Wound botulism in drug addicts in the United Kingdom

Mulleague, Larry; Bonner, Stephen; Samuel, Anish; Nichols, P.F.; Khan, Moe; Shaw, Spencer; Grüning, T.

doi:10.1046/j.1365-2044.2001.01833.x

Cited by 22 publications

(14 citation statements)

References 17 publications

(16 reference statements)

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“…C. novyi type A was the likely cause of the more serious illnesses [12,[14][15][16], although other endospore-forming bacteria were also associated with some cases including C. perfringens [16] and B. cereus [17]. Cases of wound botulism were also reported in IDUs during 2000 and these represent the first recognition of this condition in the UK [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

An investigation into the microflora of heroin

McLauchlin¹,

Mithani²,

Bolton³

et al. 2002

Journal of Medical Microbiology

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In 2000, an unusual increase of morbidity and mortality among illegal injecting drug users in the UK and Ireland was reported and Clostridium novyi was identified as the likely source of the serious infection, although infections due to C. botulinum and Bacillus cereus were also reported. Because heroin was a possibile source of infection, this study investigated the microflora of heroin samples seized in England during 2000 and 2002. Two methods were developed for the examination of the microflora of heroin. The first consisted of suspension of the drug in maximum recovery diluent (MRD) which was inoculated directly into Clostridium Botulinum Isolation Cooked Meat Broth (CBI). The second method rendered the heroin soluble in citric acid, concentrated particulate material (and bacterial cells) by filtration and removed heroin residues by washing with citric acid and phosphate-buffered saline before placing the filter in CBI broth. Duplicate CBI broths from both methods were incubated without heating and after heating at 608C for 30 min. Subcultures were made after incubation for 7 and 14 days on to eight different solid media. The methods were evaluated with heroin samples spiked with either C. botulinum or C. novyi spore suspensions; recovery of 10 spores in the original sample was demonstrated. Fifty-eight heroin samples were tested by citric acid solubilisation and 34 by the MRD suspension technique. Fifteen different grampositive species of four genera were recognised. No fungi were isolated. Aerobic endospore-forming bacteria (Bacillus spp. and Paenibacillus macerans) were the predominant microflora isolated and at least one species was isolated from each sample. B. cereus was the most common species and was isolated from 95% of all samples, with B. licheniformis isolated from 40%. Between one and five samples yielded cultures of B. coagulans, B. laterosporus, B. pumilus, B. subtilis and P. macerans. Staphylococcus spp. were isolated from 23 (40%) samples; S. warneri and S. epidermidis were the most common and were cultured from 13 (22%) and 6 (10%) samples respectively. One or two samples yielded cultures of S. aureus, S. capitis and S. haemolyticus. The remainder of the flora detected comprised two samples contaminated with C. perfringens and two samples with either C. sordellii or C. tertium. Multiple bacterial species were isolated from 43 (74%) samples, a single species from the remaining 15. In 13 samples B. cereus alone was isolated, in one B. subtilis alone and in one sample B. pumilus alone. C. botulinum and C. novyi were not isolated from any of the heroin samples. Recommendations for the optimal examination of the microflora of heroin are given.

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Section: Introductionmentioning

confidence: 99%

An investigation into the microflora of heroin

McLauchlin¹,

Mithani²,

Bolton³

et al. 2002

Journal of Medical Microbiology

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“…Abscesses were not detected in at least three patients. Descriptions of the clinical presentations of some of the confirmed cases have been published: case 3 (Anonymous, 2000;Athwal et al, 2001;Mulleague et al, 2001), case 4 (Mulleague et al, 2001), case 5 (Hood et al, 2000) and case 22 (Merrison et al, 2002). A brief summary of these and other, non-confirmed, cases follows.…”

Section: Clinical Presentation Of Casesmentioning

confidence: 99%

Wound botulism in the UK and Ireland

Brett¹,

Hallas²,

Mpamugo³

2004

Journal of Medical Microbiology

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“…REV. 157,166,213). Wound botulism follows when C. botulinum spores germinate and grow in profound wounds or abscesses that provide anaerobic conditions.…”

Section: Wound Botulismmentioning

confidence: 99%

Laboratory Diagnostics of Botulism

2006

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SUMMARY Botulism is a potentially lethal paralytic disease caused by botulinum neurotoxin. Human pathogenic neurotoxins of types A, B, E, and F are produced by a diverse group of anaerobic spore-forming bacteria, including Clostridium botulinum groups I and II, Clostridium butyricum, and Clostridium baratii. The routine laboratory diagnostics of botulism is based on the detection of botulinum neurotoxin in the patient. Detection of toxin-producing clostridia in the patient and/or the vehicle confirms the diagnosis. The neurotoxin detection is based on the mouse lethality assay. Sensitive and rapid in vitro assays have been developed, but they have not yet been appropriately validated on clinical and food matrices. Culture methods for C. botulinum are poorly developed, and efficient isolation and identification tools are lacking. Molecular techniques targeted to the neurotoxin genes are ideal for the detection and identification of C. botulinum, but they do not detect biologically active neurotoxin and should not be used alone. Apart from rapid diagnosis, the laboratory diagnostics of botulism should aim at increasing our understanding of the epidemiology and prevention of the disease. Therefore, the toxin-producing organisms should be routinely isolated from the patient and the vehicle. The physiological group and genetic traits of the isolates should be determined.

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Wound botulism in drug addicts in the United Kingdom

Cited by 22 publications

References 17 publications

An investigation into the microflora of heroin

An investigation into the microflora of heroin

Wound botulism in the UK and Ireland

Laboratory Diagnostics of Botulism

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