FW: PRO/EDR> Botulism, wound - Norway
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Maffei, Joanne
Nov 11, 2013, 4:10:12 PM11/11/13
to ls...@googlegroups.com, Aiken, James B., Hardy, Sean, DeBlieux, Peter
Nice review of wound botulism in injection drug user.
Joanne T. Maffei, M.D.
Associate Professor
LSU Health Sciences Center
Department of Medicine
Section of Infectious Diseases/HIV
ILH Infection Prevention and Control Department Medical Director
Infection Control Office (504) 903-3578
Cell Phone (504) 452-6354
-----Original Message-----
From: promed-ed...@promedmail.org [mailto:promed-ed...@promedmail.org] On Behalf Of prome...@promedmail.org
Sent: Friday, November 08, 2013 11:29 AM
To: prome...@promedmail.org; promed-...@promedmail.org
Subject: PRO/EDR> Botulism, wound - Norway
BOTULISM, WOUND - NORWAY
************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases <http://www.isid.org>
Date: Thu 7 Nov 2013
Source: Eurosurveillance 18(45):pii=20630 [edited] <http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20630>
On 18 Oct 2013, the Norwegian Institute of Public Health (NIPH) was notified by the Department of Public Health of the Municipality of Oslo of a suspected case of wound botulism. A man in his 40s with a history of injecting drugs sought medical attention on 17 Oct 2013 at a medical clinic at a hospital in Oslo. He had several abscesses and neurological symptoms including difficulty swallowing, speaking and shortness of breath. He discharged himself from the hospital against medical advice but was readmitted the following day. Botulism was suspected, and, following readmission, he was transferred to the intensive-care unit (ICU) in a 2nd hospital in Oslo. Upon admission to the ICU, he was mentally alert and had classic signs and symptoms of botulism, which at that point also included drooping eye lids, eye muscle paralysis and dry mouth. He was placed on a mechanical ventilator due to respiratory failure and was treated with botulinum antitoxin, incision of abscesses and antibiotics. The patient receives opiate substitution therapy but acknowledged long-term intramuscular injection of heroin and had injected on 18 Oct 2013.
Later on 18 Oct 2013, a 2nd case of suspected botulism in a person who injects drugs was notified by a hospital in a municipality near Oslo.
A man in his 30s was admitted to the hospital on 14 Oct 2013, discharged himself on the next day and was readmitted on the following day. He displayed neurological symptoms similar to the 1st case. He also had abscesses that had been incised by a friend before hospital admission. This patient was treated with botulinum antitoxin and antibiotics. The patient is enrolled in an opiate substitution therapy programme and stated that he had recently injected heroin intramuscularly only once, on 7 Oct 2013.
For this outbreak, a suspected case was defined as a person who injects drugs living in Norway with clinical symptoms consistent with botulism with onset after 1 Oct 2013. A confirmed case was defined as a suspected case with laboratory confirmation of botulism by mouse bioassay. As of 6 Nov 2013, a total of 4 confirmed and 2 suspected cases have been reported. Cases were between the ages of 35 and 55 years, and 2 were women. All cases have a history of injecting drugs and reside in Oslo or one of 2 neighboring counties. Onset of symptoms among cases was from 30 Sep 2013 to 22 Oct 2013. The number of days from hospitalization to laboratory confirmation ranged from 8 to 22 days (Figure 1 - [for figures, see original URL - Mod.LL]).
Laboratory testing and contact tracing to establish a possible connection between the confirmed and suspected cases are ongoing.
Preliminary results from interviews with the patients suggest that only 2 of the cases knew each other, but none had shared heroin or injecting paraphernalia.
Laboratory diagnosis
--------------------
Botulism was confirmed in 4 of the 6 cases by mouse bioassay using serum specimens between 24 Oct 2013 and 4 Nov 2013. The laboratory diagnosis was performed at the Norwegian School of Veterinary Science according to the current Nordic Committee on Food Analysis method (1).
For all 4 sera that were confirmed positive with the bioassay, the mice developed classic symptoms of the effect of botulinum neurotoxins
(2) within one day after injection.
