Wound Botulism


According to Mark Burningham, wound botulism "can be defined as clinical evidence of botulism following trauma, with a resultant infected wound and no history suggestive of foodborne illness."2 This rare illness was discovered in 1943, but there have been only 47 confirmed cases from 1951 until 1990, and only 7 patients have died. It has appeared during all months in 15 states (the most cases, 22, have come from California). The average age of a person ill with wound botulism is 27 years, and 70% of them are male. It comes from either type A or type B toxin and usually strikes the upper or lower extremities (18 cases involving each).29 Oddly, wound botulism has only been reported in the USA, except for one case in China.21 These days, wound botulism is more commonly associated with drug users, and the first case of drug-related wound botulism turned up in New York City in 1982.31

This affliction "occurs most often from subcutaneous abscesses or deeper wound infections in muscle, nerves, and soft tissues."5 The incubation period of wound botulism is four to fourteen days after the wound is inflicted;21 then, the toxin infiltrates the bloodstream through the wound, impeding the release of acetylcholine and slowly paralyzing its victim.29 It exhibits the same symptoms as foodborne botulism, but is usually limited to the neurological symptoms (ie, no constipation, nausea, vomiting, abdominal cramps, or diarrhoea.)8 It has a 10% morbidity rate.2

CASE STUDIES


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