heroin and Bacterial-Infections

Several mechanisms leading to noncardiac pulmonary edema have been reviewed. Common features are damage to and increased permeability of vascular endothelium, interstitial and alveolar edema fluid high in protein content, increased pulmonary vascular resistance and pressure, nondependent distribution of the edema and normal left atrial or wedge pressure. The available evidence suggests that in some instances the sites of leakage are the pulmonary arterial walls and, perhaps in some, overperfused, damaged capillary beds. Therapeutic obestives differ from those in cardiac pulmonary edema in that efforts are directed toward a reduction in pulmonary blood flow and pulmonary arterial pressure during the period that endothelial healing is taking place.

Topics: Altitude Sickness; Animals; Bacterial Infections; Brain Injuries; Capillaries; Capillary Permeability; Ethchlorvynol; Heroin; Humans; Hypersensitivity; Hypoxia; Lung; Paraquat; Pulmonary Alveoli; Pulmonary Artery; Pulmonary Edema; Respiratory Distress Syndrome; Ultrafiltration

People who inject drugs often get bacterial infections. Few longitudinal studies have reported the incidence and treatment costs of these infections.. For a cohort of 2335 people who inject heroin entering treatment for drug dependence between 2006 and 2017 in London, England, we reported the rates of hospitalisation or death with primary causes of cutaneous abscess, cellulitis, phlebitis, septicaemia, osteomyelitis, septic arthritis, endocarditis, or necrotising fasciitis. We compared these rates to the general population. We also used NHS reference costs to calculate the cost of admissions.. During a median of 8.0 years of follow-up, 24 % of patients (570/2335) had a severe bacterial infection, most commonly presenting with cutaneous abscesses or cellulitis. Bacterial infections accounted for 13 % of all hospital admissions. The rate was 73 per 1000 person-years (95 % CI 69-77); 50 times the general population, and the rate remained high throughout follow-up. The rate of severe bacterial infections for women was 1.50 (95 % CI 1.32-1.69) times the rate for men. The mean cost per admission was £4980, and we estimate that the annual cost of hospital treatment for people who inject heroin in London is £4.5 million.. People who inject heroin have extreme and long-term risk of severe bacterial infections.

Topics: Adolescent; Adult; Bacterial Infections; Cohort Studies; England; Female; Follow-Up Studies; Health Care Costs; Heroin; Heroin Dependence; Hospitalization; Humans; Incidence; London; Male; Middle Aged; Patient Admission; Severity of Illness Index; Substance Abuse, Intravenous; Young Adult

Topics: Bacterial Infections; Cocaine; Heroin; Humans; Narcotics; Pemphigus; Substance-Related Disorders

Transient hypothyroxinemia is common in infants less than 30 wk gestation and is associated with neurodevelopmental deficits. Reductions in T4 and T3 levels with TSH unchanged are the key features of severe illness using surrogate indices of overall severity of illness, but these do not inform the impact of individual disease conditions or drug use.. Our objective was to investigate the contribution of postnatal factors to the variations in serum levels of iodothyronines, thyroid-binding globulin, and TSH.. We recruited a cohort of infants (23-34 wk gestation; n = 780) between January 1998 and September 2001.. The study involved 11 level III Scottish neonatal intensive care units and included cohorts of infants delivered at 23-34 wk gestation.. We assessed serum levels of iodothyronines, thyroid-binding globulin, and TSH at 7, 14, and 28 d adjusted for the potentially significant postnatal influences (n = 31).. Serum levels of TSH, free T4, T3, and T4 are variably but significantly associated with bacteremia, endotracheal bacterial cultures, persistent ductus arteriosus, necrotizing enterocolitis, cerebral ultrasonography changes, oxygen dependence at 28 d, and the use of aminophylline, caffeine, dexamethasone, diamorphine, and dopamine.. There are many more associations of postnatal factors with transient hypothyroxinemia than had previously been considered in preterm infants. Alternative strategies should be considered for correction of hypothyroxinemia rather than sole reliance on the direct therapy of hormone replacement. A more oblique preventative approach may be necessary through reduction in the incidence or severity of individual illness(es). Similarly, alternatives to those drugs that interfere with the hypothalamic-pituitary-thyroid axis should be evaluated (e.g. other inotropics instead of dopamine).

