Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 9
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Gonzales y Tucker, Richard Diego and Frazee, Bradley 2014. View from the front lines: An emergency medicine perspective on clostridial infections in injection drug users. Anaerobe, Vol. 30, p. 108.

    Rusnak, Janice and Smith, Leonard 2014. Manual of Security Sensitive Microbes and Toxins.

    MacDonald, E Arnesen, T Brantsaeter, A Gerlyng, P Grepp, M Hansen, B Jønsrud, K Lundgren, B Mellegård, H Møller-Stray, J Rønning, K Vestrheim, D and Vold, L 2013. Outbreak of wound botulism in people who inject drugs, Norway, October to November 2013. Eurosurveillance, Vol. 18, Issue. 45, p. 20630.

    Marks, Michael Pollock, Emily Armstrong, Margaret Morris-Jones, Stephen Kidd, Michael Gothard, Philip Noursadeghi, Mahdad and Doherty, Justin F. 2013. Needles and the damage done: Reasons for admission and financial costs associated with injecting drug use in a Central London Teaching Hospital. Journal of Infection, Vol. 66, Issue. 1, p. 95.

    Abavare, Laura and Abavare, Charles 2012. Wound Botulism Resulting from Heroin Abuse: Can You Recognize It?. Journal of Emergency Nursing, Vol. 38, Issue. 3, p. 301.

    Hope, Vivian D. Palmateer, Norah Wiessing, Lucas Marongiu, Andrea White, Joanne Ncube, Fortune and Goldberg, David 2012. A Decade of Spore-Forming Bacterial Infections Among European Injecting Drug Users: Pronounced Regional Variation. American Journal of Public Health, Vol. 102, Issue. 1, p. 122.

    Scannell, Amalia G. M. 2012. Handbook of Food Safety Engineering.

    Manfredi, Maddalena Scoditti, Umberto Angelini, Monica de Giampaulis, Piero Borrini, Bianca Maria Macaluso, Guido Maria Pavesi, Giovanni and Vescovi, Paolo 2011. Dry mouth as an initial sign of food-borne botulism: a case report and review of the literature. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, Vol. 111, Issue. 4, p. e15.

    Rodolico, C. Barca, E. Fenicia, L. Anniballi, F. Sinardi, A. U. and Girlanda, P. 2010. Wound botulism in drug users: a still underestimated diagnosis. Neurological Sciences, Vol. 31, Issue. 6, p. 825.


Outbreak of wound botulism in injecting drug users

  • M. SCHROETER (a1), K. ALPERS (a2), U. VAN TREECK (a1), C. FRANK (a2), N. ROSENKOETTER (a1) and R. SCHAUMANN (a3)
  • DOI:
  • Published online: 07 April 2009

Between October and December 2005, 16 cases of wound botulism were notified to the health authorities of North Rhine-Westphalia, Germany. All patients were injecting drug users (IDU) and the epidemiological investigations suggested contaminated injection drugs as the most probable source of infection. Clostridium botulinum was cultivated from clinical samples of six patients and molecular typing revealed that the different isolates were clonally identical. Two samples of heroin, one of them provided by a patient, were examined but C. botulinum could not be isolated. This outbreak demonstrates that IDU are at risk for acquiring wound botulism by injecting contaminated drugs. A greater awareness of this disease is needed by physicians and a close cooperation between public health authorities, street workers, operators of sheltered injecting facilities, and medical centres focusing on IDU is essential to prevent and manage outbreaks in IDU in a timely manner.

Corresponding author
*Author for correspondence: Dr K. Alpers, Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Seestraße 10, D-13353Berlin. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

5.G Ackermann , Resistance to moxifloxacin in toxigenic Clostridium difficile isolates is associated with mutations in gyrA. Antimicrobial Agents and Chemotherapy 2001; 45: 23482353.

6.K Takeshi , Simple method for detection of Clostridium botulinum type A to F neurotoxin genes by ploymerase chain reaction. Microbiology and Immunology 1996; 40: 5–11.

7.M Lindström , Multiplex PCR assay for detection and identification of Clostridium botulinum types A, B, E, and F in food and fecal material. Applied and Environmental Microbiology 2001; 67: 56945699.

8.R Schaumann , Inducible metronidazole resistance in nim-positive and nim-negative Bacteroides fragilis group strains after several passages metronidazole containing columbia agar plates. Infection 2005; 33: 368372.

9.R Schaumann , F Laurin , AC Rodloff . Molecular typing of clinical isolates of Stenotrophomonas maltophilia by pulsed-field gel electrophoresis and random primer PCR fingerprinting. International Journal of Hygiene and Environmental Health 2008; 211: 292298.

11.CU Tuazon , H Miller , D Shamsuddin . Antimicrobial activity of street heroin. Journal of Infectious Diseases 1980; 142: 944.

12.J McLauchlin , An investigation into the microflora of heroin. Journal of Medical Microbiology 2002; 51: 10011008.

13.MM Brett , G Hallas , O Mpamugo . Wound botulism in the UK and Ireland. Journal of Medical Microbiology 2004; 53: 555561.

14.AF Merrison , Wound botulism associated with subcutaneous drug use. British Medical Journal 2002; 325: 10201021.

15.CDC. Botulism in the United States, 1899–1996. In: Handbook for Epidemiologists, Clinicians, and Laboratory Workers. Atlanta, GA: Centers for Disease Control and Prevention, 1998.

18.D Akbulut , KA Grant , J McLauchlin . Improvement in laboratory diagnosis of wound botulism and tetanus among injecting illicit-drug users by use of real-time PCR assays for neurotoxin gene fragments. Journal of Clinical Microbiology 2005; 43: 43424348.

19.DJ Passaro , Wound botulism associated with black tar heroin among injecting drug users. Journal of the American Medical Association 1998; 279: 859863.

20.SB Werner , Wound botulism in California, 1951–1998: recent epidemic in heroin injectors. Clinical Infectious Diseases 2000; 31: 10181024.

22.CDC. Wound botulism among black tar heroin users – Washington, 2003. Morbidity and Mortality Weekly Report 2003; 52: 885886.

23.AC Kimura , Outbreak of necrotizing fasciitis due to Clostridium sordellii among black-tar heroin users. Clinical Infectious Diseases 2004; 38: 8791.

26.M Schröter , Epidemiological dynamics of hepatitis C virus among 747 German individuals: new subtypes on the advance. Journal of Clinical Microbiology 2002; 40: 18661868.

27.JL Wylie , L Shah , AM Jolly . Demographic, risk behaviour and personal network variables associated with prevalent Hepatitis C, Hepatitis B, and HIV infection in injection drug users in Winnipeg, Canada. BMC Public Health 2006; 6: 229 (

28.RJ Gordon , FD Lowy . Bacterial infections in drug users. New England Journal of Medicine 2005; 353: 19451954.

29.A Fowler , A Mackay . Community-acquired methicillin resistant Staphylococcus aureus pyomyositis in an intravenous drug user. Journal of Medical Microbiology 2006; 55: 123125.

30.FS Gutzwiller , Botulism: prevention, clinical diagnosis, therapy and possible threat. Deutsche Medizinische Wochenschrift 2008; 133: 840845.

31.JG Cooper , Clostridium botulinum: an increasing complication of heroin misuse. European Journal of Emergency Medicine 2005; 12: 251252.

32.MA Wainberg . The need to promote public health in the field of illicit drug use. Canadian Medical Association Journal 2006; 175: 13951396.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *