heroin and Endocarditis

A 30-year-old man had endocarditis and hip arthritis associated with the recently recognized fungus, Scedosporium inflatum. Inhibition, and possibly cure, of endocarditis occurred with medical therapy alone. Data from in vitro susceptibility testing did not predict clinical response. This case also illustrates the need to standardize fungal susceptibility testing and to remain vigilant for emerging pathogens.

Topics: Adult; Drug Resistance, Microbial; Endocarditis; Heroin; Humans; Male; Mitral Valve; Mycetoma; Osteoarthritis, Hip; Pseudallescheria; Substance Abuse, Intravenous

Topics: Abscess; Adult; Animals; Autopsy; Blindness; Brain Diseases; Cerebrovascular Disorders; Endocarditis; Haplorhini; Hepatitis A; Heroin; Heroin Dependence; Humans; Male; Muscular Diseases; Myelitis, Transverse; Nervous System Diseases; New York City; Peripheral Nervous System Diseases; Quinine; Substance-Related Disorders; Tetanus

Topics: Adolescent; Adult; Endocarditis; Female; Hepatitis; Heroin; Humans; Lung Diseases; Male; Middle Aged; Substance-Related Disorders; Tetanus

To describe a case of amyloid A protein amyloidosis that produced an orbital inflammatory response with a novel presentation.. Case report.. A 24-year-old Caucasian women with a history of intravenous heroin use was hospitalized for tricuspid valve endocarditis and methicillin-resistant Staphylococcus aureus bacteremia, as well as acute renal failure. She received hemodialysis and intravenous daptomycin and had negative blood cultures for 3 weeks, when she developed sudden bilateral orbital swelling and blurred vision. Visual acuity was 20/200 in the right eye and 20/400 in the left eye. Examination revealed proptosis, conjunctival chemosis and desiccation, optic disk swelling, creamy choroidal infiltrates, and inferiorly located exudative retinal detachments in both eyes. Multimodal imaging demonstrated thickening of the sclera, choroid, and choriocapillaris as well as outer retinal disruption, subretinal fluid, and deposits of hyperfluorescent debris within the choriocapillaris, outer retina, and vitreous. Oral prednisone at 60 mg per day resolved the choroidal infiltrates and exudative detachments. Persistent nephrotic syndrome called for a renal biopsy, which demonstrated amyloid A protein amyloidosis.. Orbital and choroidal Amyloid A protein amyloidosis can induce a local inflammatory response manifesting as orbital swelling, papillitis, posterior scleritis, choroiditis, and exudative retinal detachment, which responds to steroid therapy. The underlying pathology is likely a reactive inflammatory, vasoocclusive process involving the choriocapillaris and orbital vasculature to the presence of amyloid fibrils.

Topics: Adult; Amyloid; Amyloidosis; Choroid; Daptomycin; Endocarditis; Female; Graves Ophthalmopathy; Heroin; Humans; Methicillin-Resistant Staphylococcus aureus; Prednisone; Retinal Detachment; Serum Amyloid A Protein; Young Adult

We report three cases of tricuspid valve infective endocarditis associated with intravenous nyoape use. Nyoape is a variable drug combination of an antiretroviral (efavirenz or ritonavir), heroin, metamphetamines and cannabis. Its use is becoming increasingly common among poor communities in South Africa. All our patients were young HIV-positive men from disadvantaged backgrounds. They all presented with tricuspid regurgitation and septic pulmonary emboli. They were treated with prolonged intravenous antibiotic courses, and one required referral for surgery.

