Infectious diseases, comorbidities and outcomes in hospitalized people who inject drugs (PWID) infections in persons who inject drugs.

Injection drug use poses a public health challenge. Clinical experience indicates that people who inject drugs (PWID) are hospitalized frequently for infectious diseases, but little is known about outcomes when admitted. Charts were identified from local hospitals between 2013-2018 using consultation lists and hospital record searches. Included individuals injected drugs in the past six months and presented with infection. Charts were accessed using the hospital information system, undergoing primary and secondary reviews using Research Electronic Data Capture (REDCap). The Wilcoxon rank-sum test was used for comparisons between outcome categories. Categorical data were summarized as count and frequency, and compared using Fisher's exact test. Of 240 individuals, 33% were admitted to the intensive care unit, 36% underwent surgery, 12% left against medical advice (AMA), and 9% died. Infectious diagnoses included bacteremia (31%), abscess (29%), endocarditis (29%), cellulitis (20%), sepsis (10%), osteomyelitis (9%), septic arthritis (8%), pneumonia (7%), discitis (2%), meningitis/encephalitis (2%), or other (7%). Sixty-six percent had stable housing and 60% had a family physician. Fifty-four percent of patient-initiated discharges were seen in the emergency department within 30 days and 29% were readmitted. PWID are at risk for infections. Understanding their healthcare trajectory is essential to improve their care.

Listeria pericarditis in a lymphoma patient: Case report and literature review.

We present a case of pericarditis with pericardial effusion secondary to Listeria monocytogenes. A 56-year-old man presented with signs of acute pericarditis, but with prior chronic lymphocytic leukemia treated with stem cell transplantation, chronic graft-versus-host disease, and a recent diagnosis of untreated diffuse large B-cell lymphoma. He developed cardiac tamponade requiring pericardiocentesis. Blood and pericardial cultures grew Listeria monocytogenes. He responded to ampicillin but later died from gram-negative sepsis. A systematic review found 10 other published English-language cases of pericarditis caused by Listeria. The most common risk factors were cirrhosis and malignancy. Only three patients survived both the listeriosis and their underlying infections. Listeria monocytogenes is a rare and often fatal cause of pericarditis, typically occurring in immunocompromised patients. Cultures showing gram-positive bacilli in the context of pericarditis in an immunocompromised patient should prompt consideration of this rare cause.

Les auteurs présentent un cas de péricardite avec effusion secondaire au Listeria monocytogenes. Un homme de 56 ans a consulté à cause de signes de péricardite aiguë. Il souffrait déjà d'une leucémie lymphoïde chronique traitée par une greffe de cellules souches et d'une réaction chronique du greffon contre l'hôte et avait récemment reçu un diagnostic de lymphome diffus à grandes cellules B non traité. Il a développé une tamponnade cardiaque exigeant une péricardiocentèse. Les cultures sanguine et péricardique ont révélé la présence de Listeria monocytogenes. Le patient a répondu à l'ampicilline, mais a fini par mourir d'un sepsis à Gram négatif. Une analyse systématique a révélé dix autres cas de péricardite causés par la Listeria dans des publications en langue anglaise. La cirrhose et les tumeurs en étaient les principaux facteurs de risque. Seulement trois patients ont survécu à la fois à la listériose et à ses infections sous-jacentes. Le Listeria monocytogenes est une cause de péricardite rare et souvent fatale, qui se déclare généralement chez des hôtes immunodéprimés. Des cultures révélant des bacilles à Gram positif dans le contexte d'une péricardite chez un hôte immunodéprimé doivent inciter à envisager cette cause rare.