Butte County Public Health Department (BCPHD) is investigating a case of wound botulism in a Butte County resident who injected black tar heroin. Laboratory testing to confirm the diagnosis is pending. The patient remains hospitalized and on a ventilator. The source of the heroin is unknown at this time. Black tar heroin has been linked to other wound botulism outbreaks in injection drug users, so there is concern that locally available black tar heroin may be contaminated.
An average of 10 cases of wound botulism are reported each year in California. Wound botulism occurs when a wound becomes infected with Clostridium botulinum (the cause of foodborne botulism) or a closely related Clostridium bacterium. The bacteria multiply in the wound and create a toxin that acts on the nerves. Most, but not all, people with wound botulism will have a visibly infected wound. Persons injecting black tar heroin into their muscles (“muscling”) or under their skin (“skin popping”) are at highest risk of wound botulism. Persons with wound botulism cannot transmit the illness to others.
Symptoms of wound botulism occur within days or weeks of injecting contaminated drug and may be mistaken for drug overdose. Symptoms can include weak or drooping eyelids, blurred or double vision, dry mouth, sore throat, slurred speech, trouble swallowing, difficulty breathing, and a progressive symmetric paralysis that begins at the face and head and travels down the body. If left untreated, symptoms may progress to paralysis of the respiratory muscles, arms, legs, and trunk with subsequent death. Prompt diagnosis and treatment is critical to decreasing the severity and duration of illness. Any injection drug users with symptoms of wound botulism should seek medical attention immediately at the nearest emergency room. Wound botulism is treated with antitoxin that must be requested on a case by case basis from the CDC through the state health department.
TO REDUCE RISK OF WOUND BOTULISM:
* Stop injecting drugs and seek treatment for opioid addiction: www.buttecounty.net/behavioralhealth/substanceuse.aspx
* Do not use black tar heroin. Use of black tar heroin is the drug that most often results in wound botulism.
* “Cooking” the drug and safe injection practices will prevent other blood borne infections, but will NOT prevent wound botulism.
BUTTE COUNTY PUBLIC HEALTH DEPARTMENT ACTIONS:
* Issued a health alert to area providers to promote rapid diagnosis and reporting.
* Coordinated with the California Department of Public Health for testing and antitoxin request.
* Conducted outreach and provided information to homeless shelters, drug treatment facilities, and other locations that serve persons who may be at risk of wound botulism.
* Alerted the public through a media release.