RESUMO
In 2010, during an outbreak of anthrax affecting people who inject drugs, a heroin user aged 37 years presented with soft tissue infection. He subsequently was found to have anthrax. We describe his management and the difficulty in distinguishing anthrax from non-anthrax lesions. His full recovery, despite an overall mortality of 30% for injectional anthrax, demonstrates that some heroin-related anthrax cases can be managed predominately with oral antibiotics and minimal surgical intervention.
Assuntos
Antraz/diagnóstico , Dependência de Heroína/microbiologia , Infecções dos Tecidos Moles/microbiologia , Abuso de Substâncias por Via Intravenosa/microbiologia , Adulto , Antraz/terapia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Desbridamento , Gerenciamento Clínico , Humanos , Masculino , Infecções dos Tecidos Moles/terapia , Resultado do TratamentoRESUMO
BACKGROUND: In heroin injectors, there have been a number of outbreaks caused by spore-forming bacteria, causing serious infections such as anthrax or botulism. These are, most likely, caused by injecting contaminated heroin, and our aim was to develop a filter that efficiently removes these bacteria and is also likely to be acceptable for use by people who inject drugs (i.e. quick, simple and not spoil the hit). METHODS: A prototype filter was designed and different filter membranes were tested to assess the volume of liquid retained, filtration time and efficiency of the filter at removing bacterial spores. Binding of active ingredients of heroin to different types of membrane filters was determined using a highly sensitive analytical chemistry technique. RESULTS: Heroin samples that were tested contained up to 580 bacteria per gramme, with the majority being Bacillus spp., which are spore-forming soil bacteria. To remove these bacteria, a prototype filter was designed to fit insulin-type syringes, which are commonly used by people who inject drugs (PWIDs). Efficient filtration of heroin samples was achieved by combining a prefilter to remove particles and a 0.22 µm filter to remove bacterial spores. The most suitable membrane was polyethersulfone (PES). This membrane had the shortest filtration time while efficiently removing bacterial spores. No or negligible amounts of active ingredients in heroin were retained by the PES membrane. CONCLUSIONS: This study successfully produced a prototype filter designed to filter bacterial spores from heroin samples. Scaled up production could produce an effective harm reduction tool, especially during outbreaks such as occurred in Europe in 2009/10 and 2012.
Assuntos
Técnicas Bacteriológicas/instrumentação , Contaminação de Medicamentos/prevenção & controle , Infecções por Bactérias Gram-Positivas/prevenção & controle , Heroína , Bacillus subtilis/isolamento & purificação , Desenho de Equipamento , Filtração/instrumentação , Redução do Dano , Dependência de Heroína/microbiologia , Humanos , Polímeros , Esporos Bacterianos/isolamento & purificação , Abuso de Substâncias por Via Intravenosa/microbiologia , SulfonasAssuntos
Antraz/etiologia , Antraz/imunologia , Dependência de Heroína/microbiologia , Abuso de Substâncias por Via Intravenosa/microbiologia , Sequência de Aminoácidos , Antígenos de Bactérias/imunologia , Bacillus anthracis/imunologia , Epitopos/química , Epitopos/imunologia , Dependência de Heroína/imunologia , Humanos , Memória Imunológica , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Abuso de Substâncias por Via Intravenosa/imunologiaAssuntos
Descompressão Cirúrgica/psicologia , Abscesso Epidural/cirurgia , Dependência de Heroína/psicologia , Dependência de Heroína/cirurgia , Medula Espinal/cirurgia , Infecções Estafilocócicas/psicologia , Descompressão Cirúrgica/métodos , Abscesso Epidural/complicações , Abscesso Epidural/microbiologia , Dependência de Heroína/complicações , Dependência de Heroína/microbiologia , Humanos , Masculino , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/cirurgia , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/microbiologia , Abuso de Substâncias por Via Intravenosa/cirurgia , Vértebras Torácicas/cirurgia , Fatores de Tempo , Adulto JovemRESUMO
Injecting drug users are prone to atypical infections. We present a case of septic thrombophlebitis secondary to Fusobacterium gonidiaformans infection in a heroin user, which demonstrates the frequently unusual nature of pathogens and presentations in this group of patients.
