Crack Cocaine and Infectious Tuberculosis

Abstract

We hypothesize that crack cocaine is independently associated with smear-positive tuberculosis (TB). In a casecontrol study of TB in London, 19 (86%) of 22 crack cocaine users with pulmonary TB were smear positive compared with 302 (36%) of 833 non-drug users. Respiratory damage caused by crack cocaine may predispose drug users to infectivity.T uberculosis (TB) has reemerged as a public health problem in London, and drug users are at high risk of contracting and spreading the disease (1). The United Kingdom has seen a substantial increase in the prevalence of drug use in the past decade, particularly crack cocaine use (2). Numbers of crack cocaine users assessed while in police custody in London increased 3-fold from 1993 through 2003 (3). There are an estimated 46,000 crack cocaine users in London; most also use opiates (4). Evidence to directly link risk for TB with crack cocaine use is lacking, although an association with tuberculin positivity has been shown. Increased exposure risk is considered largely attributable to social and lifestyle factors including homelessness, imprisonment, and drug and alcohol abuse (5). Drug users are commonly immunocompromised through HIV infection and malnutrition, resulting in increased risk for TB infection and rapid progression to active disease.Habitually smoking crack cocaine causes pulmonary damage (crack lung) (Figure). Consequently, alveolar macrophage function and cytokine production is impaired, which may enhance susceptibility to infectious diseases (6). Mycobacterium tuberculosis is an intracellular pathogen that begins the disease process after a person inhales bacilli into the terminal bronchi and pulmonary alveoli (7). Alveolar epithelial cells likely resist invasion by M. tuberculosis bacilli, enabling resident alveolar macrophages and dendritic cells suffi cient time to traverse the epithelium and phagocytose potential invading microbes (8). Several pulmonary complications are associated with the inhalation of crack cocaine (e.g., intensive cough, hemoptysis, shortness of breath, chest pain, acute bilateral pulmonary infi ltrates, thermal airway injury, pneumothorax and noncardiogenic pulmonary edema, production of carbonaceous sputum, and exacerbation of asthma) (9). Collectively, these complications have been reported as crack syndrome (10). We hypothesize that crack cocaine use increases the risk for smear-positive pulmonary TB and that a component of this risk relates to lung damage caused by crack cocaine inhalation. The StudyDetailed clinical and social data were collected by case managers for all TB patients undergoing treatment in London on July 1, 2003. The study was approved by the Metropolitan Multicentre Research Ethics Committee-United Kingdom. Analyses were restricted to pulmonary patients 15-60 years of age (n = 970). We used univariate analyses to compare the characteristics of crack cocaine users, other hard-drug users (predominantly heroin users but excluding those who used only alcohol and marijuana), and those not known to use drugs. A sep...

Tuberculosis in London: the convergence of clinical and social complexity

“…The increased risk of infectious TB among patients with social risk factors may relate to lung damage from smoking tobacco and/or crack cocaine, or delayed diagnosis [6,7]. Risk of drug resistance for those born in East Europe or East Asia reflects the burden of drug-resistant TB in those areas.…”

Usuários de crack atendidos em unidade de emergência psiquiátrica: perfil de uma série de casos Crack users treated in psychiatric emergency units: profile of a series of cases

“…1 Among the reported health problems, HIV infection and other sexually transmitted diseases, by hepatitis B and C viruses and by mycobacterium tuberculosis are related to lack of financial resources to acquire the drug and the practice of exchanging sexual intercourses for crack and/or money, to shared use of devices to consume crack -pipes made of improvised metal and aluminum cans -and, moreover, to lung damages due to drug consumption. [2][3][4] Among the social damages, school drop-out and failure, job loss, exposure to violence forms and family conflicts are often found in the social context of crack users. [5][6] Furthermore, the lack of specific health services to meet this population has overburdened the health system and pointed out flaws in the quality and effectiveness of care network to such users.…”

“…[7][8][9] It should be considered that these users are more likely to seek treatment in emergency units than in primary health services. 4 The investigation of this population in hospitals units of urgency/emergency could indicate new behaviors and changes in the pattern of use of this substance, in addition to indirectly allow an assessment of the social context of users and the effectiveness of health services. In light of the foregoing, this study aimed at establishing the sociodemographic profile and of the use of crack and other drugs of a series of cases of crack users treated in a psychiatric emergency unit.…”

Addiction aux drogues stimulantes (cocaïne, méthamphétamine et nouveaux produits de synthèse)

“…Des pneumothorax et des pneumomédiastins peuvent survenir à l'occasion de grandes variations de pression alvéolaire dues aux techniques d'inhalation à glotte fermée et au réflexe de toux déclenché par la cocaïne base [46]. La tuberculose peut être une possible complication indirecte [47], favorisée par les conditions de vie de certains sujets ayant une addiction au crack. Les pneumopathies bactériennes sont favorisées par l'usage de la voie intraveineuse [48].…”