First Case of Type E Wound Botulism Diagnosed Using

Wound botulism is a growing problem among injecting drug users. The condition is often difficult to diagnose, with laboratory confirmation in only 50% of the cases. Here we present a real-time PCR-based method for the diagnosis of wound botulism caused by Clostridium botulinum. The assay includes an internal amplification control which is amplified simultaneously with the genes encoding neurotoxin types A, B, and E. This method was used to detect the first case of wound botulism in an injecting drug user in Sweden. In addition, to the best of our knowledge, this is the first reported case of wound botulism caused by C. botulinum type E. Wound botulism has been, except in times of war, a very rare form of botulism, occurring mainly in patients with traumatic and surgical wounds that were contaminated with dirt contain- ing Clostridium botulinum spores. The spores germinate and botulinum neurotoxin is produced in vivo. The symptoms of botulism are caused by the irreversible binding of the neuro- toxin to presynaptic motor-neuron terminals, which blocks acetylcholine transmission across the neuromuscular junction. Botulism typically presents as a progressive, symmetrical, flac- cid, descending paralysis without sensory involvement; it cre- ates a pathognomonic clinical picture, but due to the rarity of