38 INFECTIOUS DISEASE, DISASTER PLANNING & WOUND CARE | 2019 | www.elitecme.com A s one of the “five most concerning infectious diseases to monitor in 2019,”1 the opioid epidemic doesn’t need much more notoriety to make its pres- ence felt throughout the healthcare industry. But a recent trend has continued to increase its troubling impact in various clinical aspects. Health officials are now warning that cli- nicians be aware of the potential for wound botulism to occur among their patients. Reportedly first observed in New York as early as 1982 in relation to the use of injected drugs, notably the use of black-tar heroin, wound bot- ulism is a rare but potentially fatal illness that is caused by skin popping, a method of inject- ing a drug under the skin instead of into a vein or a muscle (muscling).  According to recent reports by the Centers for Disease Control and Prevention (CDC) and U.S. News & World Report, the condition has become associated with the use of the black tar heroin, a cruder form of the drug that is most dangerous when injected under the skin. The substance has reportedly been found mostly in states west of the Mississippi River and is primarily being sourced from Mexico. According to U.S. News & World Report, more than 40 confirmed and likely cases of wound botulism occurred in California alone last year, with one fatal case occurring in San Diego County. According to the CDC, San Diego County has accounted for nine cases (eight confirmed, one probable) between September 2017 and May 2018, when the county generally seesjustonecaseperyear.Morethan350cases were reported to the CDC between 2001 and 2016, with 291 cases reported in California, including 15 in San Diego County. Reported reasons for the increase in cases include bad batches or increased use of black tar heroin, more users injecting the drug through skin popping, more pathogen in the environment, or a combination of such factors, according to the report by U.S. News & World Report.  Wound botulism occurs when the bacte- rium Clostridium botulinum gets into a wound and makes a toxin that attacks the body’s nerves, which can make breathing difficult and cause muscle weakness or death. It is treatable with antitoxin, but any consequences suffered Opioid Epidemic & Wound Botulism Emerging as Disease Concern By Joe Darrah ISTOCK prior to treatment cannot be undone, accord- ing to the CDC. A lengthy hospital stay may also be required. The CDC also warns provid- ers that wound botulism symptoms are similar to those of opioid overdose and can thus be dif- ficult to differentiate. San Diego County offi- cials issued alerts in October 2017 and April 2018 about the rise in cases, and in April, offi- cials said the increase represented “the largest group of wound botulism cases ever reported in San Diego County,” according to the U.S. News & World Report.  “This has to be perplexing for many, because to treat it properly, prompt recogni- tion needs to occur,” said Frank Aviles Jr, PT, CWS, FACCWS, CLT, a certified wound spe- cialist who serves as the wound care service line director at Natchitoches (LA) Regional Medical Center. “Early recognition and inter- vention is imperative for healthcare profes- sionals, as these patients require antitoxins and antimicrobials. The CDC provides informa- tion on the subject to help educated healthcare workers to recognize this serious infection, and nurses and other healthcare providers in all settings should do their research on this condition in the event that they encounter these patients. Looking back, we have seen injection drug users who developed abscesses [in our facility], but thankfully wound botu- lism was not the causative factor.” n Joe Darrah is a freelance author based in the Philadelphia region who has been covering the healthcare field since 2004 References 1. Lorenz J. Wound botulism outbreak linked to heroin raises concern of opioid epi- demic effects. Contagion Live. 2019. Accessed online: www.contagionlive.com/news/ wound-botulism-outbreak-linked-to-hero- in-raises-concern-of-opioid-epidemic-effects 2. MacDonald KL, Rutherford GW, Friedman SM, et al. Botulism and botu- lism-like illness in chronic drug abusers. Ann Intern Med. 1985;102:616-8. OPIOID EPIDEMIC  |