Author: Don Stader, M.D. Educational Pearls Wound botulism should be considered in patients with cutaneous lesions and  neuromuscular weakness. The toxin produced by clostridium botulinum is the causative agent. It forms spores, so it is very resistant to killing by heat. It presents with weakness, most often in the extraocular muscles. Treatment includes wound care and respiratory support. Anti-toxin is rarely used as it is stored at the CDC and must be flown in. References: Kalka-Moll WM, Aurbach U, Schaumann R, Schwarz R, Seifert H. Wound Botulism in Injection Drug Users. Emerging Infectious Diseases. 2007;13(6):942-943. doi:10.3201/eid1306.061336.