heroin and Sepsis

Research on the effects of opioids on immune responses was stimulated in the 1980s by the intersection of use of intravenous heroin and HIV infection, to determine if opioids were enhancing HIV progression. The majority of experiments administering opioid alkaloids (morphine and heroin)

Topics: Cytokines; Gram-Negative Anaerobic Bacteria; Heroin; HIV Infections; HIV-1; Humans; Leukocytes; Lipopolysaccharides; Morphine; Receptors, Opioid, mu; Sepsis; Toll-Like Receptor 4

A review of the clinical characteristics of heroin addiction and parameters surrounding outpatient and inpatient care of patients afflicted with heroin dependency is presented. A case report demonstrating the difficulties encountered when one elects to treat the heroin addict is included.

Topics: Adult; Dental Care for Disabled; Hepatitis; Heroin; HIV Seropositivity; Humans; Injections, Intravenous; Male; Mouth; Sepsis; Substance-Related Disorders

Although many complications of intravenous drug abuse are well described, "cotton fever" has had little mention in recent medical literature. Cotton fever is street terminology for the post-injection fever experienced by many drug users after "shooting up" with heroin reclaimed from a previously used cotton filter.. We report on a 22-year-old man with a history of intravenous drug abuse with fever 30 min after injecting heroin. He was intensely diaphoretic, tachycardic, and febrile. His workup was negative for any infectious etiology and he later admitted to reusing the same cotton balls for heroin filtration several times over in order to preserve more of the drug.. Although it is usually a benign situation, cotton fever can have a dramatic clinical and hematologic course. We present a typical case of cotton fever followed by a description of the pathophysiology and clinical presentation of this entity.

Topics: Cotton Fiber; Diagnosis, Differential; Equipment Reuse; Fever; Filtration; Heroin; Heroin Dependence; Humans; Male; Narcotics; Sepsis; Substance Abuse, Intravenous; Tachycardia; Young Adult

Anthrax had become extremely rare in Europe, but in 2010 an outbreak of anthrax among heroin users in Scotland increased awareness of contaminated heroin as a source of anthrax. We present the first two Danish cases of injectional anthrax and discuss the clinical presentations, which included both typical and more unusual manifestations.. The first patient, a 55-year old man with HIV and hepatitis C virus co-infection, presented with severe pain in the right thigh and lower abdomen after injecting heroin into the right groin. Computed tomography and ultrasonographic examination of the abdomen and right thigh showed oedematous thickened peritoneum, distended oedematous mesentery and subcutaneous oedema of the right thigh. At admission the patient was afebrile but within 24 hours he progressed to severe septic shock and abdominal compartment syndrome. Cultures of blood and intraperitoneal fluid grew Bacillus anthracis. The patient was treated with meropenem, clindamycin, ciprofloxacin and metronidazole. Despite maximum supportive care including mechanical ventilation, vasopressor treatment and continuous veno-venous hemodiafiltration the patient died on day four.The second patient, a 39-year old man with chronic hepatitis C virus infection, presented with fever and a swollen right arm after injecting heroin into his right arm. The arm was swollen from the axilla to the wrist with tense and discoloured skin. He was initially septic with low blood pressure but responded to crystalloids. During the first week, swelling progressed and the patient developed massive generalised oedema with a weight gain of 40 kg. When blood cultures grew Bacillus anthracis antibiotic treatment was changed to meropenem, moxifloxacin and metronidazole, and on day 7 hydroxycloroquin was added. The patient responded to treatment and was discharged after 29 days.. These two heroin-associated anthrax cases from Denmark corroborate that heroin contaminated with anthrax spores may be a continuous source of injectional anthrax across Europe. Clinicians and clinical microbiologists need to stay vigilant and suspect anthrax in patients with a history of heroin use who present with soft tissue or generalised infection. Marked swelling of affected soft tissue or unusual intra-abdominal oedema should strengthen clinical suspicion.

Topics: Adult; Anthrax; Bacillus anthracis; Denmark; Drug Contamination; Edema; Heroin; Humans; Male; Middle Aged; Sepsis; Soft Tissue Infections; Substance Abuse, Intravenous

Blood cultures from a heroin user who died in June 2012, a few hours after hospital admission, due to acute septic disease, revealed the presence of Bacillus anthracis. This report describes the extended diagnosis by MALDI-TOF and real-time PCR and rapid confirmation of the anthrax infection through reference laboratories. Physicians and diagnostic laboratories were informed and alerted efficiently through the reporting channels of German public health institutions, which is essential for the prevention of further cases.

