Wound botulism used to be a rare form of a rare disease but recent outbreaks among injecting drug users in the USA and UK have changed this epidemiological pattern. Three years ago when I saw my first patient it was very unfamiliar territory. But once seen, never forgotten. When some months ago I was asked to see a patient in the Intensive Therapy Unit (ITU), a known drug user, who had collapsed with respiratory failure, the history sounded unmistakable and I had little doubt what the diagnosis would be. This was the fourth case in an injecting drug user seen in our centre over the last three years.
Botulism is caused by the spore-forming strict anaerobic bacterium, Clostridium botulinum, found in soil and aquatic sediments. It produces the most potent neurotoxin known in nature. Botulinum toxin spreads systemically and binds irreversibly to the presynaptic portion of cholinergic synapses
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