FW: PRO/EDR> Botulism, wound, drug-related - USA: (WA)
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Maffei, Joanne
Nov 11, 2013, 4:12:05 PM11/11/13
to ls...@googlegroups.com, Aiken, James B., Hardy, Sean, DeBlieux, Peter
So, when I read my next email...here is a report from the US
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 11:18 AM
To: prome...@promedmail.org; promed-...@promedmail.org
Subject: PRO/EDR> Botulism, wound, drug-related - USA: (WA)
BOTULISM, WOUND, DRUG-RELATED - USA: (WASHINGTON STATE)
*******************************************************
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: Mon 4 Nov 2013
Source: Wenatchee (WA) World [edited]
<http://www.wenatcheeworld.com/news/2013/nov/04/local-botulism-case-points-to-toxic-heroin/>
A patient was diagnosed in a Chelan County hospital with wound botulism, a paralyzing toxic reaction believed to derive from injecting tainted heroin.
Chelan-Douglas Health District spokeswoman Mary Small said her agency was alerted on Wed 30 Oct 2013 to the botulin poisoning, which poses no wider risk to the general public. The health district gave notice of the health case on the following day to local health providers and police in case more such poisonings emerge, Small said. "We just wanted to put out an awareness to people who provide service and work with people who are using drugs," she said.
Botulism is a potentially fatal bacterium-related poisoning that can occur from eating tainted food or, in the case of wound botulism, introducing botulin-producing bacteria through the skin. It is not communicable from person to person.
There are about 145 cases of botulism reported each year according to the CDC. About 20 percent of all cases stem from wound infections, and most wound botulism cases are associated with the injection of black tar heroin.
The toxic bacterium is believed to live within diluting agents -- "dextrose, burned cornstarch, instant coffee, and sometimes even dirt," according to a 2004 medical study -- introduced while processing the heroin. This means disinfected needles and clean injection points can't prevent infection.
Ten Americans have died of wound botulism since 2001. Cases have been reported over the last decade among IV drug users in the Yakima (WA) area, including 2 in 2010, one in 2007, and 4 others in 2003, but Small said this appears to be the 1st such instance in the Wenatchee Valley.
[Byline: Jefferson Robbins]
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Communicated by:
ProMED-mail
<pro...@promedmail.org>
[The usual form of heroin associated with wound botulism is black tar heroin (<http://en.wikipedia.org/wiki/Black_tar_heroin>), which can contain a variable percentage of heroin; but, despite the name, what makes black tar heroin specific as a type is not actually its heroin
(diacetylmorphine) content, but rather the greater mixture of lesser acetylated morphine derivatives, predominantly 6-MAM
(6-monoacetylmorphine) and 3-MAM (3-monoacetylmorphine). This is caused by the use of the antiquated Wright-Beckett process (c. 1874), which produces a relatively crude and unrefined opiate product but does not require the complex lab equipment, high-purity acetylating chemicals, or lengthy reflux steps necessary to produce pure heroin, making it attractive to clandestine drug producers.
Black tar heroin is produced in Latin America, and is most commonly found in the western and southern parts of the USA, while also being occasionally found in western Canada and Europe. It has a varying consistency depending on manufacturing methods, cutting agents, and moisture levels, ranging in quality from a black-brown, tarry goo in unrefined form to a uniform, light-brown powder when further processed and cut with lactose.
Users who intravenously inject black tar heroin are at higher risk of venous sclerosis (a condition where the veins narrow and harden, making injection there nearly impossible) than users of powder heroin, forcing users to inject subcutaneously. Injecting the drug below the skin can produce a local anaerobic, necrotic environment allowing germination of spores of _Clostridium_ species producing necrotizing infections due to _C. perfringens_ or toxin-induced diseases such as tetanus or botulism. - Mod.LL
A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/6dEe>.]
[See Also:
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
*##########################################################*
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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:
<http://www.isid.org/donate/>
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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 11:18 AM
To: prome...@promedmail.org; promed-...@promedmail.org
Subject: PRO/EDR> Botulism, wound, drug-related - USA: (WA)
BOTULISM, WOUND, DRUG-RELATED - USA: (WASHINGTON STATE)
*******************************************************
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: Mon 4 Nov 2013
Source: Wenatchee (WA) World [edited]
<http://www.wenatcheeworld.com/news/2013/nov/04/local-botulism-case-points-to-toxic-heroin/>
A patient was diagnosed in a Chelan County hospital with wound botulism, a paralyzing toxic reaction believed to derive from injecting tainted heroin.
Chelan-Douglas Health District spokeswoman Mary Small said her agency was alerted on Wed 30 Oct 2013 to the botulin poisoning, which poses no wider risk to the general public. The health district gave notice of the health case on the following day to local health providers and police in case more such poisonings emerge, Small said. "We just wanted to put out an awareness to people who provide service and work with people who are using drugs," she said.
Botulism is a potentially fatal bacterium-related poisoning that can occur from eating tainted food or, in the case of wound botulism, introducing botulin-producing bacteria through the skin. It is not communicable from person to person.
There are about 145 cases of botulism reported each year according to the CDC. About 20 percent of all cases stem from wound infections, and most wound botulism cases are associated with the injection of black tar heroin.
The toxic bacterium is believed to live within diluting agents -- "dextrose, burned cornstarch, instant coffee, and sometimes even dirt," according to a 2004 medical study -- introduced while processing the heroin. This means disinfected needles and clean injection points can't prevent infection.
Ten Americans have died of wound botulism since 2001. Cases have been reported over the last decade among IV drug users in the Yakima (WA) area, including 2 in 2010, one in 2007, and 4 others in 2003, but Small said this appears to be the 1st such instance in the Wenatchee Valley.
[Byline: Jefferson Robbins]
--
Communicated by:
ProMED-mail
<pro...@promedmail.org>
[The usual form of heroin associated with wound botulism is black tar heroin (<http://en.wikipedia.org/wiki/Black_tar_heroin>), which can contain a variable percentage of heroin; but, despite the name, what makes black tar heroin specific as a type is not actually its heroin
(diacetylmorphine) content, but rather the greater mixture of lesser acetylated morphine derivatives, predominantly 6-MAM
(6-monoacetylmorphine) and 3-MAM (3-monoacetylmorphine). This is caused by the use of the antiquated Wright-Beckett process (c. 1874), which produces a relatively crude and unrefined opiate product but does not require the complex lab equipment, high-purity acetylating chemicals, or lengthy reflux steps necessary to produce pure heroin, making it attractive to clandestine drug producers.
Black tar heroin is produced in Latin America, and is most commonly found in the western and southern parts of the USA, while also being occasionally found in western Canada and Europe. It has a varying consistency depending on manufacturing methods, cutting agents, and moisture levels, ranging in quality from a black-brown, tarry goo in unrefined form to a uniform, light-brown powder when further processed and cut with lactose.
Users who intravenously inject black tar heroin are at higher risk of venous sclerosis (a condition where the veins narrow and harden, making injection there nearly impossible) than users of powder heroin, forcing users to inject subcutaneously. Injecting the drug below the skin can produce a local anaerobic, necrotic environment allowing germination of spores of _Clostridium_ species producing necrotizing infections due to _C. perfringens_ or toxin-induced diseases such as tetanus or botulism. - Mod.LL
A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/6dEe>.]
[See Also:
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:
<http://www.isid.org/donate/>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: pro...@promedmail.org (NOT to an individual moderator). If you do not give your full name name and affiliation, it may not be posted. You may unsub- scribe at <http://ww4.isid.org/promedmail/subscribe.php>.
For assistance from a human being, send mail to:
<postm...@promedmail.org>.
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