Complete results of subtyping of the botulinum toxin are pending, although the specimens were not positive for type E and inconclusive for type B. Bacteriological tests from abscess specimens are also ongoing. Nerve conduction studies have provided supporting evidence of botulism for one confirmed case and one suspected case. Two cases had heroin remaining, which is currently undergoing testing by cultivation at the NIPH and at a regional medical microbiological laboratory.
Investigation and control measures
----------------------------------
On 18 Oct 2013, the Department of Public Health of the Municipality of Oslo distributed information regarding the possible circulation of contaminated heroin and symptoms of botulism to emergency departments, hospital infectious disease and neurology departments and the ambulance service in order to increase vigilance among clinicians. For at least one case, botulism was only considered following the dissemination of information. This reinforces the importance of increasing awareness among clinicians of botulism linked to drug injection in order to avoid delays in diagnosis, especially in countries where it is rarely identified. The police and relevant low-threshold centers for people who inject drugs (PWID), including supervised drug consumption facilities and treatment services, were also notified in order to encourage PWID to avoid intramuscular and subcutaneous injection and to seek treatment promptly upon development of symptoms consistent with botulism. Information was published on the Municipality of Oslo website, the NIPH websites and MikInfo, a web-based platform for information-sharing for microbiologists hosted by the NIPH. Other European countries were alerted via the European Early Warning and Response System on 19 Oct 2013, and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) was informed on 20 Oct 2013. On 31 Oct 2013, the European Centre for Disease Prevention and Control and EMCDDA published a joint rapid risk assessment of the situation in Norway, recommending increased awareness among healthcare workers and public health authorities regarding the possibility of cases in other European Union/European Economic Area countries (3). Systematic interviews to collect extensive demographic, clinical and drug-use data in order to identify links between the cases in terms of residence, social networks, and drug supply are being organised by local public health authorities in collaboration with clinicians.
Botulism in people who inject drugs in Norway and Europe
-----------------------------------
Infections of spore-forming bacteria among PWID, such as botulism, tetanus, _Clostridium novyi_ infection and anthrax, have been previously reported in several European countries, most notably the UK (4,5). A review of UK cases from 1990 to 2009 indicated that while cases of tetanus, _C. novyi_ infection, and anthrax most often occur in clusters, botulism tends to occur as sporadic cases (5). Outside the UK, few clusters of wound botulism have been reported in European countries, including Ireland in 2008 (6), Germany in 2005 (7) and Switzerland in 1998 (8).
Notification of botulism has been mandatory in Norway since 1975.
Between 1990 and 2012, 40 cases of botulism were reported. Although the most common cause of botulism in Norway is the consumption of home-made fermented fish (rakefisk), 9 cases of wound botulism among PWID have been reported previously (Figure 2). All cases were sporadic, with the exception of a cluster of 3 cases in 1997 (9); before the 2013 outbreak, the most recent case of wound botulism reported through the Norwegian Surveillance System for Communicable Diseases associated with injection drug use was reported in 2010.
Contamination of heroin with _C. botulinum_ spores or other substances mixed with the drug are the most likely sources of wound botulism among PWID (10). The distribution of cases -- occurring primarily in northwestern Europe -- may reflect regional differences in heroin distribution, heroin preparation practices, and injecting drug use practice, including the type and method of injecting (5). Most of the cases in this Norwegian outbreak reported intramuscular injection of heroin (muscle popping), due to obliteration of peripheral veins following many years of intravenous injection. This practice can result in formation of wounds and abscesses with anaerobic conditions, which can lead to germination of _C. botulinum_ spores and subsequent production of toxin (10). Several cases reported using heroin that was brownish in color and had a powdery consistency. Use of black tar heroin is also reported to be a risk factor for wound botulism due to increased sclerosis of veins in black tar users and the nature of the substance, which leads to increased use of intramuscular and subcutaneous injections (11).
