Sir.—In a commentary in the December 1978 issue of the Journal (132:1167-1168, 1978), McCracken and Eitzman discussed the possible role of bacteria in the pathogenesis of necrotizing enterocolitis (NEC). The preponderant organisms cultured from infants with NEC were noted to be from the family Enterobacteriaceae. Reference was also made to the isolation of certain Clostridium species.
I would like to draw attention to a case of infant botulism and NEC reported in the October 1977 issue of Texas Medicine.1 The patient was a 6-week-old female infant who had hypotonia, extensive cranial nerve abnormalities, and constipation. Stool specimens showed type B botulinal toxin and C botulinum type B organisms. During the infant's second week of hospitalization, she had diarrhea with gross blood and mucus in the stool. Abdominal distention was not noted, although bowel sounds were hypoactive. A polymorphonuclear leukocytosis was present, and the platelet count, prothrombin time, and