Stimulated single-fiber electromyography in wound botulism

✍ Scribed by Raul N. Mandler; Ricardo A. Maselli

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 300 KB
• Volume: 19
• Category: Article
• ISSN: 0148-639X
• DOI: 10.1002/(sici)1097-4598(199609)19:9<1171::aid-mus15>3.0.co;2-y

✦ Synopsis

T h e two main forms of adult botulism include the classic foodborne, caused by the ingestion of preformed toxin, and another emergent form, wound botulism, caused by botulinum toxin released from wounds infected with ~lostridia.~ Particularly remarkable is the cluster of wound botulism in Northern California. These patients have used contaminated intravenous (IV) heroin following a subcutaneous injection technique ("poping"), which produces a slower release of the drug, as the subcutaneous tissue acts as a depot. At the same time, anaerobic bacilli, including clostridia, may colonize the injection area and produce abscesses with subsequent local and systemic intoxication. We have studied 6 wound botulism patients in the past year.' In this report we present the results of stimulated singlefiber electromyography (SSFEMG) in the last 2 patients seen, to underscore the diagnostic importance of this technique in the study of neuromuscular transmission disorders.

CASE REPORTS

Case 1. A 44year-old right-handed man with a history of IV drug abuse developed an abscess of the right upper extremity where he was injecting subcutaneous heroin. Cultures grew Staphylococcus auras. After the abscess was drained the patient was treated with antibiotics but 10 days later he began suffering from dysphagia, blurred vision, diplopia, and gener-From the