Wound botulism in an injection drug user
Presentation - Oct 27, 2005
Müller Stefanie, Tettenborn Barbara, Bönig Lutz
A 32-year-old female injection-drug user presented with abscesses on both forearms, complaints of progressive limb-weakness, difficulty speaking, swallowing and shortness of breath over the last few hours. On neurological examination she showed dysphonia and dysarthria, partial ptosis, dyspnoea and generalised weakness with diminished reflexes. Sensory and cognitive functions were preserved.Within hours the patient required mechanical ventilation. Blood count and biochemical profile, spinal fluid examination as well as computed tomography revealed no abnormalities. Due to the presentation wound botulism was suspected and antitoxin was administered within 12 hours of admission.Swab samples taken during wound debridement later confirmed Clostridium botulinum. Furthermore, the mice inoculated with the patient’s serum showed signs of botulism.
Neurophysiological studies on day three showed normal sensory responses,compound muscle action potential amplitudes (CMAP) were reduced with normal latencies and conduction velocity. On repetitive nerve stimulation with 30 Hz (RNS) an increment of 50%
Wound botulism should be suspected in a patient with acute descending paralysis, with involvement of autonomic and cranial nerves, especially in injecting drug users. In 2004 only 2 cases of wound botulism were reported to the Swiss Federal Office of Public Health (BAG).