Abstract
Outbreaks of wound botulism are rare, but clinicians and health departments should maintain suspicion for signs, symptoms, and risk factors of wound botulism among persons who inject drugs in order to initiate treatment quickly. This report describes an outbreak of three wound botulism cases among persons in two adjacent counties who injected drugs. Provisional information about these cases was previously published in the CDC National Botulism Surveillance Summary. All three cases in this outbreak were laboratory-confirmed, including one case with detection of botulinum toxin type A in a wound culture sample taken 43 days after last possible heroin exposure. Findings highlight the delay in diagnosis which led to prolonged hospitalization and the persistence of botulinum toxin in one patient.
Highlights
Botulism is a potentially fatal illness caused by a neurotoxin produced most frequently by the bacterium Clostridium botulinum
From 2002 to 2018, 376 laboratory confirmed wound botulism cases in the U.S were among persons who inject drugs (PWID) and 10% of cases reported contacts with other cases [1]
Hospital clinicians consulted with New Mexico Department of Health (NMDOH) and with the Centers for Disease Control and Prevention (CDC) Botulism Clinical Consultation Service in order to determine whether treatment with heptavalent botulism antitoxin (BAT) was appropriate for each patient with suspected botulism [8]
Summary
Botulism is a potentially fatal illness caused by a neurotoxin produced most frequently by the bacterium Clostridium botulinum. There are six different types of botulism, distinguished by the way in which neurotoxin exposure occurs—foodborne, infant, wound, adult intestinal colonization, iatrogenic, and inhalational. In 2017, 182 laboratory-confirmed botulism cases were reported in the United States [1]. Botulism typically manifests with symmetrical descending paralysis and, if untreated, the illness can lead to respiratory failure and death. C. botulinum is ubiquitous in soil and produces seven botulinum toxins (A–G). Human illnesses are caused by types A, B, E and, rarely, F [2]
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