Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—Dr Passaro and colleagues1 may have incorrectly identified the source of Clostridium botulinumspores when searching for an explanation of an outbreak of wound botulism (WB) among injecting drug users (IDUs). The authors postulate that the source of the botulism spores is contaminated "black tar" heroin (BTH) injected subcutaneously ("skin-popping"). However, it is possible that the spores come from the soiled skin of IDUs and subsequently get inoculated subcutaneously or intramuscularly during the injecting process.
Bamberger J, Terplan M. Wound Botulism Associated With Black Tar Heroin. JAMA. 1998;280(17):1479-1480. doi:10.1001/jama.280.17.1479