heroin and Infections

Fourteen previously healthy young patients with unusual community-acquired opportunistic infections were seen over a period of three years. They differ from patients previously described in that 11 were heterosexual drug abusers (including two women) and only three were homosexual men. There were eight Puerto Ricans, five blacks, and one white. Infections included Pneumocystis carinii pneumonia (seven), disseminated Mycobacterium intracellulare infection, histoplasmosis, cryptococcosis, and cytomegalovirus infection (one each), oral thrush (13), and Candida esophagitis (two). All patients had impaired cellular immunity manifested by cutaneous anergy and lymphopenia, and all 11 tested had a markedly decreased ratio of T helper/inducer cells to T suppressor/cytotoxic cells. Twelve had evidence of associated viral infection (Epstein-Barr virus in nine, cytomegalovirus in five, Herpes simplex type 2 in two). Clinical presentation was with a severe opportunistic infection or with a prodrome consisting of oral thrush and nonspecific findings including malaise, fever, lymphadenopathy, or cough. The syndrome of immunodeficiency and opportunistic infection occurs in nonwhite heterosexual drug abusers, not exclusively in white homosexual men, and patients may present for medical care before the onset of a severe opportunistic infection.

Topics: Acquired Immunodeficiency Syndrome; Adult; Black People; Candidiasis, Oral; Female; Heroin; Homosexuality; Humans; Immunity, Cellular; Infections; Male; New York City; Pneumonia, Pneumocystis; Puerto Rico; Substance-Related Disorders; T-Lymphocytes; T-Lymphocytes, Regulatory; Virus Diseases

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

Topics: Heroin; Humans; Infections; Neoplasms; Substance-Related Disorders

Topics: Heroin; Humans; Infections; Injections, Intravenous; Sepsis; Substance-Related Disorders

Topics: Adult; Brain Diseases; Encephalitis; Fungi; Heroin; Humans; Infections; Injections, Intravenous; Male; Morphine Dependence; Mycoses

Topics: Adult; Heroin; Hospitalization; Humans; Infections; London; Substance-Related Disorders

Topics: Adult; Anti-Bacterial Agents; Chloramphenicol; Cocaine; Female; Foot Diseases; Forearm; Heroin; Humans; Infections; Injections, Intravenous; Injections, Subcutaneous; Skin Ulcer; Substance-Related Disorders; Thigh

Topics: Adolescent; Adult; Cocaine; Female; Heroin; Humans; Infections; Lung Diseases; Male; Radiography; Sepsis; Substance-Related Disorders

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