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WOUND BOTULISM ACQUIRED IN THE AMAZONIAN RAIN FOREST OF ECUADOR

Wound botulism results from colonization of a contaminated wound by Clostridium botulinum and the anaerobic in situ production of a potent neurotoxin. Between 1943, when wound botulism was first recognized, and 1990, 47 laboratory-confirmed cases, mostly trauma-associated, were reported in the United States. Since 1990, wound botulism associated with injection drug use emerged as the leading cause of wound botulism in the United States; 210 of 217 cases reported to the Centers for Disease Control and Prevention between 1990 and 2002 were associated with drug injection. Despite the worldwide distribution of Clostridium botulinum spores, wound botulism has been reported only twice outside the United States, Europe, and Australia. However, wound botulism may go undiagnosed and untreated in many countries. We report two cases, both with type A toxin, from the Ecuadorian rain forest. Prompt clinical recognition, supportive care, and administration of trivalent equine botulinum antitoxin were life-saving.

Received February 10, 2005. Accepted for publication June 14, 2005.

Acknowledgments: We thank Onnalee Gomez for assistance with the literature search and German Suarez for astute diagnosis of the second case. This work was presented in part at the 50th Annual Meeting of the American Society of Tropical Medicine and Hygiene, Atlanta, Georgia, November 14, 2001.

^* Address correspondence to Megan E. Reller, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115. E-mail: megan.reller{at}tch.harvard.edu

Authors’ addresses: Megan E. Reller, Division of Infectious Diseases, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, Telephone: 617-355-6000, Fax: 617-730-0911, E-mail: megan.reller{at}tch.harvard.edu. Richard W. Douce and Darwin S. Torres, Department of Medicine, Hospital Vozandes, Quito, Ecuador, Telephone: 593-2-262-142, Fax: 593-2-269-234, E-mail: rdouce{at}hcjb.org.ec. Susan E. Maslanka, National Botulism Surveillance and Reference Laboratory, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, Telephone: 404-639-0895, Fax: 404-639-3333, E-mail: sht5{at}cdc.gov. Stephen R. Manock, Hospital Vozandes del Orienta, Pastaza, Ecuador, E-mail: smanock{at}hcjb.org.ec. Jeremy Sobel, Centers for Disease Control and Prevention, Mailstop A-38, 1600 Clifton Road, Atlanta, GA 30333, Telephone: 404-639-4633, Fax: 404-639-2205, E-mail: jsobel{at}cdc.gov.

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