Availability of botulinum antitoxin
------------------------------
The NIPH is responsible for maintaining the country's supply of botulinum antitoxin. Shortage of antitoxin has recently been a problem in several European countries (12,13). At the time the 1st cases were notified, the NIPH had only a limited supply of botulism antitoxin available. The NIPH was already in negotiations with a supplier to receive additional vials at the time of the outbreak, but accelerated the process in order to have the shipment sent from a producer outside Europe within 4 days. To address the acute need for antitoxin, other public health institutes in the Nordic countries were contacted. A limited amount of heptavalent antitoxin botulism was obtained within
24 hours from the Finnish National Institute for Health and Welfare.
However, the procurement from Finland was complicated by agreements that prevented sharing between countries, and approval from the supplier was necessary in order to receive the antitoxin. The transfer of antitoxin from Finland to Norway also required the development of a contract to regulate responsibility and liability issues. Although sufficient doses of botulinum antitoxin have now been acquired, this outbreak has demonstrated that agreements to share antitoxin should be in place between national public health institutes. This may require negotiating contracts with vendors to allow for transfer of the antitoxin between countries in outbreak situations. This is especially important, as delays in obtaining antitoxin can affect length of stay in an ICU (14).
Conclusion
----------
Contaminated heroin is suspected as the source of infection in this cluster of cases of wound botulism. Investigation into links between cases, such as shared social networks and drug suppliers, is ongoing, but preliminary results suggest that contaminated heroin was distributed in southeast Norway in the Oslo area. Improving awareness of the outbreak will increase the likelihood that PWID may promptly seek treatment or avoid intramuscular or subcutaneous injection. This outbreak also serves as a reminder for public health authorities to ensure emergency plans are in place for rapid access to antitoxin.
References
----------
1. Nordic Committee on Food Analysis (NMKL): Botulinum toxin.
Detection in foods, feeds and animal sample materials. Method no. 79, 3rd ed. Finland: NMKL; 2012. Available from:
<http://www.nmkl.org/Engelsk/index.htm>.
2. Lindstrom M, Korkeala H: Laboratory diagnostics of botulism. Clin Microbiol Rev. 2006;19: 298-314.
3. European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs and Drug Addiction: Wound botulism among people who inject heroin in Norway. 31 Oct 2013. Rapid Risk Assessment. Stockholm: EDCDC; 2013. Available from:
<http://ecdc.europa.eu/en/publications/Publications/RRA_WoundBotulism_Norway_20131028.pdf>.
4. Akbulut D, Dennis J, Gent M, et al: Wound botulism in injectors of
drugs: upsurge in cases in England during 2004. Euro Surveill.
2005;10(9):pii=561. Available from:
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=561>.
5. Hope VD, Palmateer N, Wiessing L, et al: A decade of spore-forming bacterial infections among European injecting drug users: pronounced regional variation. Am J Public Health. 2012;102: 122-125.
6. Barry J, Ward M, Cotter S, et al: Botulism in injecting drug users, Dublin, Ireland, November-December 2008. Euro Surveill.
2009;14(1):pii=19082. Available from:
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19082>.
7. Schroeter M, Alpers K, Van Treeck U, et al: Outbreak of wound botulism in injecting drug users. Epidemiol Infect. 2009;137:
1602-1608.
8. Burnens A: Cases of wound botulism in Switzerland. Euro Surveill.
2000;4(5):pii=1666. Available from:
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=1666>.
9. Kuusi M, Hasseltvedt V, Aavitsland P: Botulism in Norway. Euro Surveill. 1999 Jan;4(1):pii=44. Available from:
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=44>.
10. Gordon RJ, Lowy FD: Bacterial infections in drug users. N Engl J Med. 2005;353: 1945-1954.
11. Davis LE, King MK: Wound botulism from heroin skin popping. Curr Neurol Neurosci Rep. 2008;8: 462-468.
12. Swaan CM, van Ouwerkerk IM, Roest HJ: Cluster of botulism among Dutch tourists in Turkey, June 2008. Euro Surveill.
2010;15(14):pii=19532. Available from:
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19532>.
13. Jones RG, Corbel MJ, Sesardic D: A review of WHO International Standards for botulinum antitoxins. Biologicals. 2006;34: 223-226.