Assuntos
Infecções por Fusobacterium/complicações , Infecções por Fusobacterium/diagnóstico , Dependência de Heroína/microbiologia , Sepse/microbiologia , Tromboflebite/microbiologia , Adulto , Antibacterianos/uso terapêutico , Fusobacterium/isolamento & purificação , Infecções por Fusobacterium/tratamento farmacológico , Dependência de Heroína/complicações , Humanos , Masculino , Sepse/complicações , Sepse/diagnóstico , Abuso de Substâncias por Via Intravenosa/complicações , Tromboflebite/complicaçõesRESUMO
Wound botulism is a rare infectious disease that is becoming a frequent complication of parental drug use. Diagnosis is often difficult and based on clinical suspicion. We report the first Italian case of wound botulism due to intramuscular heroin injection in a 48-year-old man with an acute onset of slurred speech and dysphagia. The most considerable finding of electrophysiological study was the reduction in amplitude of compound muscle action potential which should be considered a useful initial electrodiagnostic sign in the clinical context of botulism. Alerting clinicians to botulism is crucial for a rapid diagnosis and appropriate treatment and thus decreasing mortality and complications.
Assuntos
Botulismo/diagnóstico , Botulismo/transmissão , Dependência de Heroína/diagnóstico , Dependência de Heroína/microbiologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/microbiologia , Clostridium botulinum/patogenicidade , Diagnóstico Diferencial , Evolução Fatal , Dependência de Heroína/complicações , Humanos , Injeções Intramusculares/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pele/lesõesAssuntos
Portador Sadio/microbiologia , Transtornos Relacionados ao Uso de Cocaína/microbiologia , Dependência de Heroína/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Cavidade Nasal/microbiologia , Infecções Estafilocócicas/microbiologia , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Feminino , Dependência de Heroína/tratamento farmacológico , Humanos , Irlanda , Masculino , Metadona/administração & dosagem , Centros de Tratamento de Abuso de SubstânciasRESUMO
Between October and December 2005, 16 cases of wound botulism were notified to the health authorities of North Rhine-Westphalia, Germany. All patients were injecting drug users (IDU) and the epidemiological investigations suggested contaminated injection drugs as the most probable source of infection. Clostridium botulinum was cultivated from clinical samples of six patients and molecular typing revealed that the different isolates were clonally identical. Two samples of heroin, one of them provided by a patient, were examined but C. botulinum could not be isolated. This outbreak demonstrates that IDU are at risk for acquiring wound botulism by injecting contaminated drugs. A greater awareness of this disease is needed by physicians and a close cooperation between public health authorities, street workers, operators of sheltered injecting facilities, and medical centres focusing on IDU is essential to prevent and manage outbreaks in IDU in a timely manner.
Assuntos
Botulismo/epidemiologia , Surtos de Doenças , Dependência de Heroína/microbiologia , Abuso de Substâncias por Via Intravenosa/microbiologia , Infecção dos Ferimentos/epidemiologia , Adulto , Botulismo/genética , Clostridium botulinum/genética , Eletroforese em Gel de Campo Pulsado , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecção dos Ferimentos/microbiologia , Adulto JovemRESUMO
A 10-year review of records of the King County Medical Examiner's Office found 87 deaths due to necrotizing fasciitis and related necrotizing soft tissue infections. In 64 of these cases there were sufficient details to provide an analysis of the manifestations, microbiology, and source of infection. One half (32) of the cases were due to injection of black tar heroin, the nearly exclusive form of heroin in the Northwest United States. Of those due to black tar injection, 24 were clostridial infections with various species represented, eight of which were Clostridium sordellii. Of the 32 cases not associated with drug injection, streptococcal species predominated, with Streptococcus pyogenes isolated in 14 cases. Only three of 32 cases not associated with injection drug use were clostridial infections. These differences were statistically significant. Staphylococcus aureus was isolated from 14 cases; two were methicillin-resistant strains. Overall, 28 of the 64 cases were polymicrobial infections, 15 due to black tar injection and 13 not associated with drug injection. This study supports the conclusion that necrotizing fasciitis due to black tar heroin injection is predominantly a clostridial disease, and in this way differs significantly from necrotizing fasciitis due to other causes.
