Botulism as a cause of respiratory failure in injecting drug users

Abstract

Background Wound botulism occurs as a consequence of inoculation of Clostridium botulinum spores into a wound.

Aim To describe such a case of wound botulism. Results A 23-year-old drug-injecting user presented with bulbar symptoms and progressive signs over a three-day period. The diagnosis of botulism was suspected and was treated with large doses of penicillin and botulinum antitoxin. The diagnosis was confirmed by the presence of serum botulinum toxin A.

Conclusion Physicians should be aware of the association of botulism in injecting drug users, particularly in Ireland.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Davis JB, Mattmain LH, Wiley M. Clostridium botulinum in a fatal wound infection.JAMA 1951; 146: 646–8.

    CAS  Google Scholar 

  2. 2.

    Passaro DJ, Werner SB, McGee J et al. Wound botulism associated with black tar heroin among injecting drug users.JAMA 1998; 279 (11): 859–63.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Anderson MW, Sharama K, Feeney CM. Wound botulism associated with black tar heroin.Acad Emery Med 1997; 4: 805–809.

    CAS  Article  Google Scholar 

  4. 4.

    Werner SB, Passaro D, McGee J et al. Wound botulism in California, 1951-1995: recent epidemic in heroin injectors.Clin Infect Dis 2000; 31: 1018–24.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Weber JT, Goodpasture HC, Alexander H et al. Wound botulism in a patient with a tooth abscess: case report and review.Clin Infect Dis 1993; 16: 635–9.

    PubMed  CAS  Google Scholar 

  6. 6.

    MacDonald KL, Rutherford GW, Friedman SM et al. Botulism and botulism-like illness in chronic drug abusers.Ann Intern Med 1985; 102(5):616–8.

    PubMed  CAS  Google Scholar 

  7. 7.

    Center for Disease Control and Prevention. Wound botulism — California 1995.JAMA 1996; 275(2): 95–6.

    Article  Google Scholar 

  8. 8.

    Sandrock CE, Murin S. Clinical predictors of respiratory failure and long-term outcome in black tar heroinassociated wound botulism.Chest 2001; 120 (2): 562–6.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Shapiro RL, Hatheway C, Swerdlow DL. Botulism in the United States: a clinical and epidemiologic review.Ann Intern Med 1998; 129 (3): 221–8.

    PubMed  CAS  Google Scholar 

  10. 10.

    Center for Disease Control. Wound botulism Associated with parenteral cocaine abuse: NewYork City.MMWR 1982; 31: 87–8.

    Google Scholar 

  11. 11.

    Hagmann M. Deaths among heroin users present a puzzle.Science 2000; 288: 1941.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Ryan JM, Paul J, Curtis S et al. Clostridium novyi infection: a fatal association with injecting drug users.Emerg Med J 2001; 18 (2): 138–9.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Bryan C. Gangrene bug “killed 35 heroin users”.BMJ 2000; 320: 1690.

    Article  Google Scholar 

  14. 14.

    Jensenius M, Løvstad RZ, Dhaenens G et al. A heroin user with a wobbly head.Lancet 2000; 356: 1160.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Hiersemenzel LP, Jermann M, Waespe W. Descending paralysis caused by wound botulism. A case report.Nervenarz 2000; 71(2): 130–3.

    Article  CAS  Google Scholar 

  16. 16.

    Scheibe F, Hug B, Rossi M. Wound botulism after drug injection.Dtsch Med Wochenschr 2002; 127 (5): 199–202.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    McGarrity L. Wound botulism in injecting drug users.Anaesthesia 2002; 57 (3): 301–2.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Mulleague L, Bonner SM, Samuel A et al. Wound botulism in drug addicts in the United Kingdom.Anaesthesia 2001; 56 (2): 120–3.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Temporal cluster of suspected wound botulism in injecting drug users — update.Commun Dis Rep CDR Wkly 2002; 12(9): 8.

    Google Scholar 

  20. 20.

    Botulism in injecting drug users.Epi-sight 2002; 3 (6): 1.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding authors

Correspondence to S FitzGerald or R Lyons or J Ryan or W Hall or C Gallagher.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

FitzGerald, S., Lyons, R., Ryan, J. et al. Botulism as a cause of respiratory failure in injecting drug users. Ir J Med Sci 172, 143 (2003). https://doi.org/10.1007/BF02914502

Download citation

Keywords

  • Heroin
  • Botulinum Toxin
  • Inject Drug User
  • NewYork City
  • Botulism