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Cluster of wound botulism in California: Clinical, electrophysiologic, and pathologic study
Author(s) -
Maselli Ricardo A.,
Ellis William,
Mandler Raul N.,
Sheikh Firdos,
Venton Grace,
Knox Stephen,
SalariNamin Hamid,
Agius Mark,
Wollmann Robert L.,
Richman David P.
Publication year - 1997
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/(sici)1097-4598(199710)20:10<1284::aid-mus11>3.0.co;2-3
Subject(s) - botulism , medicine , weakness , dysphagia , repetitive nerve stimulation , bulbar palsy , botulinum toxin , anesthesia , amyotrophy , atrophy , surgery , electromyography , pathology , physical medicine and rehabilitation , genetics , biology
Over a period of 15 months we have seen 6 patients with long‐standing history of subcutaneous heroin injections who experienced acute blurred vision, dysphagia, dysarthria, and generalized weakness. Decreased or absent deep tendon reflexes, pupillary abnormalities, incremental responses to fast repetitive nerve stimulation, and positive serology for Clostridia botulinum toxin A were found, but not in all cases. Muscle biopsies showed variable signs of neurogenic atrophy. In vitro electrophysiology studies revealed decreased end‐plate potentials quantal content, confirming the presynaptic nature of the disorder. Mechanical ventilation was required in 5 patients. Half of the patients were treated with polyvalent antitoxiin. Prognosis was favorable, though recovery was slow. In conclusion, acute bulbar weakness with visual symptoms in patients with subcutaneous heroin abuse strongly suggets the possibility of wound botulism. High diagnostic suspicion combined with histology and in vitro electrophysiology confirmation of presynaptic failure, especially in seronegative cases, may significantly improve morbidity. © 1997 John Wiley & Sons, Inc. Muscle Nerve 20: 1284–1295, 1997