Botulism is a rare disease and recurrent botulism even more rare. However, in California, recurrent wound botulism among injection drug users has been on the rise and makes up three-quarters of reported cases in the United States. A new study published in Clinical Infectious Diseases and currently available online (http://cid.oxfordjournals.org/content/early/2011/02/07/cid.cir005.full) examines this problem.
From 1993 through 2006, 17 injection drug users were identified within the surveillance system of the California Department of Public Health for having recurrent wound botulism. Clinical symptoms ranged from acute paralysis to slurred speech to difficulty swallowing, and at least one case of wound botulism for each patient was laboratory confirmed. Of those, 14 had one recurrence and three had two recurrent episodes. All of the patients reported heroin use, with 88 percent specifically reporting black tar heroin use.
"Recurrent cases suggest that exposure to botulism due to injection drug use does not result in protective immunity," according to study author Duc Vugia, MD, of the California Department of Public Health. "As a result, both clinicians and injection drug users should be aware of the potential for wound botulism to recur with continued injection drug use to allow for timely diagnosis and early administration of appropriate treatment."
Dr. Vugia added, "If these near death experiences do not change behavior among these injection drug users and if severe disease from exposure to botulism does not confer immunity, recurrent wound botulism will continue to occur and add to the health care burden. Continued efforts to reduce injection drug use and educate current users on the infectious risks associated with illicit drug use are crucial to improving the health of the injection drug use population."
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