heroin and Bacteremia

Blood cultures from a heroin user who died in June 2012, a few hours after hospital admission, due to acute septic disease, revealed the presence of Bacillus anthracis. This report describes the extended diagnosis by MALDI-TOF and real-time PCR and rapid confirmation of the anthrax infection through reference laboratories. Physicians and diagnostic laboratories were informed and alerted efficiently through the reporting channels of German public health institutions, which is essential for the prevention of further cases.

Topics: Anthrax; Bacillus anthracis; Bacteremia; Drug Contamination; Drug Users; Fatal Outcome; Genome, Bacterial; Germany; Heroin; Humans; Male; Middle Aged; Real-Time Polymerase Chain Reaction; Sepsis; Substance Abuse, Intravenous

In 2000, Ringertz et al described the first case of systemic anthrax caused by injecting heroin contaminated with anthrax. In 2008, there were 574 drug related deaths in Scotland, of which 336 were associated with heroin and or morphine. We report a rare case of septicaemic anthrax caused by injecting heroin contaminated with anthrax in Scotland.. A 32 year old intravenous drug user (IVDU), presented with a 12 hour history of increasing purulent discharge from a chronic sinus in his left groin. He had a tachycardia, pyrexia, leukocytosis and an elevated C-reactive protein (CRP). He was treated with Vancomycin, Clindamycin, Ciprofloxacin, Gentamicin and Metronidazole. Blood cultures grew Bacillus anthracis within 24 hours of presentation. He had a computed tomography (CT) scan and magnetic resonance imagining (MRI) of his abdomen, pelvis and thighs performed. These showed inflammatory change relating to the iliopsoas and an area of necrosis in the adductor magnus.He underwent an exploration of his left thigh. This revealed chronically indurated subcutaneous tissues with no evidence of a collection or necrotic muscle. Treatment with Vancomycin, Ciprofloxacin and Clindamycin continued for 14 days. Negative Pressure Wound Therapy (NPWT) device was applied utilising the Venturi™ wound sealing kit. Following 4 weeks of treatment, the wound dimensions had reduced by 77%.. Although systemic anthrax infection is rare, it should be considered when faced with severe cutaneous infection in IVDU patients. This case shows that patients with significant bacteraemia may present with no signs of haemodynamic compromise. Prompt recognition and treatment with high dose IV antimicrobial therapy increases the likelihood of survival. The use of simple wound therapy adjuncts such as NPWT can give excellent wound healing results.

Topics: Adult; Anthrax; Bacillus anthracis; Bacteremia; Drug Contamination; Drug Users; Heroin; Humans; Male; Substance Abuse, Intravenous

Topics: Adult; Analgesics, Opioid; Anesthetics, Local; Bacteremia; Baltimore; Cocaine; Diagnosis, Differential; Endocarditis, Bacterial; Female; Heroin; Humans; Leg Ulcer; Streptococcal Infections; Substance Abuse, Intravenous

Topics: Acquired Immunodeficiency Syndrome; Adult; Bacillus cereus; Bacteremia; Heroin; Humans; Male; Substance Abuse, Intravenous