Assuntos
Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Clostridium/crescimento & desenvolvimento , Fasciite Necrosante/epidemiologia , Fasciite Necrosante/microbiologia , Dependência de Heroína/epidemiologia , Dependência de Heroína/microbiologia , Feminino , Ciências Forenses , Humanos , Masculino , Estudos Retrospectivos , Washington/epidemiologiaAssuntos
Botulismo/complicações , Botulismo/diagnóstico , Dependência de Heroína/complicações , Oftalmoplegia/etiologia , Distúrbios da Fala/etiologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Dependência de Heroína/microbiologia , Humanos , Intubação Intratraqueal , Masculino , Exame Neurológico , Oftalmoplegia/microbiologia , Distúrbios da Fala/microbiologia , Abuso de Substâncias por Via Intravenosa/microbiologia , Ferimentos e Lesões/microbiologiaRESUMO
Beside immunodepression induced by the human immunodeficiency virus, fungal infections of the central nervous system are extremely rare in heroin-addict patients. We report here a case of meningo-encephalitis with myelo-radicular lesions in a 25-year-old intravenous heroin addict but non-HIV patient, who was admitted for an acute confusion associated with gait disorders. The diagnosis of Candida albicans meningo-encephalo-myelo-radiculitis was established by magnetic resonance imagery and mycological and serological examinations of cerebrospinal fluid. The infection was cured with amphotericin B lipid complex and 5-fluorocytosine. Early diagnosis and antifungal therapy for 6 months resulted in a favorable outcome. The detection of circulating Candida mannan in cerebrospinal fluid with a more sensitive technique combined to MRI were particularly decisive to confirm Candida infection diagnosis, allowing an appropriate antifungal therapy.
Assuntos
Candidíase/diagnóstico , Dependência de Heroína/complicações , Meningite Fúngica/microbiologia , Radiculopatia/microbiologia , Adulto , Antifúngicos/uso terapêutico , Candidíase/complicações , Dependência de Heroína/microbiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningite Fúngica/complicações , Radiculopatia/complicações , Resultado do TratamentoRESUMO
Aneurysm of the superior mesenteric artery (SMA) is rare. We, in this study, present the case of a 21-year-old woman with a history of heroin abuse who was admitted to our hospital for infective endocarditis complicated by floating vegetation at the posterior mitral valve. After receiving 2-week antibiotic treatment, the patient had acute abdominal pain. Computed tomography demonstrated an aneurysm at the SMA. The mycotic aneurysm was resected and the mitral valve was repaired successfully. This report reviews the pathophysiology of mycotic aneurysms of the SMA and role of computed tomography in the differential diagnosis of this condition from acute mesenteric ischaemia.
Assuntos
Aneurisma Infectado/microbiologia , Dependência de Heroína/microbiologia , Artéria Mesentérica Superior/microbiologia , Adulto , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/cirurgia , Ecocardiografia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Feminino , Humanos , Artéria Mesentérica Superior/cirurgia , Valva Mitral/microbiologia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/microbiologia , Insuficiência da Valva Mitral/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Clostridial infections in injecting drug users in the United Kingdom are a relatively new phenomenon that came to light in 2000 when cases of serious illness and deaths due to Clostridium novyi were recorded. In the period December 2003 to April 2004, the Anaerobe Reference Laboratory received twelve referrals of an extremely rare isolate, Clostridium histolyticum, from cases of infection in injecting drug users submitted from nine different hospitals in England and Scotland. Molecular typing of these isolates by two different methods of pulsed-field gel electrophoresis and PCR ribotyping revealed they are all indistinguishable, indicating a common source of the infections, most probably a batch of heroin that was recently distributed across the UK.
Assuntos
Infecções por Clostridium/epidemiologia , Clostridium histolyticum , Dependência de Heroína/microbiologia , Adulto , Infecções por Clostridium/microbiologia , Surtos de Doenças , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Escócia/epidemiologiaRESUMO
In California, black tar heroin (BTH) use among injection drug users (IDUs) has resulted in an increased number of cases of wound botulism due to Clostridium botulinum, tetanus due to Clostridium tetani, and necrotizing soft-tissue infections due to a variety of clostridia. From December 1999 to April 2000, nine IDUs in Ventura County, California, developed necrotizing fasciitis; 4 died. Cultures of wound specimens from 6 case patients yielded Clostridium sordellii. Some of the patients appeared to have the toxic shock syndrome previously reported to be characteristic of toxin-mediated C. sordellii infection, which is characterized by hypotension, marked leukocytosis, and hemoconcentration. The suspected source of this outbreak was contaminated BTH that was injected subcutaneously or intramuscularly ("skin popped"). This outbreak of C. sordellii infection serves as another example of how BTH can potentially serve as a vehicle for transmitting severe and often deadly clostridial infections, and reinforces the need to educate IDUs and clinicians about the risks associated with skin popping of BTH.
