heroin and Tuberculosis

Socioeconomic problems limit the access of drug users to health-care services. This descriptive cross-sectional study was carried out by making use of the medical records of new case tuberculosis (TB) patients hospitalized at Masih Daneshvari Hospital, the national referral centre in Iran, from 2003 to 2006. Demographic and personal characteristics of the patients and type of disease were collected and categorized. Of the 944 patients with confirmed TB, 143 (15.1%) were drug users, among whom 140 (97.9%) were men with just three women drug users. The mean age of the drug users group was 43.04 +/- 13.81 years. The type of drug used was opium in 100 cases (69.9%), heroin in 29 (20.3%), opium and heroin together in four (2.8%) and all three, opium, heroin and crack, in two (1.4%). For 238 high-risk patients, an HIV test was performed and HIV infection was confirmed in 33 cases. Patient delay was longer in drug users (P = 0.000) against other patients, whereas diagnosis delay was shorter (P = 0.007). Drug susceptibility tests were performed for 515 patients with positive cultures. One hundred and thirty-three (14.1%) were found to have 'any resistance' to anti-TB drugs, and 10 (1.1%) individuals had multidrug-resistant TB. Twenty-six (19.5%) of the individuals who showed resistance to first-line agents were drug users. There was no significant relation between drug resistance and drug use (P = 0.4). In conclusion, it seems that active case finding for TB and HIV in addict cases must be contained in harm reduction packages. Moreover, the manifestations of the disease should be considered seriously regardless of attributing them to drug use.

Topics: Adolescent; Adult; Aged; Antitubercular Agents; Crack Cocaine; Cross-Sectional Studies; Diagnosis, Differential; Drug Resistance, Multiple, Bacterial; Female; Heroin; HIV Infections; Humans; Iran; Male; Medical Records; Middle Aged; Mycobacterium tuberculosis; Opium; Patient Acceptance of Health Care; Substance Abuse, Intravenous; Tuberculosis

This study was designed to assess HIV risk behaviors, HIV seroprevalence, and tuberculosis (TB) infection in shooting gallery managers in Puerto Rico. The subjects were 464 injection drug users (IDUs), of whom 12.5% reported managing shooting galleries. The median frequency of drug injection was higher in shooting gallery managers than in nonmanagers. A trend was observed for purified protein derivative (PPD) reactivity to increase according to the length of time spent as a gallery manager, but this trend was not statistically significant. However, anergy rates increased significantly with increase in the number of months spent as shooting gallery manager (p = .021). Multivariate analyses showed that IDUs reporting shooting gallery management experience of > or = 25 months were more likely to be infected with HIV. Prevention programs need to emphasize strategies to protect the health of shooting gallery clients and, in particular, shooting gallery managers. Additional studies are required to determine effective strategies for reducing the risk of HIV and TB infection in shooting galleries.. Little information is currently available on the health status of individuals who manage the settings in which drug injection-related behaviors occur. The present study investigated HIV risk behaviors, HIV seroprevalence, and tuberculosis infection among 464 injecting drug users recruited from areas in San Juan, Puerto Rico, known to have high levels of drug activity. 58 respondents (12.5%) reported having been a shooting gallery manager, for a median duration of 18 months. Managers were more likely to be female, over 35 years of age, not married, homeless, to inject only cocaine, to inject more frequently, to have a history of incarceration, and to report disability than drug users who were not managers. No differences in rates of HIV, tuberculosis, or anergy existed between managers with 1-24 months of management experience and nonmanagers. However, gallery managers with 25 or more months of experience were nearly 3 times more likely to be infected with HIV, nearly 2 times more likely to be anergic, and 2.5 times more likely to have tuberculosis than nonmanagers. 41% of nonmanagers, 48% of managers with 1-24 months of experience, and 71% of those who had been managers for 25 months or more were HIV-seropositive. The compromised health status of long-term shooting gallery managers underscores the need for public health interventions to interrupt the spread of sexually transmitted diseases, HIV, and tuberculosis in this high-risk setting.

Topics: Adult; AIDS-Related Opportunistic Infections; Cocaine; Female; Heroin; HIV Infections; HIV Seropositivity; Humans; Male; Multivariate Analysis; Narcotics; Needle Sharing; Puerto Rico; Regression Analysis; Risk Factors; Risk-Taking; Substance Abuse, Intravenous; Time Factors; Tuberculosis

Prisoners deserve to be taken seriously and treated with respect by the physician, as does any person seeking medical care. Treatment should include an adequate history and physical examination as well as indicated laboratory tests. Anxiety is a ubiquitous problem in prison life and can adversely affect any medical condition. The diagnosis of malingering is and should be one of exclusion, and the physician should keep in mind that a seemingly healthy prisoner might have several other reasons for seeking medical help. The physician needs to be confident of the diagnosis before returning the person to the cell block, as prisoners do not have freedom of access to medical care. New standards, programs, literature, journals, and conferences have drawn attention to the jail as a place where the physician can intervene in a positive way to decrease the recycling of crime and illness. It is not enough to be able to practice good medicine in a jail. Such practice must recognize the special needs of prisoners and the special problems inherent in the jail environment.

Topics: Adult; Alcoholism; Cannabis; Diazepam; Ethics, Medical; Female; Health Services; Heroin; Humans; Male; Mental Disorders; Physician-Patient Relations; Prisoners; Prisons; Seizures; Substance-Related Disorders; Tuberculosis; United States