Journal Article

Wound Botulism in California, 1951–1998: Recent Epidemic in Heroin Injectors

S. Benson Werner, Douglas Passaro, James McGee, Robert Schechter and Duc J. Vugia

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 31, issue 4, pages 1018-1024
Published in print October 2000 | ISSN: 1058-4838
Published online October 2000 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/318134
Wound Botulism in California, 1951–1998: Recent Epidemic in Heroin Injectors

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California has reported most of the world's wound botulism (WB) cases and nearly three-fourths of the cases reported in the United States. We reviewed the clinical, epidemiologic, and laboratory features of WB. From the first case in 1951, through 1998, a total of 127 cases were identified—93 in the last 5 years. The dramatic increase has been due to an epidemic (of WB) in people who inject black tar heroin. Whereas early cases of WB occurred after gross trauma, all but 1 of the last 102 cases occurred in drug users, primarily those who inject drugs subcutaneously (“skin poppers”). Cases are occurring disproportionately in Hispanics and women. Misdiagnosis and diagnostic delays of up to 64 days have occurred. This unprecedented, ongoing epidemic is now being reported in other states. We discuss the clinical and laboratory features that distinguish botulism from conditions that can mimic it, the relative yield of various diagnostic laboratory tests for botulism, and its treatment.

Journal Article.  4385 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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