by the temblor.
Two children remain in intensive care units with the malady, which results from swallowing bacterial spores that live in soil throughout California. The third child was recently discharged from a hospital.
Infant botulism differs from adult botulism, which is caused by eating tainted food, because a baby can develop the illness by ingesting spores contained in particles of soil. State health officials said most cases of infant botulism seem to stem from construction, farming, earthquake or landslides, which create dust in the air.
The botulism toxin causes muscle paralysis, breathing problems and other disturbances to the nervous system.
Although no deaths from infant botulism have been reported in California in a decade, the malady can leave babies so sick that they must be kept alive on mechanical ventilators for weeks or months. There is no known antidote.
Health authorities said dust thrown into the air by the Jan. 17 temblor is the most likely cause of the outbreak because all the infants live in areas that were violently shaken and showed symptoms only after the quake. The babies are from Santa Monica, Granada Hills and Canyon Country.
“I thought it was pretty far-fetched at first, but now I’m convinced after we thought back to the day of the earthquake,†said Andy Orescanin, 29, a heavy equipment mechanic from Canyon Country whose 3-month-old son is in intensive care at a Kaiser hospital in Los Angeles.
“When there was that big aftershock, we saw the dust just rolling over the hills. Just clouds and clouds of dust,†said Orescanin, who spent the day sitting in the family van with the doors open after his home was damaged.
Jin Yoon, a Granada Hills homemaker whose 6-week-old daughter is on a ventilator in the pediatrics intensive care unit of Childrens Hospital in Los Angeles, said her home, too, was damaged in the quake. She and her baby spent the day in a car as thick dust settled over their neighborhood.
“We saw the dust falling down from the roof,†said Yoon, 24. “We were outside the whole day.â€
Because of its large land mass and high birthrate, California has about half of the 75 to 100 cases of infant botulism diagnosed annually in the United States.
The symptoms of the disease, which only strikes infants less than a year old, include constipation, poor eating, weak cry, poor head control and general listlessness.
The botulism poison, produced in the large intestine, slowly damages nerve endings and often leads to partial or complete paralysis and serious respiratory problems.
In mild cases, hospitalized babies are fitted with feeding tubes because they cannot swallow properly. In one-third to one-half of all cases, babies must be put on ventilators so they can breathe.
If such treatments are not administered, the poison can fatally injure the nervous system. But most children recover after they begin to develop some immunity to the toxin and their nerve endings regenerate spontaneously.
Survivors usually recover full nerve and muscle function, said Dr. Robert Schechter, an infant botulism expert with the state Department of Health Services in Berkeley.
Yoon and Orescanin said their babies got sick 10 days to two weeks after the quake. Orescanin said the first sign was that his son, Thomas, was not eating well. At first, he and his wife thought the baby had the flu. But he got progressively weaker.
“We noticed that when we held him . . . he felt like a wet noodle,†Orescanin said. Later, the child became dehydrated, had difficulty breathing and “his face got real long, like he was losing his facial muscles.â€
The third victim, a 3 1/2-month-old Santa Monica girl, was discharged after a short stay at Cedars-Sinai Medical Center.
The overall U.S. fatality rate for infant botulism is unknown, partly because some mild cases are never diagnosed and because the disease is sometimes mistaken for other maladies. A 1977 study indicated that nine of 211 deaths attributed to sudden infant death syndrome in California may actually have been caused by unrecognized infant botulism.
But Schechter said that among babies that reach the hospital, the death rate is less than 1%.
Dr. Wendy Mitchell, a professor of neurology and pediatrics at USC School of Medicine, said infant botulism is often misdiagnosed, especially in sparsely populated areas where few cases surface.
“If you don’t know what it looks like, it looks like everything else that goes wrong with a little infant--infections, metabolic problems,†Mitchell said.
Orescanin said doctors initially misdiagnosed the problem in his son. One physician said the baby had the flu, another said it had “a genetic defect,†Orescanin said.
He said that “after a lot of praying,†his son was seen by a doctor at the Kaiser hospital in Panorama City who recognized the disease.
“She had never seen it before, but she had heard of it,†he said.
Yoon said she went to five different doctors before the malady was finally recognized at Childrens Hospital. Her baby had turned white and briefly stopped breathing before being admitted.
“She can’t breathe, so she’s breathing by machine,†said Yoon. “But she’s doing fine. She’s doing great right now.â€
Dr. Stephen Arnon, head of the state health department’s infant botulism program, said doctors are not certain that airborne spores in dust caused the outbreak, but that is the most likely explanation.
“California is just very generously endowed with spores. They’re everywhere,†he said. “There was a quake and that kicked up dust clouds. We know that’s where the bacteria live. So there is a suspicion that the quake kind of triggered†the outbreak.
State researchers are checking records to see if earlier quakes prompted outbreaks of infant botulism. Schechter said two cases were reported in the Bay Area after the 1989 Loma Prieta quake, but they are within the expected number of cases for the region and it is not clear if they were related to the temblor.
Arnon said each of the three sick infants in Los Angeles County has been enrolled in a clinical trial of a drug called botulism immune globulin, originally developed by the Army as an antidote for germ warfare. Researchers hope the drug, also known as BIG, will prove effective in arresting the malady, although it is not expected to be an antidote.
The trial, supervised by the state health department, began two years ago. More than 50 infants are being studied, but only half have been injected with the substance. The other half receive a placebo.
Researchers believe the drug may work by preventing botulism toxin from attaching itself to nerve endings.
While it is hoped the drug can stop the illness from getting worse, “it is not a dramatic antidote to existing illness,†Arnon said.
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