Cluster of wound botulism in california: Clinical, electrophysiologic, and pathologic study

Ricardo A Maselli, William Ellis, Raul N. Mandler, Firdos Sheikh, Grace Senton, Stephen Knox, Hamid Salari-Namin, Mark Agius, Robert L. Wollmann, David P Richman

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


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 suggests 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.

Original languageEnglish (US)
Pages (from-to)1284-1295
Number of pages12
JournalMuscle and Nerve
Issue number10
StatePublished - 1997


  • Addiction
  • Neuromuscular junction
  • Wound botulism

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)


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