A history of drug injection or a food history that does not identify a probable source for foodborne botulism should prompt consideration of wound botulism and elicitation of a thorough history and physical examination for evidence of cellulitis or abscess. A meticulous physical examination is necessary because wounds containing C. botulinum may be small and initially unnoticed. Initial treatment decisions should not necessarily await neurologic test results. The administration of antitoxin is not contraindicated by pregnancy. Wounds suspected of being contaminated with C. botulinum should be widely debrided and irrigated, ideally after the administration of botulinal antitoxin.
Mechanical ventilation is the main supportive therapy for treatment of severe botulism.
Because of the increase in wound botulism cases, CDHS has publicized this problem through press releases and provided informational materials for county health officials, ED physicians, and community-based organizations offering outreach to drug users. In addition, injecting-drug users should be reminded of the health risks associated with illicit drug use, including the possibility of botulism. Botulism associated with Clostridium botulinum sinusitis after intranasal cocaine abuse. Equine antitoxin use and other factors that predict outcome in type A foodborne botulism. Mandell, Douglas and Bennett's principles and practice of infectious diseases.