Infections with Spore-forming Bacteria in Persons Who Inject Drugs, 2000-2009

Overview

Journal Emerg Infect Dis

Specialty Infectious Diseases

Date 2012 Dec 25

PMID 23260795

Citations 17

Authors

Norah E Palmateer

Vivian D Hope

Kirsty Roy

Andrea Marongiu

Joanne M White

Kathie A Grant

Colin N Ramsay

David J Goldberg

Fortune Ncube

Affiliations

Soon will be listed here.

Abstract

Since 2000 in the United Kingdom, infections caused by spore-forming bacteria have been associated with increasing illness and death among persons who inject drugs (PWID). To assess temporal and geographic trends in these illnesses (botulism, tetanus, Clostridium novyi infection, and anthrax), we compared rates across England and Scotland for 2000-2009. Overall, 295 infections were reported: 1.45 per 1,000 PWID in England and 4.01 per 1,000 PWID in Scotland. The higher rate in Scotland was mainly attributable to C. novyi infection and anthrax; rates of botulism and tetanus were comparable in both countries. The temporal and geographic clustering of cases of C. novyi and anthrax into outbreaks suggests possible contamination of specific heroin batches; in contrast, the more sporadic nature of tetanus and botulism cases suggests that these spores might more commonly exist in the drug supply or local environment although at varying levels. PWID should be advised about treatment programs, injecting hygiene, risks, and vaccinations.

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References

Cole C, Jones L, McVeigh J, Kicman A, Syed Q, Bellis M . Adulterants in illicit drugs: a review of empirical evidence. Drug Test Anal. 2011; 3(2):89-96. DOI: 10.1002/dta.220. View

Hope V, Judd A, Hickman M, Sutton A, Stimson G, Parry J . HIV prevalence among injecting drug users in England and Wales 1990 to 2003: evidence for increased transmission in recent years. AIDS. 2005; 19(11):1207-14. DOI: 10.1097/01.aids.0000176222.71355.a1. View

Taylor A, Hutchinson S, Lingappa J, Wadd S, Ahmed S, Gruer L . Severe illness and death among injecting drug users in Scotland: a case-control study. Epidemiol Infect. 2005; 133(2):193-204. PMC: 2870238. DOI: 10.1017/s0950268804003504. View

Hope V, Marongiu A, Parry J, Ncube F . The extent of injection site infection in injecting drug users: findings from a national surveillance study. Epidemiol Infect. 2010; 138(10):1510-8. DOI: 10.1017/S0950268810000324. View

Hankins C, Palmer D, Singh R . Unintended subcutaneous and intramuscular injection by drug users. CMAJ. 2001; 163(11):1425-6. PMC: 80404. View

Siegel H, HELPERN M, EHRENREICH T . The diagnosis of death from intravenous narcotism. With emphasis on the pathologic aspects. J Forensic Sci. 1966; 11(1):1-16. View

Hahne S, White J, Crowcroft N, Brett M, George R, Beeching N . Tetanus in injecting drug users, United Kingdom. Emerg Infect Dis. 2006; 12(4):709-10. PMC: 3294684. DOI: 10.3201/eid1204.050599. View

McLAUCHLIN J, Mithani V, Bolton F, Nichols G, Bellis M, Syed Q . An investigation into the microflora of heroin. J Med Microbiol. 2002; 51(11):1001-1008. DOI: 10.1099/0022-1317-51-11-1001. View

Brett M, Hood J, Brazier J, Duerden B, Hahne S . Soft tissue infections caused by spore-forming bacteria in injecting drug users in the United Kingdom. Epidemiol Infect. 2005; 133(4):575-82. PMC: 2870283. DOI: 10.1017/s0950268805003845. View

10.

Cook T, Protheroe R, Handel J . Tetanus: a review of the literature. Br J Anaesth. 2001; 87(3):477-87. DOI: 10.1093/bja/87.3.477. View

11.

Horowitz B, Swensen E, Marquardt K . Wound botulism associated with black tar heroin. JAMA. 1998; 280(17):1479-80. View

12.

McGuigan C, Penrice G, Gruer L, Ahmed S, Goldberg D, Black M . Lethal outbreak of infection with Clostridium novyi type A and other spore-forming organisms in Scottish injecting drug users. J Med Microbiol. 2002; 51(11):971-977. DOI: 10.1099/0022-1317-51-11-971. View

13.

Werner S, Passaro D, McGee J, Schechter R, Vugia D . Wound botulism in California, 1951-1998: recent epidemic in heroin injectors. Clin Infect Dis. 2000; 31(4):1018-24. DOI: 10.1086/318134. View

14.

Dwyer R, Topp L, Maher L, Power R, Hellard M, Walsh N . Prevalences and correlates of non-viral injecting-related injuries and diseases in a convenience sample of Australian injecting drug users. Drug Alcohol Depend. 2008; 100(1-2):9-16. DOI: 10.1016/j.drugalcdep.2008.08.016. View

15.

Rushdy A, White J, Ramsay M, Crowcroft N . Tetanus in England and Wales, 1984-2000. Epidemiol Infect. 2003; 130(1):71-7. PMC: 2869940. DOI: 10.1017/s0950268802007884. View

16.

Ramsay C, Stirling A, Smith J, Hawkins G, Brooks T, Hood J . An outbreak of infection with Bacillus anthracis in injecting drug users in Scotland. Euro Surveill. 2010; 15(2). DOI: 10.2807/ese.15.02.19465-en. View

17.

Baymiller S . Botulism in critical care: a case study in wound botulism. Am J Crit Care. 2001; 10(3):172-80. View

18.

SAPIRA J . The narcotic addict as a medical patient. Am J Med. 1968; 45(4):555-88. DOI: 10.1016/0002-9343(68)90172-1. View

19.

Hickman M, Higgins V, Hope V, Bellis M, Tilling K, Walker A . Injecting drug use in Brighton, Liverpool, and London: best estimates of prevalence and coverage of public health indicators. J Epidemiol Community Health. 2004; 58(9):766-71. PMC: 1732885. DOI: 10.1136/jech.2003.015164. View

20.

Akbulut D, Dennis J, Gent M, Grant K, Hope V, Ohai C . Wound botulism in injectors of drugs: upsurge in cases in England during 2004. Euro Surveill. 2005; 10(9):172-4. View