[Wound botulism in heroin addicts in Germany].
METHODS
5 heroin addicts (aged 31-44 years; 1 female, 4 men) presented with a history of blurred vision and diplopia followed by dysarthria. 3 of the patients also developed respiratory failure requiring long-term ventilatory support. Physical examination revealed cranial nerve deficits and abscesses at injection sites in 3 of them.


METHODS
In 4 patients wound botulism was diagnosed on the basis of symptoms, course of the illness and response to specific treatment. Clostridium botulinum was grown from wound swab in one patient.


METHODS
Two of the patients, having been injected with antitoxin immediately after admission, were discharged almost symptom-free after only a few days. Adjuvant antibiotics and, in 3 patients, surgical débridement of the abscesses were needed.


CONCLUSIONS
Progressive cranial nerve pareses in addicts who inject drugs intravenously or intramuscularly should raise the suspicion of wound botulism and require hospitalization. While indirect demonstration of toxin supports the diagnosis, false-negative results are common.
Kuhn
J
J
Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität zu Köln. JKuhn11@aol.com
Gerbershagen
K
K
Schaumann
R
R
Langenberg
U
U
Rodloff
A C
AC
Mueller
W
W
Hartmann-Klosterkoetter
U
U
Bewermeyer
H
H