NHS staff are investigating two suspected cases of wound botulism in injecting drug users.
It has been confirmed that one case has been identified in NHS Greater Glasgow and Clyde and one in NHS Lanarkshire. Both individuals are receiving hospital treatment
The reported onset of symptoms was in early October 2015.
The cause of the infections is being investigated with the focus on injecting heroin users.
The development comes four months after Police Scotland confirmed 44 people in Scotland were admitted to hospitals in the six months from December, last year with illness where botulism was suspected. It was understood ten of those people died.
In a circular Duncan Hill, specialist pharmacist in substance abuse for NHS Lanarkshire has said the source of the infection is "currently unknown" but warned that previous investigations have linked cases to batches of illicit contaminated heroin.
"As such there is a potential for more cases to arise," he warned.
Foil was given out by healthcare workers to cut down the risks connected to injecting, following a botulism outbreak in the city.
Users can use the foil to heat up and inhale the class-A substance instead of injecting with a needle.
Around 300 addiction staff were trained up as part of the project to encourage drug users to try foil.
The pilot started in September last year but was stepped up following the cases of heroin being contaminated with the botulism toxin.
Patients with botulism can often have blurred vision, slurred speech, difficulty swallowing and muscle weakness.
If left untreated the illness can lead to paralysis and death.
Mr Hill warned: "Due to the complex nature of heroin distribution across Scotland, there is a potential for cases of wound botulism to arise locally."
He asked all relevant health practitioners to increase awareness in hospitals and other healthcare settings to support prompt diagnosis and treatment as well as reporting possible or probable cases to the NHS.
He called for increased awareness among heroin users, their social networks and drug treatment and harm reduction services regarding the signs and symptoms of wound botulism infection and of the importance of seeking medical treatment immediately.
He said heroin users should be encouraged to reduce or eliminate use use by promoting access to appropriately-dosed opiate substitution treatment.
Mr Hill added: "The potential risk will depend on the stage of contamination. If heroin contamination occurred early in the stage of distribution, it cannot be excluded that additional wound botulism-infected heroin injectors will be identified.
"Can you please take any opportunity to raise the awareness amongst injecting drug users of the potential for serious soft tissue infections and to advise them to seek medical attention immediately should they develop such a condition.
"Wound botulism is a rare and very serious bacterial infection that is acquired when spores of the botulism bacterium get into the body. The spores can be found in soil but may also be present in contaminated supplies of street drugs such as heroin.
"Drug users may become infected through injecting the contaminated drugs into the skin and muscles.
"People who inject drugs who develop clinical signs of botulism should be referred hospital for evaluation and sampling. Sampling cannot be done in primary care."
Dr Gillian Penrice, NHS Greater Glasgow and Clyde Consultant in Public Heath Medicine, added: “I urge all drug injecting heroin users to be extremely alert.
"Heroin users should avoid injecting heroin into their muscles. Injecting heroin into a vein or smoking can reduce the risk of botulism, although not using heroin at all is by far the best course of action."
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