Top 5 Takeaways

1. Initial Case Identification: The outbreak was first identified when a 33-year-old male experiencing homelessness was hospitalized with severe symptoms including bilateral ptosis, extremity weakness, and respiratory failure.
2. Botulism Confirmation: Botulism neurotoxin types A and B were detected in the serum of the initial patient and subsequent patients, confirming the diagnosis.
3. Drug Use Link: The outbreak was linked to the injection of black tar heroin, with patients sharing drugs and exhibiting similar symptoms.
4. Widespread Impact: A total of seven patients were identified, with four requiring mechanical ventilation and prolonged intensive care.
5. Public Health Response: The outbreak highlighted the need for increased awareness and improved case-finding efforts among persons who inject drugs and healthcare providers.

Original Article Author and Citation

Corresponding Author

Leslie D. Edwards, fjr2@cdc.gov, 404-718-3830

Suggested Citation

Edwards LD, Gomez I, Wada S, et al. Notes from the Field: Wound Botulism Outbreak Among a Group of Persons Who Inject Drugs — Dallas, Texas, 2020. MMWR Morb Mortal Wkly Rep 2022;71:556–557. DOI: http://dx.doi.org/10.15585/mmwr.mm7115a3

Summary

In December 2020, Dallas County Health and Human Services identified a wound botulism outbreak among persons who inject drugs. The initial case involved a 33-year-old male with severe neurological and respiratory symptoms. Subsequent cases were linked to the injection of black tar heroin. Seven patients were identified, with four requiring mechanical ventilation. The outbreak underscored the importance of awareness and case-finding efforts among drug users and healthcare providers.

Methods

The investigation involved clinical consultations, administration of heptavalent botulinum antitoxin (BAT), and laboratory testing using the BoNT Endopep-MS assay to detect botulism neurotoxins. Interviews with patients and their acquaintances helped identify additional cases.

Discussion

This outbreak, the first reported in Texas and the largest outside California, highlighted the challenges in identifying and linking cases due to stigma and the need for increased awareness among drug users and healthcare providers. The investigation revealed that public health efforts could be improved by educating patients and sharing information through syringe exchange programs.

Conclusion

The wound botulism outbreak in Dallas emphasized the need for heightened awareness and improved case-finding strategies among persons who inject drugs. Public health officials should focus on educating at-risk populations and healthcare providers to identify and manage future cases effectively.

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