heroin and Endocarditis--Bacterial

Medical complications of heroin overdose and the diseases of addicts play an increasingly important role in the daily routine of hospital medical departments. The percentage of drug-related admissions to the Medical Clinic of the University Hospital, Zürich, increased from 0.18% to 4.45% between 1972 and 1983. During this 12-year period, 492 patients were admitted 569 times because of heroin overdose or intoxications combined with other drugs, and 191 drug addicts were hospitalized 226 times for a variety of medical problems. Certain complications, such as heroin pulmonary edema and talc granulomas of the lung, occur only in parenteral drug addiction. Other diseases such as right heart endocarditis, Candida-endophthalmitis, septic arthritis and osteomyelitis are almost exclusively observed in intravenous drug abusers. Sexually transmitted infections and hepatitis B are frequently diagnosed in addicts.

Topics: Adolescent; Adult; Age Factors; Arthritis, Infectious; Candidiasis; Cardiovascular Diseases; Endocarditis, Bacterial; Female; Hepatitis, Viral, Human; Heroin; Heroin Dependence; Humans; Length of Stay; Lung Diseases; Male; Nervous System Diseases; Osteomyelitis; Pulmonary Edema; Rhabdomyolysis; Sex Factors; Sexually Transmitted Diseases; Skin Diseases; Switzerland

Injection drug users (IDUs) develop more right-sided infective endocarditis (IE) than non-IDUs, but it is not known whether this risk is specific to any particular injected drug. This study reviews the clinical characteristics of IE in an urban population and examines the association of drug type with manifestations of IE.. A retrospective cohort of 247 cases of IE was analyzed. Demographic, clinical, microbiologic, and echocardiographic data were collected.. Our cohort featured a 74% IDU rate, most with heroin. Staphylococcus aureus was the most prevalent organism. S. aureus IE was more likely to occur in IDUs versus non-IDUs (OR 5.5, p<0.0001). Enterococcus faecalis IE was less likely to occur in IDUs (OR 0.21, p=0.02). Tricuspid valve (TV) IE was more likely to occur in IDUs (OR 4.37, p=0.001), while mitral valve (MV) IE occurred less commonly in IDUs (OR 0.40, p=0.005). TV IE occurred more frequently in heroin users vs. IDUs not using heroin (OR 4.03, p=0.033).. The epidemiology of IE in this cohort is different from that reported recently in other cohorts, likely due to the high prevalence of IDU. Heroin use may underlie the association between IDU and right-sided endocarditis.

Topics: Endocarditis; Endocarditis, Bacterial; Female; Heart Valve Diseases; Heroin; Hospitals, Urban; Humans; Male; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; 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

Two cases of pneumothorax secondary to pulmonary septic infarctions occurred in the course of tricuspid endocarditis in intravenous drug misusers. This unusual complication must be considered in patients with right sided endocarditis who develop pleuritic chest pain, haemoptysis, or breathlessness.

Topics: Adult; Endocarditis, Bacterial; Heroin; Humans; Male; Pneumothorax; Pulmonary Embolism; Substance Abuse, Intravenous; Tricuspid Valve

Topics: Adult; Decision Making; Endocarditis, Bacterial; Ethics, Medical; Female; Heart Valve Prosthesis; Heroin; HIV Infections; Humans; Mitral Valve Insufficiency; Needle Sharing; Problem Solving; Substance Abuse, Intravenous

We have reported a case of high-level gentamicin-resistant enterococcal endocarditis as a complication of intravenous narcotic abuse. Because routine screening of enterococcal blood isolates for high-level aminoglycoside resistance was not done, the patient possibly received suboptimal therapy. This case amplifies the necessity of a systematic screening program for enterococcal blood isolates to detect high-level resistance to gentamicin and streptomycin in clinical laboratories.

Topics: Adult; Endocarditis, Bacterial; Enterococcus faecalis; Evaluation Studies as Topic; Gentamicins; Heroin; Humans; Male; Microbial Sensitivity Tests; Streptococcal Infections; Streptomycin; Substance Abuse, Intravenous

We assessed risk factors for human immunodeficiency virus (HIV) infection in 633 heterosexual intravenous drug users. The HIV seroprevalence was 26% in blacks, 10% in Hispanics, and 6% in whites. Intravenous cocaine use significantly increased the risk of HIV infection, with a seroprevalence of 35% in daily cocaine users (odds ratio, 6.4; 95% confidence interval, 3.0 to 13.3). Black subjects were more likely to use cocaine regularly. Drug use in shooting galleries and sharing of drug injection equipment were also associated with HIV infection and were more common in cocaine users. By multivariate analysis, black race, daily cocaine injection by blacks and Hispanics, all other cocaine injection, heavy use prior to entry into methadone treatment by blacks, and use of drugs in shooting galleries were independent predictors of HIV infection. Methadone therapy was associated with substantial reductions in heroin use and some reduction in cocaine use, but 24% of cocaine users receiving methadone began or increased cocaine injection after entry into treatment.

