Los Angeles County health officials say that since June 2018, three suspected cases of wound botulism associated with heroin injection have been reported in the county and apparently are unknown to each other. This prompted an alert issued for healthcare providers to be aware of the symptoms and treatment of wound botulism.
All three patients presented with symptoms to include diplopia, ptosis, dysphagia, slurred speech, and muscle weakness. All required intensive care treatment and two had respiratory failure requiring intubation. All patients were treated with Botulism Antitoxin Heptavalent (BAT®) released by LAC DPH Acute Communicable Disease Control Program (ACDC). The sources of the heroin remain unknown and additional cases may occur.
Botulism is a rare, potentially fatal paralytic illness caused by the neurotoxins produced by Clostridium botulinum. Wound botulism occurs when a wound is contaminated by C. botulinum spores that germinate and produce toxin inside the wound. Wound botulism in drug abusers occurs in dermal abscesses from subcutaneous or intramuscular injection (skin or muscle “popping”).
Between 2013-2017, fourteen confirmed cases of wound botulism have occurred in Los Angeles County (average 2.8 /year, range 1-6/year). Of these 14, 8 cases were associated with black tar heroin, 4 with heroin, and 2 were associated with injection of cocaine and methamphetamine. In 2018 to date, there has been 1 confirmed case of wound botulism, which was associated with black tar heroin.
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