Wound Botulism Associated With Black Tar Heroin Among Injecting Drug Users

Staphylococcus aureus Infections in Injection Drug Users: Risk Factors and Prevention Strategies

“…Epidemics of Pseudomonas aeruginosa endocarditis have been described in IDUs, mainly abusers of pentazocine and tripelenamine, and are presumably associated with the mixing of drugs in contaminated water [53]. Finally, a recent outbreak of a clonal strain of group A streptococcus among drug users in Bern, Switzerland, may have been caused by contaminated cocaine or its containers [54], and an epidemic of wound botulism in California, may have resulted from contamination of black tar heroin most likely when it was diluted ("cut"), possibly with soil [55]. Inhalation druguse paraphernalia were identified as potential vehicles of transmission of S. aureus in inhalation drug users [56].…”

Wound Botulism Acquired in the Amazonian Rain Forest of Ecuador

“…6,7 Cases associated with trauma nearly disappeared and were replaced by an epidemic of wound botulism associated with injection drug use, specifically "skin popping" with black tar heroin. Three-fourths of the cases in the United States were reported from California.…”

“…5 Since 1990, the number of wound botulism cases reported in the United States has increased dramatically; almost all have been associated with injection of black tar heroin in residents of California. 6,7 A few cases have been reported in association with paranasal sinus infections from cocaine sniffing. 8,9 Case reports of drug-associated wound botulism from Europe followed.…”

Wound botulism in drug addicts in the United Kingdom

“…Although never reported in the UK, the association of wound botulism and injecting drug addiction has been described in the USA. In the 10 years to 1996, 78 cases were reported in the USA, the majority linked to`black tar heroin' and`skin popping' [3,14]. Of these, 66 patients were Type A, nine were Type B and three were unknown.…”