14. Offerman SR, Schaefer M, Thundiyil JG, Cook MD, Holmes JF: Wound botulism in injection drug users: time to antitoxin correlates with intensive care unit length of stay. West J Emerg Med. 2009;10:
251-256.
[Authors: MacDonald E, Arnesen TM, Brantsaeter AB, et al]
--
Communicated by:
ProMED-mail
<pro...@promedmail.org>
[Most of the reports of wound botulism linked to intramuscular or subcutaneous injection of (usually) heroin of the black tar variety are described in western Europe or the western part of the USA. - Mod.LL
A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/1FEs>.]
[See Also:
Botulism, wound, drug-related - USA: (WA) ...to be archived
2011
----
Botulism, wound, drug-related - USA (02): (WA) 20110924.2896 Botulism, wound, drug-related - USA: (TX) 20110907.2730
2010
----
Botulism, wound, drug-related - USA: (WA) 20100113.0155
2008
----
Botulism, wound, drug-related - Ireland (02) 20081212.3907 Botulism, wound, drug-related - Ireland 20081128.3753 Botulism, wound, drug-related - USA: (CA) 20081121.3679
2007
----
Botulism, wound, drug-related - USA (WA) 20070603.1795
2006
----
Botulism, wound, drug-related - USA (WA) 20060329.0953
2005
----
Botulism, wound, drug-related - Germany (NRW) 20051219.3636
2004
----
Botulism, wound, drug-related - USA (CA) 20041219.3345 Botulism, wound, drug-related - UK (England, Wales) 20040923.2627
2002
----
Botulism, wound drug-related - UK 20021116.5821 Botulism, wound drug-related - UK not Ireland 20021101.5684 Botulism, wound, drug-related - UK, Ireland 20021031.5675 Botulism, wound, drug-associated (02) 20020305.3690 Botulism, wound, drug-related 20020303.3670 Botulism, wound, drug-related - USA (California) 20020228.3655 Botulism, wound, drug-related - UK: alert 20020223.3614] .................................................ll/msp/dk
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held responsible for errors or omissions or held liable for any damages incurred as a result of use or reliance upon posted or archived material.
************************************************************
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Joanne T. Maffei, M.D.
Associate Professor
LSU Health Sciences Center
Department of Medicine
Section of Infectious Diseases/HIV
ILH Infection Prevention and Control Department Medical Director
Infection Control Office (504) 903-3578
Cell Phone (504) 452-6354
-----Original Message-----
From: promed-ed...@promedmail.org [mailto:promed-ed...@promedmail.org] On Behalf Of prome...@promedmail.org
Sent: Friday, November 08, 2013 11:29 AM
To: prome...@promedmail.org; promed-...@promedmail.org
Subject: PRO/EDR> Botulism, wound - Norway
BOTULISM, WOUND - NORWAY
************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases <http://www.isid.org>
Date: Thu 7 Nov 2013
Source: Eurosurveillance 18(45):pii=20630 [edited] <http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20630>
On 18 Oct 2013, the Norwegian Institute of Public Health (NIPH) was notified by the Department of Public Health of the Municipality of Oslo of a suspected case of wound botulism. A man in his 40s with a history of injecting drugs sought medical attention on 17 Oct 2013 at a medical clinic at a hospital in Oslo. He had several abscesses and neurological symptoms including difficulty swallowing, speaking and shortness of breath. He discharged himself from the hospital against medical advice but was readmitted the following day. Botulism was suspected, and, following readmission, he was transferred to the intensive-care unit (ICU) in a 2nd hospital in Oslo. Upon admission to the ICU, he was mentally alert and had classic signs and symptoms of botulism, which at that point also included drooping eye lids, eye muscle paralysis and dry mouth. He was placed on a mechanical ventilator due to respiratory failure and was treated with botulinum antitoxin, incision of abscesses and antibiotics. The patient receives opiate substitution therapy but acknowledged long-term intramuscular injection of heroin and had injected on 18 Oct 2013.
