Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California 94804, USA.
Clin Infect Dis. 2011 Apr 1;52(7):862-6. doi: 10.1093/cid/cir005. Epub 2011 Feb 11.
Botulism is an acute neurologic illness characterized by cranial nerve palsies and descending flaccid paralysis. Botulism is a rare disease and recurrent botulism even more rare. We review cases of recurrent wound botulism (WB) among injection drug users (IDUs) in California from 1993 through 2006 and describe 2 case patients.
From botulism surveillance data for 1993-2006, we identified patients with >1 episode of clinical WB, defined as acute descending paralysis with a visible wound or recent history of injection drug use. For each patient, ≥1 of their WB episodes was laboratory confirmed. We extracted demographic, clinical, and laboratory information from case and laboratory reports and compared clinical characteristic frequency of initial and second WB episodes.
During 1993-2006, 17 IDUs had recurrent WB, 14 with 1 recurrence and 3 with 2 recurrences. Of 25 laboratory-confirmed episodes, 22 were confirmed through serum testing and 3 through wound testing. Patients were 32-61 years old, and 94% were male. All patients reported heroin injections; 88% specified black tar heroin use and 76% reported subcutaneous injection. The most common presentations were having a visible wound, speech difficulty, double vision, respiratory difficulty, and trouble swallowing. There were no significant differences in clinical presentation between initial and second episodes.
As the California epidemic of WB among IDUs continues, WB episodes are recurring. Both clinicians and IDUs should be aware of the potential for WB to recur among IDUs to enable timely diagnosis and early botulinum antitoxin administration and supportive care.
肉毒中毒是一种以颅神经麻痹和下行弛缓性瘫痪为特征的急性神经疾病。肉毒中毒是一种罕见的疾病，而复发性肉毒中毒则更为罕见。我们回顾了 1993 年至 2006 年期间加利福尼亚州注射吸毒者（IDU）中反复发作的伤口肉毒中毒（WB）病例，并描述了 2 例病例患者。
根据 1993-2006 年的肉毒中毒监测数据，我们确定了患有> 1 次临床 WB 发作的患者，将其定义为具有可见伤口或近期注射吸毒史的急性下行性瘫痪。每位患者的 WB 发作均至少有 1 次通过实验室确认。我们从病例和实验室报告中提取了人口统计学，临床和实验室信息，并比较了初始和第二次 WB 发作的临床特征频率。
在 1993-2006 年期间，有 17 名 IDU 患有复发性 WB，其中 14 名患者有 1 次复发，3 名患者有 2 次复发。在 25 次经实验室确认的发作中，有 22 次通过血清检测得到确认，有 3 次通过伤口检测得到确认。患者年龄为 32-61 岁，94％为男性。所有患者均报告使用海洛因注射；88％的人指定使用黑焦油海洛因，76％的人报告使用皮下注射。最常见的表现为有可见的伤口，言语困难，复视，呼吸困难和吞咽困难。在初始和第二次发作之间，临床表现没有明显差异。
随着加利福尼亚州 IDU 中 WB 流行的继续，WB 发作仍在继续。临床医生和 IDU 都应意识到 WB 在 IDU 中复发的可能性，以便及时诊断并尽早使用肉毒杆菌抗毒素进行治疗和支持性护理。
