Lethal endomyocarditis caused by chronic “Krokodil” intoxication

Sorrentino, Antonella; Trotta, Silvia; Colucci, Anna Pia; Aventaggiato, Lucia; Marzullo, Andrea; Solarino, Biagio

doi:10.1007/s12024-018-9967-9

Cited by 17 publications

(18 citation statements)

References 23 publications

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“…Although heroin has been shown to cause oxidative stressinduced myocarditis, heroin did not affect the LV function in this AP4C -apical 4-chamber, AP2C -apical 2-chambers, SAX-B -short-axis basal, SAX-M -short-axis medial, SAX-A -short-axis apical study (16)(17)(18). Therefore, if there is no other risk factor to disrupt cardiac functioning (e.g., alcohol use), the use of heroin alone may not result in impairment of the LV function.…”

Section: Discussionmentioning

confidence: 78%

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Speckle Tracking Strain Assessment of Left Ventricle in Synthetic Cannabinoid and Heroin Users

Demirkıran¹

2018

Anatol J Cardiol

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ObjectiveThere is growing evidence regarding the numerous adverse effects of synthetic cannabinoids (SCBs) on the cardiovascular system; however, no studies have shown the cardiovascular effects of opioids using strain echocardiography. This study examines the cardiac structure and function using echocardiographic strain imaging in heroin and synthetic cannabinoid users.MethodsThis double-blind study included patients who were admitted or referred to a rehabilitation center for heroin (n=31) and synthetic cannabinoid users (n=30). Heroin users and synthetic cannabinoid users were compared with healthy volunteers (n=32) using two-dimensional (2D) speckle-tracking (ST) echocardiography.ResultsNo differences were found in the baseline characteristics and 2D echocardiography values. The mean global longitudinal strain value was −20.5%±2.4% for SCB users, −22.3%±2.4% for opioid users, and −22.5%±2.2% for healthy volunteers (p=0.024). The mean apical 2-chamber (AP2C) L-strain values were −20.1%±3.1%, −22.4%±3.0%, and −22.3%±2.8% for SCB users, opioid users, and healthy volunteers, respectively (p=0.032). The mean apical 4-chamber (AP4C) L-strain values were −20.7%±2.5% for SCB users, −23.2%±3.2% for opioid users, and −23.8%±3.1% for healthy volunteers (p<0.001).ConclusionSCBs are potential causes of subclinical left ventricular dysfunction.

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Section: Discussionmentioning

confidence: 78%

“…In addition, biochemical studies have shown creatine kinase, creatine kinase-MB, and uric acid changes. Significant alteration in the levels of reduced and oxidized glutathione in the kidney and heart suggest that oxidative stress may be involved in krokodil-mediated toxicity (17,18).…”

Section: Introductionmentioning

confidence: 99%

Speckle Tracking Strain Assessment of Left Ventricle in Synthetic Cannabinoid and Heroin Users

Demirkıran¹

2018

Anatol J Cardiol

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“…The occurrence of opioid receptors in the heart and their cross-talk to the cardiac β-adrenergic receptors might explain the cardiac vascular side effects caused by chronic opioid abuse [ 57 , 58 , 59 , 60 ].…”

Section: Resultsmentioning

confidence: 99%

Opioid-Induced Immunomodulation: Consequences for the Experimental Coxsackievirus B3-Induced Myocarditis Model

Pappritz

Linthout

2020

Biology

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Myocarditis is an inflammatory disorder of the heart predominantly caused by infectious agents. Since more than sixty years, the Coxsackievirus B3 (CVB3)-induced myocarditis mouse model is the experimental model used to investigate viral myocarditis. The pathogenesis of viral myocarditis is conceptually a multiphase process, initiated by the infection of cardiomyocytes, followed by activation of the immune system, and resulting in myocardial fibrosis and left ventricular dysfunction. In parallel to the direct infection of the heart, CVB3 replicates in lymphatic organs such as the pancreas. Due to infection of the pancreas, the model of experimental CVB3-induced myocarditis is estimated as a severe burden for the challenged animals. Application of analgesics in frame of the animal welfare act (European directive 2010/63/EU) is more and more becoming a matter of debate. For this purpose, we summarized published studies for 13 different opioids and discussed their potential impact on CVB3-induced myocarditis. In addition, with this summary we also want to provide guidance for researchers beyond the myocarditis field to estimate the impact of opioids on the immune system for their specific model. In the literature, both immunosuppressive as well as immune-activating effects of opioids have been described, but examinations in experimental CVB3-induced myocarditis have still not been reported so far. Based on the existing publications, administration of opioids in experimental CVB3-induced myocarditis might result in more severe disease progression, including higher mortality, or a less pronounced myocarditis model, failing to be used for the establishment of new treatment options. Taken together, the applicability of opioids in experimental CVB3-induced myocarditis and in inflammatory models in general needs to be carefully evaluated and further investigated.

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“…Since its appearance in Russia, the drug quickly spread to other neighboring former Soviet republics, especially Ukraine (which had around 20 000 cases in 2011), , as well as Georgia, − Armenia, , and Kazakhstan. , The first western European country to report cases of krokodil use was Germany in 2011 . Subsequently, cases (both confirmed and suspected) have been reported in other European countries, such as France, Italy, Norway, Spain, and Poland, , with a significant part of them imported from Eastern Europe through immigrants from former Soviet republics . It is noteworthy that various reviews mention cases reported in the Czech Republic, Sweden, Belgium, and Portugal, ,,, but reliable information about these cases could not be found by the authors of the current review.…”

Section: Desomorphine (Krokodil)mentioning

confidence: 99%

DARK Classics in Chemical Neuroscience: Heroin and Desomorphine

Mella

Romero-Parra

Recabarren‐Gajardo

2020

ACS Chem. Neurosci.

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Opioids are arguably one of the most important pharmacologic classes, mainly due to their rich history, their useful and potent analgesic effects, and also, just as importantly, their "Dark Side", constituted by their reinforcing properties that have led countless of users to a spiral of addiction, biological dependence, tolerance, withdrawal syndromes, and death. Among the most significant abused and addictive known opioids are heroin and desomorphine, both synthetic derivatives of morphine that belong to the 4,5-epoxymorphinan structural chemical group of the opioid family drugs. These agents share not only structural, pharmacological, and epidemiological features but also a common geographical distribution. A drop in Afghan heroin production and its "exports" to Russia gave rise to widespread consumption of desomorphine in ex-Soviet republics during the first decade of the 21st century, representing an economical and accessible alternative for misusers to this sort of derivative. Herein we review the state of the art of history, chemistry and synthesis, pharmacology, and impact on society of these "cursed cousins".

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Lethal endomyocarditis caused by chronic “Krokodil” intoxication

Cited by 17 publications

References 23 publications

Speckle Tracking Strain Assessment of Left Ventricle in Synthetic Cannabinoid and Heroin Users

Speckle Tracking Strain Assessment of Left Ventricle in Synthetic Cannabinoid and Heroin Users

Opioid-Induced Immunomodulation: Consequences for the Experimental Coxsackievirus B3-Induced Myocarditis Model

DARK Classics in Chemical Neuroscience: Heroin and Desomorphine

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