Los Angeles: Health alert issued over wound botulism linked to heroin

By NewsDesk @infectiousdiseasenews

Los Angeles County health officials issued a health alert this week after reporting several recent cases of wound botulism associated with heroin injection.

Since October 13, 2019, two confirmed and two suspected cases of wound botulism associated with heroin injection have been reported in LA County. The cases are apparently unknown to each other and are not geographically clustered. The sources of the heroin remain unknown and additional cases may occur.

All four cases had wound infections or abscesses and a recent history of injecting heroin. Presenting symptoms included diplopia, ptosis, dysphagia, slurred speech, facial paralysis, difficulty breathing and muscle weakness. All required intensive care treatment and two had respiratory failure requiring intubation. All patients received Botulism Antitoxin Heptavalent (BAT®).

In the five years from 2014-2018, Los Angeles County officials reported 18 wound botulism cases of which 9 cases were associated with black tar heroin, 7 with heroin, and 2 were associated with injection/inhalation of cocaine and/or methamphetamine.

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In 2019, six total cases have been reported.

Botulism is a rare, potentially fatal paralytic illness caused by the neurotoxins produced by Clostridium botulinum. Wound botulism occurs when a wound infected with C. botulinum secretes the toxin. Wound botulism in drug users may occur in abscesses from subcutaneous or intramuscular injection (skin or muscle “popping”).