Later on 18 Oct 2013, a 2nd case of suspected botulism in a person who injects drugs was notified by a hospital in a municipality near Oslo.
A man in his 30s was admitted to the hospital on 14 Oct 2013, discharged himself on the next day and was readmitted on the following day. He displayed neurological symptoms similar to the 1st case. He also had abscesses that had been incised by a friend before hospital admission. This patient was treated with botulinum antitoxin and antibiotics. The patient is enrolled in an opiate substitution therapy programme and stated that he had recently injected heroin intramuscularly only once, on 7 Oct 2013.
For this outbreak, a suspected case was defined as a person who injects drugs living in Norway with clinical symptoms consistent with botulism with onset after 1 Oct 2013. A confirmed case was defined as a suspected case with laboratory confirmation of botulism by mouse bioassay. As of 6 Nov 2013, a total of 4 confirmed and 2 suspected cases have been reported. Cases were between the ages of 35 and 55 years, and 2 were women. All cases have a history of injecting drugs and reside in Oslo or one of 2 neighboring counties. Onset of symptoms among cases was from 30 Sep 2013 to 22 Oct 2013. The number of days from hospitalization to laboratory confirmation ranged from 8 to 22 days (Figure 1 - [for figures, see original URL - Mod.LL]).
Laboratory testing and contact tracing to establish a possible connection between the confirmed and suspected cases are ongoing.
Preliminary results from interviews with the patients suggest that only 2 of the cases knew each other, but none had shared heroin or injecting paraphernalia.
Laboratory diagnosis
--------------------
Botulism was confirmed in 4 of the 6 cases by mouse bioassay using serum specimens between 24 Oct 2013 and 4 Nov 2013. The laboratory diagnosis was performed at the Norwegian School of Veterinary Science according to the current Nordic Committee on Food Analysis method (1).
For all 4 sera that were confirmed positive with the bioassay, the mice developed classic symptoms of the effect of botulinum neurotoxins
(2) within one day after injection.
Complete results of subtyping of the botulinum toxin are pending, although the specimens were not positive for type E and inconclusive for type B. Bacteriological tests from abscess specimens are also ongoing. Nerve conduction studies have provided supporting evidence of botulism for one confirmed case and one suspected case. Two cases had heroin remaining, which is currently undergoing testing by cultivation at the NIPH and at a regional medical microbiological laboratory.
Investigation and control measures
----------------------------------
On 18 Oct 2013, the Department of Public Health of the Municipality of Oslo distributed information regarding the possible circulation of contaminated heroin and symptoms of botulism to emergency departments, hospital infectious disease and neurology departments and the ambulance service in order to increase vigilance among clinicians. For at least one case, botulism was only considered following the dissemination of information. This reinforces the importance of increasing awareness among clinicians of botulism linked to drug injection in order to avoid delays in diagnosis, especially in countries where it is rarely identified. The police and relevant low-threshold centers for people who inject drugs (PWID), including supervised drug consumption facilities and treatment services, were also notified in order to encourage PWID to avoid intramuscular and subcutaneous injection and to seek treatment promptly upon development of symptoms consistent with botulism. Information was published on the Municipality of Oslo website, the NIPH websites and MikInfo, a web-based platform for information-sharing for microbiologists hosted by the NIPH. Other European countries were alerted via the European Early Warning and Response System on 19 Oct 2013, and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) was informed on 20 Oct 2013. On 31 Oct 2013, the European Centre for Disease Prevention and Control and EMCDDA published a joint rapid risk assessment of the situation in Norway, recommending increased awareness among healthcare workers and public health authorities regarding the possibility of cases in other European Union/European Economic Area countries (3). Systematic interviews to collect extensive demographic, clinical and drug-use data in order to identify links between the cases in terms of residence, social networks, and drug supply are being organised by local public health authorities in collaboration with clinicians.