Topics: Black or African American; Cocaine; Endocarditis, Bacterial; Female; Heroin; Hispanic or Latino; HIV Seropositivity; Humans; Injections, Intravenous; Male; Methadone; San Francisco; Substance-Related Disorders; Syphilis; White People

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

Thirteen patients developed a renal disease after using heroin alone or in combination with other drugs, for a period of 3 to 12 years. Eleven were IV drug addicts, 2 were sniffers. Six patients had acute tubular necrosis, due to rhabdomyolysis in 5 and to prolonged gentamicin therapy for bacterial endocarditis in 1. Five patients manifested a nephrotic syndrome, and renal biopsy showed various types of glomerulonephritis (GN) without glomerular sclerosis. The two last patients had hypertension with intrarenal vascular lesions and HBsAg was present in their serum. Chronic hemodialysis and/or renal transplantation were required in 2 cases with GN; all other patients recovered normal serum creatinine. There was no specific pathologic picture of heroin abuse in this series.

Topics: Adult; Endocarditis, Bacterial; Female; Gentamicins; Glomerulonephritis; Heroin; Humans; Hypertension, Renovascular; Kidney; Kidney Diseases; Kidney Tubular Necrosis, Acute; Male; Rhabdomyolysis; Substance-Related Disorders

Topics: Adult; Endocarditis, Bacterial; Female; Haemophilus; Haemophilus Infections; Heroin; Humans; Streptococcal Infections; Streptococcus sanguis; Substance-Related Disorders

Topics: Endocarditis, Bacterial; Heroin; Humans; Injections, Intravenous; Staphylococcal Infections

Acute bacterial endocarditis, a fulminating disorder most often caused by Staphylococcus aureus, is uncommon in pregnancy. However, the frequency of this disease may be increasing due to the prevalence of intravenous drug abuse. Three cases occurred during pregnancy at Charity Hospital, New Orleans; all three patients were intravenous drug abusers. One patient had polymicrobial disease.

Topics: Acute Disease; Adult; Endocarditis, Bacterial; Female; Heroin; Humans; Injections, Intravenous; Pentazocine; Pregnancy; Pregnancy Complications, Infectious; Staphylococcus aureus; Substance-Related Disorders; Tripelennamine

The authors report on 20 cases of bacterial endocarditis in heroin addicts, i.e. 9.1% of all cases of that infection observed over an 8-year period. The disease involved the tricuspid valve in 80% of the cases and was due to Staphylococcus aureus in the same percentage of patients. Diagnosis was sometimes difficult in the right heart but was confirmed by repeated echocardiography. Combined antibiotic therapy was administered for 45 days. Only one patient died of relapsing endocarditis on valve prosthesis. Six patients were operated upon: 2 for cardiac failure, 2 for persistent infection and 2 for recurrent pulmonary embolism. Three patients underwent valve replacement and 3 tricuspidectomy. The persistence of pulmonary embolism after eradication of the infecting organism does not seem to warrant surgery.

Topics: Adult; Echocardiography; Endocarditis, Bacterial; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Recurrence; Staphylococcal Infections; Tricuspid Valve

Topics: Endocarditis, Bacterial; Heroin; Humans; Illinois; Injections, Intravenous; Pseudomonas Infections; Substance-Related Disorders; Syringes

The presence of systemic disease may further increase the risk of bacterial endocarditis in the patient on chronic hemodialysis. Three patients are described; one with primary amyloidosis, a second with insulin dependent diabetes mellitus, and a third with heroin nephropathy who developed S.B.E. While the presence of the uremic state may hinder the recognition of endocarditis, the development of transient neurologic deficits, recent access infections and recurrent bacteremic episodes should be looked for as early clues to the diagnosis in this patient population.

Topics: Adult; Amyloidosis; Diabetic Nephropathies; Endocarditis, Bacterial; Heroin; Humans; Male; Middle Aged; Renal Dialysis; Substance-Related Disorders; Uremia

Topics: Aspergillus; Bacillus; Bacteria; Clostridium perfringens; Drug Contamination; Endocarditis, Bacterial; Escherichia coli; Heroin; Heroin Dependence; Humans; Injections; Needles; Staphylococcal Infections; Staphylococcus; Syringes

Topics: Aneurysm, Infected; Arterial Occlusive Diseases; Cardiomegaly; Edema; Endocarditis, Bacterial; Hand; Heroin; Humans; Injections, Intra-Arterial; Injections, Intravenous; Ischemia; Lung Diseases; Lymphadenitis; Pneumonia; Pneumonia, Aspiration; Pulmonary Edema; Pulmonary Embolism; Substance-Related Disorders; Tuberculosis, Pulmonary; Vascular Diseases; Venous Insufficiency

Topics: Adult; Coma; Endocarditis, Bacterial; Heroin; Heroin Dependence; Humans; Jaundice; Male; Sepsis; Staphylococcal Infections; Substance-Related Disorders