Assuntos
Infecções por Clostridium/epidemiologia , Clostridium , Surtos de Doenças , Fasciite Necrosante/epidemiologia , Dependência de Heroína/complicações , Adulto , California/epidemiologia , Infecções por Clostridium/complicações , Fasciite Necrosante/complicações , Feminino , Dependência de Heroína/microbiologia , Hospitalização , Humanos , Pessoa de Meia-Idade , Abuso de Substâncias por Via Intravenosa/complicaçõesRESUMO
A high frequency of Bartonella elizabethae seropositivity (39%) was recorded among intravenous heroin addicts in Stockholm, Sweden, who died from a lethal injection. Some of the B. elizabethae-seropositive individuals also had antibodies to B. henselae Houston-1, B. grahamii, and B. quintana, but none had antibodies to B. henselae Marseille or B. vinsonii subsp. vinsonii. Hepatitis was a frequent finding but no case had peliosis hepatitis. There was no case of endocarditis, but in three persons active subacute-to-chronic myocarditis was found; two of these cases were Bartonella-positive and HIV-negative.
Assuntos
Bartonella/isolamento & purificação , Dependência de Heroína/microbiologia , Adulto , Antígenos de Bactérias/sangue , Autopsia , Bartonella/imunologia , Infecções por Bartonella/diagnóstico , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Medicina Legal , Dependência de Heroína/mortalidade , Humanos , Masculino , Abuso de Substâncias por Via Intravenosa/microbiologia , SuéciaRESUMO
Invasive infections caused by bacteria and fungi are common complications of intravenous drug abuse. Various vital organs and structures may be affected, e.g. the cardiac valves, the larger arteries, the bones, the joints and the central nervous system. However, due to the high frequency of low-virulent microbes of skin and oral origin, the clinical picture may be atypical with subacute course and few focal signs and symptoms. The complexity of this problem is illustrated by eight cases of serious bacterial and fungal infections recently diagnosed at our hospitals. All patients were HIV negative intravenous heroin addicts. The clinical spectrum was wide and included skin abscesses, pyomyositis, spondylodiscitis, septic arthritis, costal osteomyelitis, infective endocarditis, recurrent bacteraemia, and multiple brain abscesses.
Assuntos
Infecções Bacterianas/etiologia , Dependência de Heroína/microbiologia , Micoses/etiologia , Abuso de Substâncias por Via Intravenosa/microbiologia , Abscesso/microbiologia , Adulto , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Infecções Bacterianas/diagnóstico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/microbiologia , Candidíase/diagnóstico , Candidíase/etiologia , Discite/diagnóstico por imagem , Discite/microbiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Espaço Epidural , Feminino , Dependência de Heroína/complicações , Humanos , Masculino , Micoses/diagnóstico , Miosite/microbiologia , Miosite/patologia , Radiografia , Infecções Estafilocócicas/etiologia , Abuso de Substâncias por Via Intravenosa/complicaçõesAssuntos
Endocardite Bacteriana/patologia , Dependência de Heroína/microbiologia , Infecções Estafilocócicas/patologia , Adulto , Amputação Cirúrgica , Endocardite Bacteriana/complicações , Endocardite Bacteriana/cirurgia , Feminino , Dedos , Pé/cirurgia , Implante de Prótese de Valva Cardíaca , Dependência de Heroína/complicações , Dependência de Heroína/patologia , Humanos , Pele/patologia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/cirurgia , Staphylococcus aureus/isolamento & purificação , Dedos do Pé/cirurgiaRESUMO
Candida albicans is a ubiquitous commensal organism of humans. Several studies have examined outbreaks of candidiasis in heroin addicts utilizing a variety of methods to assess the epidemiological relatedness of the isolates and suggested the association of certain subtypes with disease in this patient population. The aim of the present study was to assess a separate group of isolates of C. albicans from heroin addicts in Spain using a DNA typing method. Results showed that, of the 34 isolates from heroin addicts, 20 were in subgroup IA, 10 were in subgroup IB and no isolates were of the subtype IA2. In addition, four isolates were in a recently described subgroup IC. Control isolates from the same geographical region (Spain) showed a distribution similar to the Spanish heroin addict isolates (12 subgroup IA, three subgroup IB, two subgroup IC and no isolates of the subtype IA2). In this study isolates from the same locality appeared similar irrespective of the patient population from which they were isolated. These results indicated that there may be differing geographical diversity of C. albicans than has previously been reported and that the newly described genotypic subgroup (IC) of C. albicans may be more widespread than previously shown.