Infections with Spore-forming Bacteria in Persons Who Inject Drugs, 2000–2009

Abstract

Clusters of almost 300 cases in time and location might be the result of contamination of specific heroin batches.

Not in the vein: ‘missed hits’, subcutaneous and intramuscular injections and associated harms among people who inject psychoactive drugs in Bristol, United Kingdom

“…Intentional or accidental subcutaneous and intramuscular injections among people who inject psychoactive drugs are known to be a risk factor for injection related bacterial infections (Binswanger, Kral, Bluthenthal, & Rybold, 2000;Pirozzi, Van, Pontious, & Meyr, 2014), particularly those caused by anaerobic organisms, such as, wound botulism and tetanus (CDC, 1995;Brett, Hood, Brazier, Duerden, & Hahne, 2005;Palmateer, et al, 2013).…”

“…Considering the extent of injecting site infections among people who inject drugs in the United Kingdom (Hope, Kimber, Hickman, Vickerman, & Ncube, 2008), in particular the substantial and ongoing problems with wound botulism and tetanus (Palmateer, et al, 2013;Anon, 2015), data on the extent of, and the harms associated with, both intentional and accidental subcutaneous and intramuscular injections among this population are needed to help inform public health responses. Our study aimed to address this knowledge gap by asking participants about intentional subcutaneous or intramuscular injections and also about 'missed hits'.…”

Injectional anthrax infection due to heroin use induces strong immunological memory

“…Clusters of infection derived from contaminated drug batches were seen during 2009–2010 when there were over 80 anthrax cases in Scotland and SE England, seemingly related to a single batch of anthrax-contaminated heroin. 1–3 There have been a further 13 cases in the UK, Germany, Denmark and France during 2012–2013. 4 Contamination most likely occurs through exporting drug batches concealed in animal hides, through the manufacturing laboratory containing equipment contaminated with anthrax spores or through heroin having been ‘cut’ with contaminated material such as powdered bone.…”

Development of a filter to prevent infections with spore-forming bacteria in injecting drug users

“…People who inject drugs (PWIDs) frequently suffer from infections, in particular, skin and soft tissue infections, which are estimated to cost the NHS in the UK up to £30 million annually [2]. Since 2000, there have been, across Europe, several outbreaks amongst PWIDs of particularly serious, life threatening infections caused by brown heroin that is contaminated with bacteria such as Bacillus and Clostridium , leading to severe skin and soft tissue infections such as anthrax, wound botulism, gas gangrene and tetanus [3]. In 2000, there were 60 confirmed cases of Clostridium novyi infection amongst PWIDs in Scotland, with an 87% fatality rate [4], with further cases reported across Europe.…”

“…As mentioned above, the main cause of infections with Bacillus and Clostridium species is contaminated heroin [3–5, 11]. The ‘street’ process for preparing brown heroin includes the use of acidic substrates such as citric acid in water and flame heating [7].…”