Clinical characteristic frequency of WB patients’ initial and second episodes was compared with the Mc Nemar test, which accounted for the correlated nature of the data. The self-reported length of time from symptom onset to presentation for initial and subsequent infections was compared using the Wilcoxon signed-rank test.

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Early treatment with botulinum antitoxin and supportive care may prevent the progression to respiratory failure.

Recovery often takes weeks to months, although 95% of cases in the United States achieve full recovery.

The patient's serum or culture extracts, alone or mixed with monovalent botulinum antitoxin, are injected into the peritoneum of mice.

Mice are then observed for signs or symptoms of botulism.

There were no significant differences in clinical presentation between initial and second episodes.

As the California epidemic of WB among IDUs continues, WB episodes are recurring.If botulinum toxin is present in the sample, mice receiving the appropriate monovalent botulinum antitoxin are asymptomatic and survive.During 1993–2006, we identified 17 case patients with recurrent WB, 14 with 1 recurrent episode and 3 with 2 recurrent episodes.We reported the first documented case of recurrent WB early in the epidemic with an IDU having had 2 separate episodes of wound botulism, first in 1995 then in 1997, both due to type A Bo NT [5].In this report, we review and summarize the epidemiologic and clinical characteristics of 17 IDUs with recurrent WB in California from 1993 through 2006 and describe 2 case patients’ clinical presentations in detail.The 3 major forms of naturally occurring botulism are (1) food-borne botulism resulting from ingestion of foods containing preformed Bo NT, (2) intestinal (infant and adult intestinal toxemia) botulism resulting from contaminates a wound and also produces Bo NT in situ [1, 2].