Abstract Details

Title A Case of Botulism Diagnosis in Intravenous Methamphetamine Use

Topic Infectious Disease

Presentation(s) P8 - Poster Session 8 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-008

Objective Wound botulism is a rare, neuromuscular junction disease caused by the most potent neurotoxin known to humankind. Like all forms of Botulism, infection is caused by botulinum neurotoxins (BoNTs) produced by the bacteria Clostridium botulinum, most commonly type A and B. Common scenarios leading to C. botulinum infection are injection drug use (“skin-popping”) or contamination of drug material such as black tar heroin with botulinum toxin.

Background Our patient is a 62 year old female with Diabetes Mellitus type II, lower extremity DVT, Nicotine dependence and Intravenous methamphetamine use.

Design/Methods N/A

Results Our patient's presentation was four days after their symptoms began. Five hours after admission the patient was started on Rocephin for concern of cellulitis of right hand and boil vs abscess on left arm. 18 hours later the patient worsened requiring intubation for NIF of 0, worsening dysarthria and inability to protect their airway. Neurologic examination worsened with the patient becoming progressively weaker and displaying flaccid paralysis with absent reflexes in their extremities. Approximately 48 hours later, the team had a discussion with the neurologist regarding concern for possible botulinum infection with patient’s history of IVDU, and flaccid paralysis. Consults were placed to infectious disease for recommendations and to general surgery for Incision and drainage of abscess on left hand and eschar on right hand. The local the health department was contacted. The health department then contacted the CDC. The patient received botulinum antitoxin approximately 36 hours after admission.

Conclusions This case highlights the emerging public health concern of wound botulism associated with IV drug use, including methamphetamine. Healthcare providers should maintain a high index of suspicion for wound botulism in individuals with a history of drug use paying special attention to heroin and methamphetamine use.

Authors/Disclosures
Leslie Moore PRESENTER	No disclosure on file
Ethan Porter	No disclosure on file
Christian Ratzlaff	No disclosure on file
Pradeep Kumbham, MD (Mercy Hospital)	Dr. Kumbham has nothing to disclose.
Christina Home (Mercy Hospital NWA)	No disclosure on file
Bala Simon (Arkansas Department of Health)	No disclosure on file

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