Topics: Anthrax; Bacillus anthracis; Bacteremia; Drug Contamination; Drug Users; Fatal Outcome; Genome, Bacterial; Germany; Heroin; Humans; Male; Middle Aged; Real-Time Polymerase Chain Reaction; Sepsis; Substance Abuse, Intravenous

A patient with methicillin-resistant Staphylococcus aureus bacteremia received vancomycin (MIC = 0.8 microgram/ml, MBC = 15 micrograms/ml) and heparin simultaneously through the same intravenous line to treat a septic deep venous thrombosis. Bacteremia persisted for 7 days. Bacteremia terminated when the simultaneous infusion of heparin and vancomycin through the same line was stopped. This suggested that an interaction between vancomycin and heparin may have occurred, which resulted in a reduction in vancomycin activity. To test for such an interaction, mixtures of heparin and vancomycin in various concentrations were made and tested for antimicrobial activity against the organisms in the patient. A precipitate formed at the concentrations achieved in the intravenous lines, and when the vancomycin concentrations were measured by bioassay, a 50 to 60% reduction in activity was noted. In contrast, when these solutions were prepared and mixed at microgram concentrations, a precipitate was no longer observed, and antimicrobial activity was not reduced. Heparin appeared to interact unfavorably with vancomycin at the concentrations in the intravenous lines when these drugs were administered simultaneously to patients. This may be the cause of poor therapeutic responses to vancomycin in some patients, especially those infected with tolerant organisms.

Topics: Adult; Drug Combinations; Heparin; Heroin; Humans; Infusions, Parenteral; Male; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Substance-Related Disorders; Thrombophlebitis; Vancomycin

Heroin addiction is associated with several severe and occasionally fatal renal complications. Acute renal failure consequent to rhabdomyolysis and myoglobinuria, when treated supportively, carries a good prognosis. Staphylococcal or other bacterial septicemia may in itself prove fatal and is associated with a proliferative immune complex, acute glomerulonephritis, which generally follows the course and prognosis of septicemia. The necrotizing angiitis reported in heroin addicts still is largely undefined. Focal and segmental glomerular sclerosis is the most common pathologic finding in the syndrome of heroin-associated nephropathy (HAN). Typically, HAN presents with massive proteinuria and progresses rapidly to renal failure. Presumptive evidence supports the premise that heroin or its vehicles elicits immunologically mediated renal damage. The antigen still is unidentified. Removing the antigenic challenge by stopping heroin injection apparently interdicts the progression of renal disease. Renal transplantation can be effectively accomplished in patients with HAN without early recurrence if patients discontinue the use of heroin.

Topics: Acute Kidney Injury; Adult; Female; Glomerulonephritis; Heroin; Heroin Dependence; Humans; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Myoglobinuria; Polyarteritis Nodosa; Prognosis; Proteinuria; Sepsis; Syndrome; Transplantation, Homologous

Topics: Adult; Bronchography; Drug-Related Side Effects and Adverse Reactions; Granuloma; Heart Valve Diseases; Heroin; Heroin Dependence; Humans; Hypertension, Pulmonary; Injections, Intravenous; Lung; Lung Diseases; Male; Narcotics; Pulmonary Edema; Respiratory Tract Infections; Sepsis; Substance-Related Disorders; Syringes; Talc; Tricuspid Valve; Tuberculosis, Pulmonary

Topics: Barbiturates; England; Female; Follow-Up Studies; Heroin; Heroin Dependence; Homosexuality; Humans; Methadone; Narcotics; Sepsis; Social Behavior; Substance-Related Disorders

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

Topics: Adolescent; Adult; Aged; Burns; Colon; Endotoxins; Female; Gastrointestinal Hemorrhage; Heroin; Humans; Intestinal Obstruction; Ischemia; Kidney Transplantation; Liver Cirrhosis; Liver Diseases; Lung Diseases, Parasitic; Male; Middle Aged; Mononuclear Phagocyte System; Morphine Dependence; Peritonitis; Sepsis; Shock, Septic; Transplantation, Homologous; Urinary Fistula; Urinary Tract Infections

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: 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; Blister; Clinical Enzyme Tests; Coma; Diagnostic Errors; Heroin; Humans; Male; Pulmonary Edema; Sepsis

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

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

Topics: Antibodies, Anti-Idiotypic; Escherichia coli; gamma-Globulins; Heroin; Humans; Immunoelectrophoresis; Immunoglobulin G; Immunoglobulin M; Leukocytes; Opsonin Proteins; Phagocytosis; Sepsis; Serratia marcescens; Staphylococcus; Substance-Related Disorders

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

Topics: Abscess; Hepatitis A; Heroin; Humans; Injections; New York City; Sepsis; Substance-Related Disorders

Topics: Adolescent; Adult; Alcoholism; Amphetamine; Barbiturates; Cannabis; Cocaine; Hepatitis A; Hepatitis B; Heroin; Humans; Lysergic Acid Diethylamide; Male; Middle Aged; Opium; Phenothiazines; Prisons; Psychotic Disorders; Sepsis; Smoking; Substance-Related Disorders; United Kingdom

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

Topics: Cocaine; Family Practice; Forensic Medicine; Heroin; Humans; Sepsis; State Medicine; Substance-Related Disorders; United Kingdom; 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