In a follow-up on the wound botulism situation linked to injecting black tar heroin in San Diego County, health officials are reporting three additional cases, bringing the total to six in the past month.
According to the San Diego County Health and Human Services Agency, five of the cases are men and have been confirmed with botulism by the California Department of Public Health. The latest case is a 25-year-old woman who is being tested for confirmation. Although all were hospitalized and treated with anti-toxin obtained from California Department of Public Health, one of the previously reported cases, a 67-year-old man, has died.
Two of the six cases are connected, but the others appear to be unrelated and the sources of the black tar heroin are unknown. Investigation is continuing and additional cases may occur.
“This is the largest group of wound botulism cases ever reported in San Diego County,” said Wilma Wooten, M.D., M.P.H., County public health officer. “Black tar heroin users can suffer from overdose, skin infections, endocarditis, botulism, and other serious illnesses that can be life-threatening. We urge anyone who uses this substance to seek treatment.”
Botulism is best known as a potentially lethal paralytic disease that results from ingestion of preserved food containing preformed botulinum toxin. Wound botulism is a clinically similar syndrome of flaccid, symmetric, descending paralysis that results when spores of Clostridium botulinum, an obligate anaerobe, are inoculated into a wound or other devitalized tissue. After gaining access to this relatively anaerobic environment, the spores germinate and elaborate the most potent toxin known.
Botulism: 29 confirmed foodborne cases in the US in 2016, most linked to Mississippi outbreak
According to the National Institute on Drug Abuse, “Black tar” heroin is sticky like roofing tar or hard like coal and is predominantly produced in Mexico and sold in U.S. areas west of the Mississippi River. The dark color associated with black tar heroin results from crude processing methods that leave behind impurities. Impure heroin is usually dissolved, diluted, and injected into veins, muscles, or under the skin.
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