Injection
drug use (IDU), specifically non-intravenous "skin-popping" of
heroin, seems to provide optimal conditions for Clostridial
infection and toxin production. IDU is therefore a major risk factor for
wound botulism and Clostridial necrotizing
soft tissue infections (NSTI) and continues to be linked to cases of
tetanus. Case clusters of all 3 diseases have occurred among IDUs in Western U.S. and Europe. Medical personnel who care for the IDU population must be thoroughly familiar with the clinical presentation and management of these diseases.
Wound botulism presents with bulbar symptoms and signs that are easily overlooked; rapid acquisition and administration of
antitoxin can prevent neuromuscular
respiratory failure. In addition to Clostridium perfringens, IDU-related NSTIs can be caused by Clostridium sordellii and Clostridium novyi, which may share a distinct clinical presentation. Early definitive NSTI management, which decreases mortality, requires a low index of suspicion on the part of emergency physicians and low threshold for surgical exploration and
debridement on the part of the surgeon.
Tetanus should be preventable in the IDU population through careful attention to vaccination status.