Botulism in people who inject drugs in Norway and Europe
-----------------------------------
Infections of spore-forming bacteria among PWID, such as botulism, tetanus, _Clostridium novyi_ infection and anthrax, have been previously reported in several European countries, most notably the UK (4,5). A review of UK cases from 1990 to 2009 indicated that while cases of tetanus, _C. novyi_ infection, and anthrax most often occur in clusters, botulism tends to occur as sporadic cases (5). Outside the UK, few clusters of wound botulism have been reported in European countries, including Ireland in 2008 (6), Germany in 2005 (7) and Switzerland in 1998 (8).
Notification of botulism has been mandatory in Norway since 1975.
Between 1990 and 2012, 40 cases of botulism were reported. Although the most common cause of botulism in Norway is the consumption of home-made fermented fish (rakefisk), 9 cases of wound botulism among PWID have been reported previously (Figure 2). All cases were sporadic, with the exception of a cluster of 3 cases in 1997 (9); before the 2013 outbreak, the most recent case of wound botulism reported through the Norwegian Surveillance System for Communicable Diseases associated with injection drug use was reported in 2010.
Contamination of heroin with _C. botulinum_ spores or other substances mixed with the drug are the most likely sources of wound botulism among PWID (10). The distribution of cases -- occurring primarily in northwestern Europe -- may reflect regional differences in heroin distribution, heroin preparation practices, and injecting drug use practice, including the type and method of injecting (5). Most of the cases in this Norwegian outbreak reported intramuscular injection of heroin (muscle popping), due to obliteration of peripheral veins following many years of intravenous injection. This practice can result in formation of wounds and abscesses with anaerobic conditions, which can lead to germination of _C. botulinum_ spores and subsequent production of toxin (10). Several cases reported using heroin that was brownish in color and had a powdery consistency. Use of black tar heroin is also reported to be a risk factor for wound botulism due to increased sclerosis of veins in black tar users and the nature of the substance, which leads to increased use of intramuscular and subcutaneous injections (11).
Availability of botulinum antitoxin
------------------------------
The NIPH is responsible for maintaining the country's supply of botulinum antitoxin. Shortage of antitoxin has recently been a problem in several European countries (12,13). At the time the 1st cases were notified, the NIPH had only a limited supply of botulism antitoxin available. The NIPH was already in negotiations with a supplier to receive additional vials at the time of the outbreak, but accelerated the process in order to have the shipment sent from a producer outside Europe within 4 days. To address the acute need for antitoxin, other public health institutes in the Nordic countries were contacted. A limited amount of heptavalent antitoxin botulism was obtained within
24 hours from the Finnish National Institute for Health and Welfare.
However, the procurement from Finland was complicated by agreements that prevented sharing between countries, and approval from the supplier was necessary in order to receive the antitoxin. The transfer of antitoxin from Finland to Norway also required the development of a contract to regulate responsibility and liability issues. Although sufficient doses of botulinum antitoxin have now been acquired, this outbreak has demonstrated that agreements to share antitoxin should be in place between national public health institutes. This may require negotiating contracts with vendors to allow for transfer of the antitoxin between countries in outbreak situations. This is especially important, as delays in obtaining antitoxin can affect length of stay in an ICU (14).
Conclusion
----------
Contaminated heroin is suspected as the source of infection in this cluster of cases of wound botulism. Investigation into links between cases, such as shared social networks and drug suppliers, is ongoing, but preliminary results suggest that contaminated heroin was distributed in southeast Norway in the Oslo area. Improving awareness of the outbreak will increase the likelihood that PWID may promptly seek treatment or avoid intramuscular or subcutaneous injection. This outbreak also serves as a reminder for public health authorities to ensure emergency plans are in place for rapid access to antitoxin.
References
----------
1. Nordic Committee on Food Analysis (NMKL): Botulinum toxin.
Detection in foods, feeds and animal sample materials. Method no. 79, 3rd ed. Finland: NMKL; 2012. Available from:
<http://www.nmkl.org/Engelsk/index.htm>.
2. Lindstrom M, Korkeala H: Laboratory diagnostics of botulism. Clin Microbiol Rev. 2006;19: 298-314.
3. European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs and Drug Addiction: Wound botulism among people who inject heroin in Norway. 31 Oct 2013. Rapid Risk Assessment. Stockholm: EDCDC; 2013. Available from:
<http://ecdc.europa.eu/en/publications/Publications/RRA_WoundBotulism_Norway_20131028.pdf>.
