Volume 74, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Wound botulism results from colonization of a contaminated wound by and the anaerobic 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 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.


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  1. Dolly JO, Black J, Williams RS, Melling J, 1984. Acceptors for botulinum neurotoxin reside on motor nerve terminals and mediate its internalization. Nature 307 : 457–460.
  2. Arnon SS, 1980. Infant botulism. Annu Rev Med 31 : 541–560.
  3. Merson MH, Dowell VR Jr, 1973. Epidemiologic, clinical and laboratory aspects of wound botulism. N Engl J Med 289 : 1005–1010.
  4. Davis JB, Mattman LH, Wiley M, 1951. Clostridium botulinum in a fatal wound infection. JAMA 146 : 646–648.
  5. Weber JT, Goodpasture HC, Alexander H, Werner SB, Hatheway CL, Tauxe RV, 1993. Wound botulism in a patient with a tooth abscess: case report and review. Clin Infect Dis 16 : 635–639.
  6. Passaro DJ, Werner SB, McGee J, MacKenzie WR, Vugia DJ, 1998. Wound botulism associated with black tar heroin among injecting drug users. JAMA 279 : 859–863.
  7. Werner SB, Passaro D, McGee J, Schechter R, Vugia DJ, 2000. Wound botulism in California, 1951–1998: recent epidemic in heroin injectors. Clin Infect Dis 31 : 1018–1024.
  8. Kudrow DB, Henry DA, Haake DA, Marshall G, Mathisen G, 1988. Botulism associated with Clostridium botulinum sinusitis after intranasal cocaine abuse. Ann Intern Med 109 : 984–985.
  9. MacDonald KL, Rutherford GW, Friedman SM, Dietz JR, Kaye BR, McKinley GF, Tenney JH, Cohen ML, 1985. Botulism and botulism-like illness in chronic drug abusers. Ann Intern Med 102 : 616–618.
  10. Rundervoort RS, van der Ven AJ, Vermeulen C, van Oosten-brugge RJ, 2003. The clinical diagnosis ‘wound botulism’ in an injecting drug addict. Ned Tijdschr Geneeskd 147 : 124–127.
  11. Anonymous, 2000. Wound botulism in injecting drug user: second case in England. Commun Dis Rep CDR Wkly 10 : 221–224.
  12. Anonymous, 2000. Wound botulism in an injecting drug user in London. Commun Dis Rep CDR Wkly 10 : 177–180.
  13. Athwal BS, Gale AN, Brett MM, Youl BD, 2001. Wound botulism in the UK. Lancet 357 : 234.
  14. Aureli P, Fenicia L, Ferrini AM, Martini M, Beccia G, 1992. Wound botulism:clinical and microbiological findings of an Italian case. Eur J Epidemiol 8 : 750–752.
  15. Aureli P, Fenica L, Franciosa G, 1999. Classic and emergent forms of botulism: the current status in Italy. Eur Surveill 4 : 7–9.
  16. Boyer A, Salah A, 2002. Clinical and epidemiological characteristics of botulism in France. Ann Med Interne (Paris) 153 : 300–310.
  17. Brett MM, Hallas G, Mpamugo O, 2004. Wound botulism in the UK and Ireland. J Med Microbiol 53 : 555–561.
  18. Wang WJ, Wang LP, 1983. Wound botulism. Report of a case complicating head injury. Chin Med J 96 : 315–317.
  19. Lasdica S, Fainstein D, Casas P, Maurizi D, Gertiser MA, Czerniecki A, 2000. Botulismo por herida: una causa de paralisis muscular generalizada. Med Intensiva 24 : 281–284.
  20. MacDonald KL, Cohen ML, Blake PA, 1986. The changing epidemiology of adult botulism in the United States. Am J Epidemiol 124 : 794–799.
  21. Maselli RA, Ellis W, Mandler RN, Sheikh F, Senton G, Knox S, Salari-Namin H, Agius M, Wollmann RL, Richman DP, 1997. Cluster of wound botulism in California: clinical, electrophysiologic, and pathologic study. Muscle Nerve 20 : 1284–1295.
  22. Department of Health Services, 1986. Wound botulism in California: a 35-year review. California Morbidity. July 3. Sacramento, CA: California State Department of Health.
  23. Centers for Disease Control and Prevention, 1971. Type A botulism from wound infection - Palo Alto, California. MMWR Morbid Mortal Wkly Rep 20 : 183–184.
  24. Centers for Disease Control and Prevention, 1996. Wound botulism-California, 1995. MMWR Morb Mortal Wkly Rep 275 : 95–96.
  25. Fullerton P, Gogna NK, Stoddart R, 1980. Wound botulism. Med J Aust 1 : 662–663.
  26. Hughes JM, Blumenthal JR, Merson MH, Lombard GL, Dowell VR Jr, Gangarosa EJ, 1981. Clinical features of types A and B food-borne botulism. Ann Intern Med 95 : 442–445.
  27. de Jesus PV Jr, Slater R, Spitz LK, Penn AS, 1973. Neuromuscular physiology of wound botulism. Arch Neurol 29 : 425–431.
  28. Cherington M, 1990. Botulism. Semin Neurol 10 : 27–31.
  29. Cherington M, 1998. Clinical spectrum of botulism. Muscle Nerve 21 : 701–710.
  30. Cherington M, 1982. Electrophysiologic methods as an aid in diagnosis of botulism: a review. Muscle Nerve 5 : S28–S29.
  31. Hatheway CL, 1988. Botulism. Balows A, Hausler WJ Jr, Ohashi M, Turano A, eds. Laboratory Diagnosis of Infectious Diseases: Principles and Practice. New York: Springer-Verlag, 111–133.
  32. Dowell VR Jr, Hawkins TM, 1973. Laboratory methods in anaerobic bacteriology. Washington, DC: Government Printing Office. HEW Publication No. 73-8222.
  33. Tacket CO, Shandera WX, Mann JM, Hargrett NT, Blake PA, 1984. Equine antitoxin use and other factors that predict outcome in type A foodborne botulism. Am J Med 76 : 794–798.
  34. Chang GY, Ganguly G, 2003. Early antitoxin treatment in wound botulism results in better outcome. Eur Neurol 49 : 151–153.
  35. Sandrock CE, Murin S, 2001. Clinical predictors of respiratory failure and long-term outcome in black tar heroin-associated wound botulism. Chest 120 : 562–566.

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  • Received : 10 Feb 2005
  • Accepted : 14 Jun 2005

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