WOUND BOTULISM

All published cases of wound botulism were reviewed to describe the ep idemiology, clinical manifestations, diagnosis, and treatment of this rare infection. The MEDLINE data base of English-language literature w as searched from 1966 to 1992, using the keywords ''wound botulism''. Cases published during this period were identified, and the bibliograp hies of these articles were used to identify cases published before ME DLINE's search limit of 1966. Because of the limited number of publish ed cases , all were reviewed. Data related to epidemiology, clinical m anifestations, diagnosis and treatment were collected on each case. Wh en possible, cross-references from case series or reviews were used to corroborate and supplement data for a given case. There were 40 cases identified as wound botulism. The case fatality rate was 10%. The 36 survivors had significant morbidity requiring prolonged medical care. Wound botulism is a rare life-threatening complication of trauma and i v drug abuse. The diagnosis should be considered in any patient with e ither of these risk factors who develop paresis of cranial nerves and a descending pattern of weakness. Treatment, including administration of antitoxin, should be initiated prior to definitive diagnosis by mic robiologic laboratory tests.