title: Wound botulism acquired in the Amazonian rain forest of Ecuador.
abstract: Wound botulism results from colonization of a contaminated wound by Clostridium botulinum and the anaerobic in situ production of a potent neurotoxin. Between 1943, when wound botulism was first recognized, and 1990, 47 laboratory-confirmed cases, mostly trauma-associated, were reported in the United States. Since 1990, wound botulism associated with injection drug use emerged as the leading cause of wound botulism in the United States; 210 of 217 cases reported to the Centers for Disease Control and Prevention between 1990 and 2002 were associated with drug injection. Despite the worldwide distribution of Clostridium botulinum spores, wound botulism has been reported only twice outside the United States, Europe, and Australia. However, wound botulism may go undiagnosed and untreated in many countries. We report two cases, both with type A toxin, from the Ecuadorian rain forest. Prompt clinical recognition, supportive care, and administration of trivalent equine botulinum antitoxin were life-saving.
authors.affiliation: Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. megan.reller@tch.harvard.edu
authors.forename: Megan E
authors.initials: ME
authors.lastname: Reller
authors.forename: Richard W
authors.initials: RW
authors.lastname: Douce
authors.forename: Susan E
authors.initials: SE
authors.lastname: Maslanka
authors.forename: Darwin S
authors.initials: DS
authors.lastname: Torres
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Manock
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sobel
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage; D001904:Botulinum Antitoxin / Q000008:administration & dosage; D001906:Botulism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D003014:Clostridium botulinum / Q000302:isolation & purification*; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004484:Ecuador; D006801:Humans; D008297:Male; D011859:Radiography; D012121:Respiration, Artificial; D014946:Wound Infection / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D014950:Wounds, Penetrating
chemical_list: D000890:Anti-Infective Agents; D001904:Botulinum Antitoxin