4. Akbulut D, Dennis J, Gent M, et al: Wound botulism in injectors of
drugs: upsurge in cases in England during 2004. Euro Surveill.
2005;10(9):pii=561. Available from:
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=561>.
5. Hope VD, Palmateer N, Wiessing L, et al: A decade of spore-forming bacterial infections among European injecting drug users: pronounced regional variation. Am J Public Health. 2012;102: 122-125.
6. Barry J, Ward M, Cotter S, et al: Botulism in injecting drug users, Dublin, Ireland, November-December 2008. Euro Surveill.
2009;14(1):pii=19082. Available from:
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19082>.
7. Schroeter M, Alpers K, Van Treeck U, et al: Outbreak of wound botulism in injecting drug users. Epidemiol Infect. 2009;137:
1602-1608.
8. Burnens A: Cases of wound botulism in Switzerland. Euro Surveill.
2000;4(5):pii=1666. Available from:
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=1666>.
9. Kuusi M, Hasseltvedt V, Aavitsland P: Botulism in Norway. Euro Surveill. 1999 Jan;4(1):pii=44. Available from:
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=44>.
10. Gordon RJ, Lowy FD: Bacterial infections in drug users. N Engl J Med. 2005;353: 1945-1954.
11. Davis LE, King MK: Wound botulism from heroin skin popping. Curr Neurol Neurosci Rep. 2008;8: 462-468.
12. Swaan CM, van Ouwerkerk IM, Roest HJ: Cluster of botulism among Dutch tourists in Turkey, June 2008. Euro Surveill.
2010;15(14):pii=19532. Available from:
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19532>.
13. Jones RG, Corbel MJ, Sesardic D: A review of WHO International Standards for botulinum antitoxins. Biologicals. 2006;34: 223-226.
14. Offerman SR, Schaefer M, Thundiyil JG, Cook MD, Holmes JF: Wound botulism in injection drug users: time to antitoxin correlates with intensive care unit length of stay. West J Emerg Med. 2009;10:
251-256.
[Authors: MacDonald E, Arnesen TM, Brantsaeter AB, et al]
--
Communicated by:
ProMED-mail
<pro...@promedmail.org>
[Most of the reports of wound botulism linked to intramuscular or subcutaneous injection of (usually) heroin of the black tar variety are described in western Europe or the western part of the USA. - Mod.LL
A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/1FEs>.]
[See Also:
Botulism, wound, drug-related - USA: (WA) ...to be archived
2011
----
Botulism, wound, drug-related - USA (02): (WA) 20110924.2896 Botulism, wound, drug-related - USA: (TX) 20110907.2730
2010
----
Botulism, wound, drug-related - USA: (WA) 20100113.0155
2008
----
Botulism, wound, drug-related - Ireland (02) 20081212.3907 Botulism, wound, drug-related - Ireland 20081128.3753 Botulism, wound, drug-related - USA: (CA) 20081121.3679
2007
----
Botulism, wound, drug-related - USA (WA) 20070603.1795
2006
----
Botulism, wound, drug-related - USA (WA) 20060329.0953
2005
----
Botulism, wound, drug-related - Germany (NRW) 20051219.3636
2004
----
Botulism, wound, drug-related - USA (CA) 20041219.3345 Botulism, wound, drug-related - UK (England, Wales) 20040923.2627
2002
----
Botulism, wound drug-related - UK 20021116.5821 Botulism, wound drug-related - UK not Ireland 20021101.5684 Botulism, wound, drug-related - UK, Ireland 20021031.5675 Botulism, wound, drug-associated (02) 20020305.3690 Botulism, wound, drug-related 20020303.3670 Botulism, wound, drug-related - USA (California) 20020228.3655 Botulism, wound, drug-related - UK: alert 20020223.3614] .................................................ll/msp/dk
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held responsible for errors or omissions or held liable for any damages incurred as a result of use or reliance upon posted or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
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