The Texas Department of State Health Services has reported two confirmed and one suspected case of botulism associated with injection drug use since July 30, 2024. Due to the nature of this illness, more cases may occur. Clinicians are advised to follow recommended guidelines and report any suspected cases to their local health department or public health region immediately while the patient is still under their care.
Wound botulism is a rare and potentially fatal paralytic illness caused by Clostridium botulinum spores contaminating a wound, which then germinate and produce neurotoxins. Patients typically present with sudden paralysis or weakness in facial muscles, leading to blurred or double vision, drooping eyelids, slurred speech, difficulty swallowing, or an impaired gag reflex. These initial symptoms often progress to paralysis affecting the trunk, arms, and legs.
A recent outbreak in Northeast Texas has identified three cases among individuals with a history of injecting heroin. All three patients experienced generalized weakness and acute respiratory failure requiring intubation. Public health officials are still investigating the source of infection and caution that additional cases may emerge.
Clinicians are urged to maintain a high index of suspicion for wound botulism in patients presenting with compatible symptoms who report injection drug use. Symptoms include blurred or double vision, drooping eyelids, slurred speech, difficulty swallowing or speaking, dry mouth, muscle weakness, and muscle paralysis starting from the face downwards.
Suspected cases should be referred immediately to the nearest emergency department for potential neurology and infectious disease consultations. Surgical consultations may be necessary for thorough debridement of wounds and abscesses. Wound specimens should be sent for anaerobic culture while serum testing for C. botulinum toxin can be conducted by public health laboratories.
Public health staff must facilitate laboratory testing at state health departments and request antitoxin treatment from the Centers for Disease Control and Prevention (CDC). Physicians can obtain clinical consultation regarding potential cases through the CDC Botulism Clinical Consultation Service by calling 770-488-7100.
The public is advised against using illegal injectable drugs such as heroin and sharing needles. Immediate medical treatment should be sought if symptoms of botulism appear in oneself or others. Untreated wound botulism can lead to severe complications including paralysis of respiratory muscles and death.
