Tacoma Pierce County Health Department (February 13, 2013) — A probable case of wound botulism has been reported in Pierce County. The patient is an injecting drug user (heroin). Wound botulism, caused by C. botulinum spores, may occur following trauma or drug injection or snorting.

Botulism should be suspected in all injection drug users with flaccid paralysis, ophthalmoplegia, ptosis or other cranial nerve palsies, particularly when the paralysis is:

• Descending;

• Symmetric; and

• Associated with a normal cerebrospinal fluid protein level.

Healthcare providers should be on alert for small wounds. Inspection should include the intranasal septum. Treatment usually requires rapid debridement of contaminated wound sites, as well as the systemic administration of botulinum antitoxin.

Initial treatment decisions should not necessarily await neurological test results. Risk for death and duration of hospitalization can be reduced by prompt administration of botulism antitoxin. Tacoma-Pierce County Health Department will arrange for testing and botulism antitoxin. Washington State Department of Health has access to botulism antitoxin. The State Public Health Laboratories are responsible for testing of botulism toxins.

Clinically suspect cases of botulism should be immediately reported to:

Tacoma Pierce County Health Department

Communicable Disease Control

(253) 798-6410

During afterhours and weekends, calls are answered by an answering service that will connect you with our on-call staff

http://www.tpchd.org/files/library/92b35b2a040be181.pdf