An outbreak of serious illness and death among injecting drug users in England during 2000

The extent of injection site infection in injecting drug users: findings from a national surveillance study

“…Annual reports of severe group A streptococcal infections in IDUs have increased more than tenfold from less than ten in the mid-1990s to 143 in 2004 [17], although reports have since declined [17]. There have been outbreaks of Clostridium novyi, tetanus and wound botulism in IDUs [20][21][22] in recent years. Community-acquired methicillin-resistant Staphylococcus aureus infection has also been reported in IDUs [23].…”

Isolation and identification of Clostridium spp. from infections associated with the injection of drugs: experiences of a microbiological investigation team

“…The outbreak of a clostridial infection among IDUs in 2000 [1,2] served to remind practising clinical microbiologists of some salient lessons. The fact that serious infections and deaths occurred as a result of injecting material containing clostridial spores into human tissue reminds us that so-called 'old' clostridial diseases are not consigned to history.…”

“…If illicit substances used by injecting drug users (IDU) become contaminated with these spores, their injection, particularly non-intravenous injection, may result in severe illness or death such as occurred in parts of the UK during 2000. Between April and August 2000, a total of 108 cases of IDU-associated infections was identified, 60 in Scotland (including 50 in Glasgow), 22 in Dublin and 26 in England, and there were 43 deaths [1,2]. Typically, the illness was characterised by the development of moderate to severe inflammation at or near an injection site several days after extravascular injection of heroin that had been dissolved in heated acid.…”

Clostridial toxins in the pathogenesis of gas gangrene

“…Outbreaks of severe soft tissue infection have been described among extravascularly injecting drug (heroin) users in Scotland, Ireland, England, and the United States [28][29][30][31]. Clinical findings included severe injection site necrosis with massive edema and a rapidly fatal systemic illness characterized by hypotension, pulmonary edema, pericardial and pleural effusions, and leukocytosis.…”