But infants can become ill by ingesting the spores themselves, which create toxin in the oxygen-free environment of the child's intestines. Botulinum bacterial spores travel widely, and can be found in a variety of sources, including foods such as honey.
Infant botulism is rare, but the mortality rate is high if severe cases are not diagnosed and treated quickly. It strikes as many as 100 babies a year in the United States, most younger than 6 months.
There have been more than 1,700 confirmed cases in nearly 50 states since its recognition as a distinct disease in 1976. Parents may notice infrequent bowel movements, listlessness, lethargy, poor feeding, and drooling from the mouth because of an inability to swallow, as babies, essentially, become "floppy." The progression of weakness eventually necessitates hospital admission. The toxin can cause paralysis and loss of muscle tone in the respiratory tract, resulting in asphyxiation and possibly death.
Before Tessler was definitively diagnosed, her doctors had contacted infant botulism experts at the California Department of Health Services who were developing a new human-derived botulinum antitoxin for infants. There are seven known types of botulinum toxin, types A through G, each of which must be treated with antitoxin derived from different antibodies. The California researchers' antitoxin was for types A and B, which accounted for all but three of more than 1,500 infant botulism cases reported to that point. But the toxin found in Tessler's sample, it turned out, was type F, a rare form. There was no suitable antitoxin available. None, that is, except for the antitoxin derived from First Flight's blood.
The Army had stored First Flight's antitoxin, the only one for all seven botulinum toxin types. But, up to then, only 59 adults — no children — had received the equine-derived botulinum antitoxin. So the Bairds now faced a dilemma: try the antitoxin on their daughter or wait the many months it would take, while she was on the ventilator, for the poison to work its way out of her body.
"A doctor suggested injecting me," Tracy Baird recalls. "He said if Mom has a reaction — she may stop breathing — the baby likely will too. Other doctors said the shot wouldn't help Tess because, at that point, she'd been sick for more than a week." The Bairds chose the antitoxin injections, with a fearful Tracy getting the first one, just enough to test for adverse reactions. Everyone waited an hour for reactions, but none came.
The Army's doses were for adults, and little Tess weighed only seven pounds. As Tracy was doing all right, doctors decided to administer almost one-half the adult dose intravenously to Tessler. Within four hours there was some movement in her hands and toes. Twelve hours after the first dose, she received a second one and gradually began to improve. Within a week, Tessler Baird was breathing on her own again, and was fully mobile. She spent three weeks recovering in the hospital.
Three years later, the only signs of her disease are scars on her chest from feeding tubes. "She's absolutely perfect," Tracy says and smiles. "A normal, ornery child."
"It's unbelievable to me that the Department of Defense — with its bombs, airplanes and guns — also manages these medical research and treatment programs," Tracy says. "Thankfully, we were able to use its treatment. The military saved my daughter's life."
The horse that helped save Tessler began his medical career in 1978 when he was 10 years old. Already retired from racing, First Flight had served as a ceremonial caisson horse for funeral and military processions at Arlington National Cemetery. But, skittish in crowds, he is said to have bolted with a general's coffin during a somber funeral. Needless to say, he was retired again. Soon thereafter, he was selected for a then-new botulinum antitoxin program.