heroin and Osteomyelitis

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

On a national level, heroin-related hospital admissions have reached an all-time high. With the foot being the fourth most common injection site, heroin-related lower-extremity infections have become more prevalent owing to many factors, including drug preparation, injection practices, and unknown additives.. We present a 16-month case series in which eight patients with lower-extremity infections secondary to heroin abuse presented to The Jewish Hospital in Cincinnati, Ohio.. Three cases of osteomyelitis were seen. All of the infections were cultured and yielded a wide array of microbes, including. This case series brings to light many considerations in the diagnosis and management of the heroin user, including multivariable attenuation of immunity, existing predisposition to infection backed by unsterile drug preparation and injection practices, innocuous presentation of deep infections, microbial spectrum, and recommendations on antimicrobial intervention, noncompliance, and poor follow-up. By having greater knowledge in unique considerations of diagnosis and treatment, more efficient care can be provided to this unique patient population.

Topics: Adult; Anti-Bacterial Agents; Female; Heroin; Heroin Dependence; Humans; Hyperalgesia; Lower Extremity; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Pain Management; Patient Compliance; Radiography; Soft Tissue Infections; Substance Abuse, Intravenous

We describe 3 patients with a history of intravenous (iv) heroin addiction presenting with indolent, persisting lumbar pain. Clinical findings and initial investigations were unremarkable. Gallium scintigraphy revealed septic spondylodiscitis, and cultures of material obtained by biopsy were positive for Candida albicans in all 3 cases. Two patients were treated with iv amphotericin B and the other with fluconazole with excellent results. Surgical treatment was needed only in one patient because of neurological involvement.

Topics: Adult; Candidiasis; Discitis; Female; Heroin; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Radiography; Substance Abuse, Intravenous; Thoracic Vertebrae

We reviewed the radiographs of 14 patients who had cervical osteomyelitis and were IV heroin users. Eleven were men and three were women. Their age range was 33-48 years (mean, 39 years). Eleven regularly used the jugular vein access, and three alternated between the jugular and femoral veins. Initial radiographs of the cervical spine in 13 patients showed destruction of two or more vertebral bodies and the adjacent intervertebral disk, as well as a prevertebral soft-tissue mass. In one patient, findings on initial radiographs were normal, but marked destruction at two contiguous intervertebral levels and a large prevertebral abscess were identified 2 weeks later. All the patients had positive results on cultures of joint aspirates or bone biopsy materials (10 patients) or blood (four patients). Ten grew Staphylococcus aureus; two, Staphylococcus epidermidis; one, Streptococcus viridans; and one, Pseudomonas aeruginosa. CT in nine patients showed inflammatory reaction adjacent to the carotid sheath resulting from the repeated jugular injections and delineated the extent of prevertebral abscess and bone destruction. Scintigrams were of minimal value in establishing the diagnosis. Advanced vertebral body destruction, disk space infection, prevertebral abscess, and anterior cervical inflammatory reaction appear to be typical findings on radiographs in heroin abusers with cervical osteomyelitis.

Topics: Adult; Cervical Vertebrae; Female; Femoral Vein; Heroin; Humans; Jugular Veins; Male; Middle Aged; Osteomyelitis; Radiography; Substance Abuse, Intravenous

Seven young men developed similar manifestations of disseminated candidiasis after a single episode of intravenous heroin abuse. Sequential development of lesions of the eye, skin, and bone or costal cartilage was noted within 10 days after injection. Skin lesions were confined to the scalp and other hair bearing areas. Candida albicans was cultured readily from affected skin and costal cartilage. Histological examination of scalp biopsy specimens showed infiltration of hair follicles with chronic inflammatory cells and C albicans. Pseudohyphas of C albicans were also identified in and around hair shafts. The skin, skeletal, and small eye lesions resolved on systemic treatment with 1 g amphotericin B plus flucytosine. Pars plana vitrectomy plus local instillation of amphotericin B cured progressive chorioretinitis. These features may represent a distinctive syndrome of disseminated candidiasis in heroin abusers. Systemic antifungal treatment is curative in most cases.

Topics: Candidiasis; Candidiasis, Cutaneous; Eye Diseases; Heroin; Humans; Male; Osteochondritis; Osteomyelitis; Ribs; Substance-Related Disorders; Syndrome

Topics: Adult; Age Factors; Back Pain; Heroin; Humans; Joints; Lumbar Vertebrae; Male; Osteomyelitis; Pseudomonas aeruginosa; Pseudomonas Infections; Spinal Diseases; Substance-Related Disorders; Time Factors

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: Abscess; Adult; Arthritis, Infectious; Blood; Cartilage; Female; Heroin; Heroin Dependence; Humans; Knee Joint; Male; Osteomyelitis; Pseudomonas aeruginosa; Radiography; Ribs; Staphylococcus; Sternoclavicular Joint; Sternum; Substance-Related Disorders; Suppuration

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

Topics: Adult; Female; Fluorine; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Radioisotopes; Radionuclide Imaging; Sacroiliac Joint; Substance-Related Disorders

Topics: Adult; Carbenicillin; Gentamicins; Heroin; Humans; Intervertebral Disc; Male; Osteomyelitis; Polymyxins; Pseudomonas aeruginosa; Pseudomonas Infections; Spinal Diseases; Substance-Related Disorders

Topics: Adult; Cartilage Diseases; Female; Heroin; Humans; Injections, Intravenous; Lumbar Vertebrae; Male; Osteomyelitis; Pseudomonas aeruginosa; Pseudomonas Infections; Spinal Diseases; Substance-Related Disorders

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

Topics: Adolescent; Adult; Arthritis, Infectious; Candidiasis; Chronic Disease; Female; Hepatitis; Heroin; Humans; Male; Osteomyelitis; Pseudomonas aeruginosa; Pseudomonas Infections; Sepsis; Spondylitis; Staphylococcal Infections; Substance-Related Disorders

Topics: Adult; Coma; Female; Hepatitis B; Heroin; Humans; Male; Osteomyelitis; Pulmonary Edema; Sepsis; Substance-Related Disorders