Topics: Adult; Alkynes; Anti-Bacterial Agents; Benzoxazines; Cannabis; Cyclopropanes; Endocarditis; Heroin; HIV Infections; Humans; Illicit Drugs; Male; Methamphetamine; Pulmonary Embolism; Ritonavir; South Africa; Substance-Related Disorders; Tricuspid Valve; Tricuspid Valve Insufficiency; Young Adult

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

We report a successful transplantation of a human tricuspid valve in a human. We used a fresh tricuspid homograft with its chordae tendineae and papillary muscles, harvested 5 days earlier under sterile conditions from a multiorgan donor a few minutes after cardiectomy (the heart was not suitable for cardiac transplantation) and immediately stored at 4 degrees C. We elected to implant the homograft in a young heroin addict. Our experience demonstrates that the implantation of an atrioventricular homograft in the orthotopic position is technically feasible and can achieve good results, at least in the short term.

Topics: Adolescent; Endocarditis; Heroin; Humans; Male; Staphylococcal Infections; Substance-Related Disorders; Transplantation, Homologous; Tricuspid Valve; Tricuspid Valve Insufficiency

A 42-year-old abuser of intravenous drugs developed fulminant aortic insufficiency necessitating a prosthetic valve replacement. Trichosporon cutaneum was isolated from the surgical specimen. The patient received a total of 3,195 g of amphotericin B, and 148 g of 5-fluorocytosine during his four-month hospitalization. He manifested no additional signs of persistent fungal infection, but died one year later from an intracerebral hemorrhage.

Topics: Adult; Endocarditis; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Mitosporic Fungi; Mycoses; Substance-Related Disorders

Immediate attention must be given to the respiratory system of the heroin abuser; then he should be given naloxone HCl. Search for evidence of use of additional drugs, which may compound problems. Pulmonary edema, aspiration pneumonia and pulmonary embolization are the most common complications. Infections, particularly endocarditis, and cardiac arrhythmia also occur with heroin overdose. Hepatitis is common. Treatment must include not only attention to the presenting symptoms but also referral to a rehabilitation center when possible.

Topics: Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Dose-Response Relationship, Drug; Emergency Service, Hospital; Endocarditis; Female; Genital Diseases, Female; Heroin; Heroin Dependence; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infections; Male; Methadone; Naloxone; Pulmonary Edema; Respiratory Insufficiency

Topics: Abscess; Aneurysm, Infected; Arteritis; Arthritis; Chemical and Drug Induced Liver Injury; Drainage; Endocarditis; Gastrointestinal Diseases; Hand; Heart Valve Prosthesis; Heroin; Heroin Dependence; Humans; Injections, Intra-Arterial; Injections, Intravenous; Injections, Subcutaneous; Lung Diseases; Myositis; Narcotics; Pancreatitis; Phlebitis; Substance-Related Disorders; Surgical Procedures, Operative

Topics: Abscess; Adolescent; Adult; Chemical and Drug Induced Liver Injury; Chromosomes; Endocarditis; Female; Heroin; Heroin Dependence; Humans; Liver; Lung Diseases; Male; Methadone; Nephrotic Syndrome; Nervous System Diseases; Osteomyelitis

Topics: Adult; Age Factors; Amenorrhea; Endocarditis; Female; France; Gangrene; Hepatitis; Heroin; Humans; Injections; Male; Middle Aged; Morphinans; Pharmaceutic Aids; Sepsis; Sexually Transmitted Diseases; Skin Manifestations; Social Behavior Disorders; Social Conditions; Substance-Related Disorders

Topics: Adult; Amphotericin B; Aortic Valve Insufficiency; Benzene Derivatives; Candidiasis; Endocarditis; Female; Flucytosine; Follow-Up Studies; Heart Septal Defects, Ventricular; Heart Valve Prosthesis; Heroin; Humans; Imidazoles; Male; Mitral Valve Insufficiency; Oxacillin; Pacemaker, Artificial; Radiography, Thoracic; Substance-Related Disorders; Tricuspid Valve Insufficiency

Topics: Adult; Endocarditis; Heroin; Humans; Hygiene; Male; Substance-Related Disorders

Topics: Adult; Candidiasis; Endocarditis; Heroin; Humans; Injections, Intravenous; Male; Morphine Dependence; Pseudomonas Infections; Pulmonary Embolism; Staphylococcal Infections; Sterilization; Tricuspid Valve

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