The incidence of wound botulism in injection drug users has increased since the introduction of black tar heroin. Many species of the Clostridium genus, most commonly Clostridium botulinum, Clostridium baratii, and Clostridium butyricum, have been associated with wound botulism. Patients often present with progressive bulbar weakness, including dysphagia, cranial nerve palsies, and loss of speech, in addition to symmetrical descending weakness of the upper extremities that may progress to the chest and lower extremities. In this article, we present 3 cases of wound botulism, in which the patients presented with bulbar weakness and were treated with botulism antitoxin heptavalent. The time to antitoxin administration and its effect on the patients’ clinical courses is compared.

The cases of human infections caused by Serratia fonticola are relatively rare. The few cases that have been reported primarily describe skin and soft tissue, urinary, and biliary tract infections. We describe a case of a 59-year-old man with infected bilateral lower extremity wounds who developed endocarditis due to S fonticola confirmed with transesophageal echocardiogram. The patient was treated with 6 weeks of antibiotic therapy and had an uneventful recovery. After a thorough review of the literature using PubMed and Google Scholar, we concluded that this is the first reported case of endocarditis caused by S fonticola.