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Anti-Bacterial Agents; Endocarditis, Bacterial; Enterobacteriaceae Infections; Female; Gastrointestinal Hemorrhage; Hemiplegia; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Prospective Studies; Pseudomonas Infections; Pulmonary Embolism; Respiratory Insufficiency; Splenomegaly; Staphylococcal Infections; Streptococcal Infections; Substance-Related Disorders

Topics: Adult; Candida; Candidiasis; Endocarditis, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; Heart Failure; Heroin; Heroin Dependence; Humans; Male; Neurologic Manifestations; Panophthalmitis; Skin Manifestations; Splenomegaly; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus; Substance-Related Disorders

Topics: Endocarditis, Bacterial; Heroin; Humans; Infections; Osteomyelitis; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Substance-Related Disorders

Topics: Endocarditis, Bacterial; Heroin; Heroin Dependence; Humans; Naloxone; Substance Withdrawal Syndrome; Substance-Related Disorders; Tetanus

Topics: Adult; Amphetamine; Amputation, Surgical; Aneurysm; Angiography; Arm; Arteries; Barbiturates; Blood Vessels; Candidiasis; Codeine; Endocarditis, Bacterial; Female; Heparin; Heroin; Humans; Injections, Intra-Arterial; Ischemia; Leg; Male; Methylphenidate; Substance-Related Disorders; Vascular Diseases; Vasodilator Agents; Veins

Topics: Adult; Endocarditis, Bacterial; Heroin; Humans; Injections; Male; Staphylococcal Infections; Substance-Related Disorders; Tricuspid Valve

Topics: Abscess; Adult; Autopsy; Diagnosis, Differential; Disseminated Intravascular Coagulation; Endocarditis, Bacterial; Heroin; Humans; Infarction; Kidney Diseases; Lung Abscess; Male; Myocardium; Pleural Effusion; Pulmonary Embolism; Splenic Diseases; Splenic Infarction; Staphylococcal Infections; Staphylococcus; Substance-Related Disorders; Tricuspid Valve

Topics: Acinetobacter; Acinetobacter Infections; Adult; Aortic Valve; Autopsy; Endocarditis, Bacterial; Female; Heroin; Humans; 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

Topics: Adult; Animals; Anti-Bacterial Agents; Dogs; Endocarditis, Bacterial; Female; Heart; Hemodynamics; Heroin; Humans; Male; Morphine Dependence; Pseudomonas Infections; Tricuspid Valve Insufficiency

Topics: Endocarditis, Bacterial; Heroin; Humans; Sepsis; Staphylococcal Infections; Substance-Related Disorders

Topics: Adult; Aneurysm; Aneurysm, Infected; Endocarditis, Bacterial; Female; Heroin; Humans; Hypertension, Pulmonary; Injections, Intravenous; Lung Diseases; Male; Methylphenidate; Middle Aged; Pneumonia; Pneumonia, Aspiration; Pulmonary Edema; Pulmonary Embolism; Radiography; Substance-Related Disorders; Thrombophlebitis; Thrombosis; Tuberculosis, Pulmonary; Vascular Diseases

Topics: Adult; Anti-Bacterial Agents; Bacteroides; Bacteroides Infections; Endocarditis, Bacterial; Escherichia coli Infections; Heroin; Humans; Injections, Intravenous; Male; Pulmonary Embolism; Staphylococcal Infections; Streptococcal Infections; Substance-Related Disorders

Topics: Adult; Aged; Brain Diseases; Cerebral Cortex; Endocarditis, Bacterial; Female; Fungi; Granuloma; Heroin; Humans; Male; Meningitis; Middle Aged; Morphine Dependence; Substance-Related Disorders

Topics: Adolescent; Adult; Brain; Brain Damage, Chronic; Endocarditis, Bacterial; Female; Heroin; Humans; Male; Myelitis; New York City; Polyneuropathies; Substance-Related Disorders; Tetanus

Topics: Adult; Angiography; Electrocardiography; Endocarditis, Bacterial; Female; Heroin; Humans; Male; Phonocardiography; Pulmonary Valve Insufficiency; Staphylococcal Infections; Substance-Related Disorders

Topics: Adolescent; Adult; Drug and Narcotic Control; Endocarditis, Bacterial; Female; Heroin; Humans; Hypertension, Pulmonary; Male; Opium; Substance-Related Disorders; Thrombophlebitis; United States

Topics: Abscess; Arthritis; Arthritis, Infectious; Bacteroides; Benzoates; Brain Abscess; Camphor; Cellulitis; Endocarditis; Endocarditis, Bacterial; Endocarditis, Subacute Bacterial; Hepatitis; Hepatitis B virus; Heroin; Humans; Infections; Meningitis; Methicillin; Opium; Penicillin G; Pneumothorax; Sepsis; Staphylococcal Infections; Substance-Related Disorders; Toxicology

Topics: Endocarditis; Endocarditis, Bacterial; Heroin; Humans; Staphylococcal Infections; Substance-Related Disorders