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8 : Wound Botulism, Tetanus, and Necrotizing Fasciitis among Injecting Drug Users in California: the Clostridial Connection

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Wound Botulism, Tetanus, and Necrotizing Fasciitis among Injecting Drug Users in California: the Clostridial Connection, Page 1 of 2

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Abstract:

Diseases caused by clostridia are often mediated via toxins. For botulism and tetanus, specific neurotoxins produced by and affect different areas in the nervous system to cause weakness or spasticity. In 1995, the California Department of Health Services (CDHS) documented an increase in the reported number of cases of wound botulism (WB) that started in 1994. A total of 96 cases of tetanus were reported to occur in California between 1988 and 2000. Necrotizing soft tissue infections (NSTIs) and necrotizing fasciitis are not reportable conditions in California. The proportion of cases with necrotizing fasciitis was over 80% at two of the three hospitals, and the mortality rate ranged from 10 to 27%. The recent epidemic of wound botulism (WB), tetanus, and NSTIs among injecting drug users (IDUs) in California is likely due, in great part, to skin popping of black tar heroin (BTH) contaminated with species. Injection drug use is a complicated issue, and IDUs are a difficult population to reach with prevention messages. These messages will have to address drug rehabilitation to decrease the risk of infection with blood-borne pathogens along with the risk for WB, tetanus, and NSTIs. In recent years, California clinicians have seen increasing numbers of serious infections among IDUs, including WB, tetanus, and necrotizing fasciitis. The recent epidemics of WB, tetanus, and NSTIs among IDUs in California are likely due, in great part, to skin popping of BTH contaminated with species.

Citation: Vugia D, Werner S, Woodfill C. 2004. Wound Botulism, Tetanus, and Necrotizing Fasciitis among Injecting Drug Users in California: the Clostridial Connection, p 111-120. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch8
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Figures

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Figure 1

Number of IDUs with WB in California by year, 1988 to 2000. (Source: California Department of Health Services.)

Citation: Vugia D, Werner S, Woodfill C. 2004. Wound Botulism, Tetanus, and Necrotizing Fasciitis among Injecting Drug Users in California: the Clostridial Connection, p 111-120. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch8
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Image of Figure 2
Figure 2

Number of IDUs with tetanus in California by year of onset, 1988 to 2000. (Source: California Department of Health Services.)

Citation: Vugia D, Werner S, Woodfill C. 2004. Wound Botulism, Tetanus, and Necrotizing Fasciitis among Injecting Drug Users in California: the Clostridial Connection, p 111-120. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch8
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Figure 3

Number of cases of necrotizing soft tissue infections by year at a hospital in Oakland, Calif., 1990 to 1995. (Reprinted from with permission of the publisher. Copyrighted 1996, American Medical Association.)

Citation: Vugia D, Werner S, Woodfill C. 2004. Wound Botulism, Tetanus, and Necrotizing Fasciitis among Injecting Drug Users in California: the Clostridial Connection, p 111-120. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch8
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Figure 4

Number of IDUs with necrotizing soft tissue infections by year at a hospital in San Francisco, Calif., 1992 to 1997. (Reprinted from with permission of the publisher. Copyrighted 1998, American Medical Association.)

Citation: Vugia D, Werner S, Woodfill C. 2004. Wound Botulism, Tetanus, and Necrotizing Fasciitis among Injecting Drug Users in California: the Clostridial Connection, p 111-120. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch8
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Figure 5

Number of IDUs with necrotizing soft tissue infections by year at a hospital in Sacramento, Calif., 1987 to 1999. (Reprinted from with permission of the publisher.)

Citation: Vugia D, Werner S, Woodfill C. 2004. Wound Botulism, Tetanus, and Necrotizing Fasciitis among Injecting Drug Users in California: the Clostridial Connection, p 111-120. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch8
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References

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Tables

Generic image for table
Table 1

Selected clostridia and associated clinical illnesses

Citation: Vugia D, Werner S, Woodfill C. 2004. Wound Botulism, Tetanus, and Necrotizing Fasciitis among Injecting Drug Users in California: the Clostridial Connection, p 111-120. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch8
Generic image for table
Table 2

Characteristics of NSTIs involving IDUs at three California hospitals

Citation: Vugia D, Werner S, Woodfill C. 2004. Wound Botulism, Tetanus, and Necrotizing Fasciitis among Injecting Drug Users in California: the Clostridial Connection, p 111-120. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch8
Generic image for table
Table 3

Bacteriologic findings of NSTIs among IDUs at three California hospitals

Citation: Vugia D, Werner S, Woodfill C. 2004. Wound Botulism, Tetanus, and Necrotizing Fasciitis among Injecting Drug Users in California: the Clostridial Connection, p 111-120. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch8

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