Topics: Aminophylline; Bacterial Infections; Caffeine; Dexamethasone; Dopamine; Heroin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Thyroid Hormones; Thyroxine

Topics: Bacterial Infections; Bacteroides Infections; Endocarditis, Bacterial; Fusobacterium Infections; Heroin; Humans; Male; Middle Aged; Staphylococcal Infections; Streptococcal Infections; Substance-Related Disorders; Veillonella

Topics: Adolescent; Adult; Bacterial Infections; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male

Thirty-one samples of street heroin were analyzed bacteriologically and chemically as to their microbial burden and chemical adulterants (fillers). Sixty-one percent of the samples were positive for microbial growth. Many species were isolated from the positive samples with Bacillus sp (79%) and Aspergillus sp (10%) predominating. The level of contamination ranged from 1.6 X 10(2) to 3.7 X 10(4) organisms per gram. We obtained cultures from 16 addicts from the Chicago area and 21 from the New Orleans area who had soft-tissue infections related to their habit. Infections in this group of patients were usually polymicrobial; however, there was no correlation between the organisms recovered from street heroin and the addicts' infections. Most drug-related infections appear to be related to the addicts' own oral and dermal microflora. No correlation was observed between the chemical fillers and the bacteria recovered from the heroin.

Topics: Bacterial Infections; Drug Contamination; Heroin; Humans; Illicit Drugs

Topics: Adult; Autoantibodies; Bacterial Infections; Biopsy; Chemical and Drug Induced Liver Injury; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Diagnosis, Differential; Female; Halothane; Hepatitis; Hepatitis B Antibodies; Hepatitis B Surface Antigens; Hepatitis, Viral, Human; Heroin; Heroin Dependence; Humans; Hypergammaglobulinemia; Liver; Liver Diseases; Liver Function Tests; Male; Middle Aged

The diagnosis of pyogenic vertebral osteomyelitis was made in seven narcotic addicts between 1967 and 1972. Vertebrae involved were either cervical or lumbar. Bacteriologic diagnosis was made in each case by percutaneous needle biopsy and aspiration. Staphylococcus aureus was cultured in two patients. Five patients had infections due to Gram-negative bacteria, including Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterobacter. All patients were cured by treatment with antibiotics and immobilization.

Topics: Adolescent; Adult; Bacteria; Bacterial Infections; Biopsy, Needle; California; Cervical Vertebrae; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Klebsiella pneumoniae; Lumbar Vertebrae; Male; Osteomyelitis; Pseudomonas aeruginosa; Radiography; Staphylococcal Infections; Substance-Related Disorders

Topics: Adolescent; Adult; Bacterial Infections; Child; Heroin; Humans; Injections, Intravenous; Injections, Subcutaneous; New York City; Opium; Substance-Related Disorders

Topics: Bacterial Infections; Heroin; Humans; Joint Diseases; Sacroiliac Joint; Spinal Diseases; Spondylitis; Substance-Related Disorders

Topics: Bacterial Infections; Heroin; Humans; Injections, Intravenous; Needles; Osteomyelitis; Sterilization; Substance-Related Disorders

These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California, San Francisco. Taken from transcriptions, they are prepared by Drs. Sydney E. Salmon and Robert W. Schrier, Assistant Professors of Medicine, under the direction of Dr. Lloyd H. Smith, Jr., Professor of Medicine and Chairman of the Department of Medicine. Requests for reprints should be sent to the Department of Medicine, University of California, San Francisco, San Francisco, Ca. 94122.

Topics: Bacterial Infections; Chemical and Drug Induced Liver Injury; Endocarditis, Bacterial; Heroin; Humans; Lung Diseases; Malaria; Substance Withdrawal Syndrome; Substance-Related Disorders; Tetanus