Public Health – Seattle & King County is investigating two cases of suspected botulism in King County residents who may have been infected by injecting contaminated “black tar” heroin.

Texas has reported four similar cases among injection drug users since August 26, 2011. No link between the King County and Texas cases has been identified. Botulism is a life-threatening but rare illness caused by a toxin produced by Clostridium botulinum bacteria.

“There is no way for a person on the street to tell if black tar heroin is contaminated, nor any way to clean it to make it safe,” said Dr. Jeff Duchin, chief of the Communicable Disease Epidemiology and Immunization Section for Public Health – Seattle & King County. “The best way for injection drug users to prevent getting the disease is not to use heroin, but for those who do, they need to be aware of the risk of botulism and seek medical attention immediately if they develop symptoms.”

Symptoms of wound botulism can occur several days after being exposed to the bacteria but may develop up to two weeks later. The most notable initial symptoms are blurred vision and difficulty speaking or swallowing, associated with fatigue, dizziness and worsening weakness that can lead to paralysis. Usually there is no fever or change in consciousness from the infection.

In serious cases, people experience paralysis of breathing muscles, which may lead to death without hospital treatment. Some need to be on a breathing machine until they can breathe on their own. Full recovery may take months.

The first King County resident is an adult female with a history of “black tar” heroin injection who presented to a King County hospital with slurred speech, double vision, and drooping eyelids at the end of August. About a week later, an adult male with a similar history of injection drug use was admitted with similar symptoms. Both worsened and required admission to an intensive care unit. Botulism is strongly suspected in both cases, and testing to confirm the diagnosis is pending at the Washington State Public Health Laboratory.

Botulism-producing bacteria can contaminate “black-tar” heroin, and injection drug users can develop botulism after injecting even if infected wounds are not apparent. Botulism also can be transmitted by consuming food that is contaminated with toxin-producing bacteria or their spores.

Not using heroin is the best way to prevent botulism, but for those who continue to use, other ways to reduce the risk include:

• Ensure that all works and skin are clean.

• Don’t use “black tar” heroin, which cannot be cleaned. “Cooking” the drug does not kill botulism bacteria.

• Don’t share needles, syringes, filters, cookers, or water.

• Always use a new sterile syringe.

• If reusing a syringe, clean it well with bleach.

• Get a tetanus shot every five years.

Public Health has also alerted local health care providers to be alert for the signs and symptoms of botulism and consider the diagnosis early so that treatment can be administered.

For more information refer to Public Health – Seattle & King County’s website at: www.kingcounty.gov.