Lethal outbreak of infection with Clostridium novyi type A and other spore-forming organisms in Scottish injecting drug users

McGuigan, Christopher; Penrice, G.; Gruer, Laurence; Ahmed, S Faisal; Goldberg, David J.; Black, Marjorie; Salmon, Jane E.; Hood, John

doi:10.1099/0022-1317-51-11-971

Cited by 85 publications

(91 citation statements)

References 16 publications

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“…A summary of the results from these 16 samples is given in Table 4. Examination of syringe residues during 2000 also yielded cultures of C. perfringens [16,34] and C. botulinum types A and B [35]. Results from that investigation (Table 4), together with the 58 samples described in this study did not identify any samples of heroin contaminated with either C. novyi or C. botulinum despite the fact that spiking experiments demonstrated that the procedures described here were capable of recovering these bacteria.…”

Section: Discussionmentioning

confidence: 75%

“…Because only very low levels of all bacteria were detected, the possibility that C. novyi and C. botulinum were both present but were below the detection limit of the method used here cannot be excluded. However, these studies did identify contamination of heroin by B. cereus, C. perfringens and S. aureus, all of which were isolated from clinical samples collected from infected IDUs during the 2000 outbreak [16,17]. B. cereus endocarditis and ophthalmitis from contaminated heroin or injection paraphernalia have been reported elsewhere [23,36].…”

Section: Discussionmentioning

confidence: 99%

“…IDUs in 2000, 16 samples of heroin were collected in England and Scotland (two of which were not identified as part of the outbreak) and examined by various techniques [16,17,34,35]. One of the samples was obtained from an IDU and indistinguishable isolates of B. cereus were obtained from both the aspirate from an injection site wound and from a heroin sample used by the patient [17,34].…”

Section: Discussionmentioning

confidence: 99%

“…All media should be incubated at 308C. [16,34,35], two samples (plus wrapping for one sample) were unrelated to this outbreak. Ã One B. cereus isolate directly linked to infection in a heroin user [17].…”

Section: Discussionmentioning

confidence: 99%

“…During the intensive investigation more than 108 cases with at least 43 deaths were recognised between April and Aug. 2000 [10][11][12][13]. C. novyi type A was the likely cause of the more serious illnesses [12,[14][15][16], although other endospore-forming bacteria were also associated with some cases including C. perfringens [16] and B. cereus [17]. Cases of wound botulism were also reported in IDUs during 2000 and these represent the first recognition of this condition in the UK [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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An investigation into the microflora of heroin

McLauchlin¹,

Mithani²,

Bolton³

et al. 2002

Journal of Medical Microbiology

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In 2000, an unusual increase of morbidity and mortality among illegal injecting drug users in the UK and Ireland was reported and Clostridium novyi was identified as the likely source of the serious infection, although infections due to C. botulinum and Bacillus cereus were also reported. Because heroin was a possibile source of infection, this study investigated the microflora of heroin samples seized in England during 2000 and 2002. Two methods were developed for the examination of the microflora of heroin. The first consisted of suspension of the drug in maximum recovery diluent (MRD) which was inoculated directly into Clostridium Botulinum Isolation Cooked Meat Broth (CBI). The second method rendered the heroin soluble in citric acid, concentrated particulate material (and bacterial cells) by filtration and removed heroin residues by washing with citric acid and phosphate-buffered saline before placing the filter in CBI broth. Duplicate CBI broths from both methods were incubated without heating and after heating at 608C for 30 min. Subcultures were made after incubation for 7 and 14 days on to eight different solid media. The methods were evaluated with heroin samples spiked with either C. botulinum or C. novyi spore suspensions; recovery of 10 spores in the original sample was demonstrated. Fifty-eight heroin samples were tested by citric acid solubilisation and 34 by the MRD suspension technique. Fifteen different grampositive species of four genera were recognised. No fungi were isolated. Aerobic endospore-forming bacteria (Bacillus spp. and Paenibacillus macerans) were the predominant microflora isolated and at least one species was isolated from each sample. B. cereus was the most common species and was isolated from 95% of all samples, with B. licheniformis isolated from 40%. Between one and five samples yielded cultures of B. coagulans, B. laterosporus, B. pumilus, B. subtilis and P. macerans. Staphylococcus spp. were isolated from 23 (40%) samples; S. warneri and S. epidermidis were the most common and were cultured from 13 (22%) and 6 (10%) samples respectively. One or two samples yielded cultures of S. aureus, S. capitis and S. haemolyticus. The remainder of the flora detected comprised two samples contaminated with C. perfringens and two samples with either C. sordellii or C. tertium. Multiple bacterial species were isolated from 43 (74%) samples, a single species from the remaining 15. In 13 samples B. cereus alone was isolated, in one B. subtilis alone and in one sample B. pumilus alone. C. botulinum and C. novyi were not isolated from any of the heroin samples. Recommendations for the optimal examination of the microflora of heroin are given.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An investigation into the microflora of heroin

McLauchlin¹,

Mithani²,

Bolton³

et al. 2002

Journal of Medical Microbiology

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Main Conclusions and Recommendations

Bernard¹,

Grunow²,

Marcus³

et al. 2000

Carcinogenic and Anticarcinogenic Factors in Food

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The largest European populations of sea lamprey appear to be in the NW of the Iberian Peninsula (NW Spain and N Portugal) and W-SW France, regions that also contain the main sea lamprey commercial fisheries. Recent research shows evidence of population structuring in western Iberian Peninsula that indicates the existence of three different stocks. This structuring may exist in other regions across the geographical range of the species, like in France, and further studies are needed to clarify this, in order to adequately manage the different stocks.

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Histotoxic Clostridia

Songer¹

2004

Pathogenesis of Bacterial Infections in Animals

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Lethal outbreak of infection with Clostridium novyi type A and other spore-forming organisms in Scottish injecting drug users

Cited by 85 publications

References 16 publications

An investigation into the microflora of heroin

An investigation into the microflora of heroin

Main Conclusions and Recommendations

Histotoxic Clostridia

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