Epidemiologic, Clinical and Laboratory Aspects of Wound Botulism

An analysis of the clinical, epidemiologic and laboratory aspects of nine patients with wound botulism showed that all had characteristic clinical findings, including respiratory paralysis. Five cases were reported between April, 1971, and November, 1972. Laboratory confirmation was obtained in six cases by demonstration of botulinal toxin in serum or isolation of Clostridium botulinum from a wound or both; all were Type A. Although four of the nine patients died, only one of the six most recent cases was fatal. Electromyography was helpful in confirming the diagnosis in three cases. A diagnosis of wound botulism should be considered when characteristic neurologic abnormalities are present and no food item can be implicated epidemiologically. Use of proper laboratory methods for detection of botulinal toxin and identification of clostridial isolates is imperative. (N Engl J Med 289:1005–1010, 1973).