Article: Wound botulism among black tar heroin users--Washington, 2003.

During August 22-26, 2003, four injection-drug users (IDUs) in Yakima County, Washington, sought medical care at the same hospital with complaints of several days of weakness, drooping eyelids, blurred vision, and difficulty speaking and swallowing. All four were regular, nonintravenous injectors of black tar heroin (BTH), and one also snorted BTH. This report summarizes the investigation of these cases, which implicated wound botulism (WB) as the cause of illness.

Of the four patients, two were men; the patients had a median age of 38 years (range: 31-50 years). Two patients were married and used drugs at the same time and in the same setting as the third ...

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