Wound Botulism

BAH-choo-lihz-uhm

Botulism is caused by a type of bacteria (Clostridia) that makes toxins. Wound botulism is when the bacteria gets into the body through an injury to the skin. The bacteria usually grow in places where there is not much oxygen. They can grow in a deep wound such as:

• Puncture wound

• Pocket of infection (abscess) under the skin

• Where black tar heroin is injected under the skin or in a muscle

• Surgery incision

• Broken bone that has come through the skin (open fracture)

In some cases, wound botulism may happen in a scrape or sore that isn’t deep.

Symptoms from wound botulism can take 10 days or more to appear. They are caused by muscle paralysis and can include:

• Trouble swallowing

• Slurred speech

• Feeling weak all over

• Double or blurry vision

• Eye movements you can’t control

• Drooping eyelids

• Dry mouth

• Tongue that feels thick

• Trouble breathing

• Trouble urinating

• Constipation

Your healthcare provider will ask about your symptoms and give you a physical exam. If the healthcare provider thinks you likely have wound botulism, they will start treating you right away before test results are back. You may need blood tests. Your healthcare provider will also take a sample from the wound area. A tiny piece of tissue may be cut from the wound or a swab may be used to collect pus. These samples are sent to a lab for testing to confirm the diagnosis. You may have other tests such as imaging tests, nerve and muscle function tests, or spinal tap (lumbar puncture).

Botulism is a medical emergency. It must be treated right away.

Botulism is first treated with a medicine called antitoxin. This medicine stops the toxin from doing more harm. But it does not reverse all the damage the toxin has already done. You may need to stay in the hospital for weeks or months during and after treatment. If you have trouble breathing, you may need to be on a breathing machine (ventilator). You will use this machine until you can breathe on your own. Muscle paralysis can get better over time.

You may need surgery on the wound. This is done to remove the infected part of the wound. Tissue around the wound may be removed as well. This is to make sure all the bacteria and toxins are gone. You may also be given antibiotic medicine.

Your wound may be at risk for another infection at the same time. Tell your healthcare provider if you have a fever.

If untreated, symptoms from wound botulism can get worse and lead to death from breathing failure. Botulism can cause paralysis that can last for weeks or months. After treatment, you may be tired and short of breath for months or years. You may need physical therapy to help you get better over time.

If you have a deep wound that looks infected, get medical care right away. Be alert to the symptoms of botulism. You can also prevent this problem by not injecting illegal drugs. Heating heroin does not kill the bacteria that cause wound botulism.

If you have symptoms of botulism, call your healthcare provider or go to the emergency room right away.

Call your provider if you have any of the following:

• Fever of 100.4°F (38°C) or higher or as advised by your provider

• Redness, swelling, warmth, or fluid leaking from a wound

• Pain that gets worse

• Symptoms that don’t get better, or get worse

• New symptoms