Shooting up: the interface of microbial infections and drug abuse

Abstract

Illicit drug control has been on the global agenda for more than a century. Infections have long been recognized as one of the most serious complications of drug abuse. Drug users are susceptible to pulmonary, endovascular, skin and soft tissue, bone and joint, and sexually transmitted infections caused by a wide range of bacterial, viral, fungal and protozoal pathogens. In addition, injection drug users are at increased risk for parenterally acquired infections such as human immunodeficiency virus, hepatitis B virus, hepatitis C virus, tetanus and malaria. Factors related to drug use, such as unsterile injection practices, contaminated drug paraphernalia and drug adulterants, increase the exposure to microbial pathogens. Illicit drugs also affect several components of the complex immune system and thus modulate host immunity. In addition, lifestyle practices such as multiple sexual partners, overcrowded housing arrangements and malnutrition serve as co-factors in increasing the risk of infection. In this review we present an overview of the unique aspects of microbial pathogenesis, immune modulation and common infections associated with drug use. We have restricted the definition of drug abuse to the use of illegal drugs (such as opiates, marijuana, cocaine, heroin and amphetamines), not including alcohol and nicotine.

Rapid brain death caused by a cerebellar abscess with Fusobacterium nucleatum in a young man with drug abuse: a case report

“…This might have contributed to the delay in the performance of the CT scan and the diagnosis. Next to the increased risk for abscess formation associated with intravenous drug abuse drug-induced immune suppression (described for both amphetamine and cannaboids) might predispose for infections with unusual clinical course and symptoms [19,20]. Moreover, skin eruptions classified as Prurigo subacuta could originate from amphetamine abuse [21].…”

Drugs of Abuse Effects on Immunity and Microbial Pathogenesis

“…Drug users are susceptible to several systemic tissue infections such as pulmonary, endovascular, skin and soft tissue, bone and joint, and sexually transmitted infections caused by a wide range of bacterial, viral, fungal and protozoal pathogens (Khalsa and Elkashef 2010). Injection drug users are especially at increased risk for parenterally acquired infections, the most common being human immunodeficiency virus, hepatitis B virus, hepatitis C virus, tetanus and malaria (Cook 2011;Kaushik et al 2011;Murray et al 2011). Confounding variables such as sharing of unsterilized, contaminated needles, drug adulterants, nutritional status, environment influences, history of drug use and genetic variability can contribute to the frequency of infections in these patients; however, epidemiological studies suggest that the immune modulating effects to be a major factor in disease prevalence (Kaushik et al 2011).…”

“…Injection drug users are especially at increased risk for parenterally acquired infections, the most common being human immunodeficiency virus, hepatitis B virus, hepatitis C virus, tetanus and malaria (Cook 2011;Kaushik et al 2011;Murray et al 2011). Confounding variables such as sharing of unsterilized, contaminated needles, drug adulterants, nutritional status, environment influences, history of drug use and genetic variability can contribute to the frequency of infections in these patients; however, epidemiological studies suggest that the immune modulating effects to be a major factor in disease prevalence (Kaushik et al 2011). Areas of research where there are still gaps in knowledge include gender roles and gender differences in drug-using behaviors, disease prevalence, the impact of drug abuse on maternalinfant transmission, and fetal risk to infectious agents thus compromising the health of the developing fetus.…”

Optimising health and safety of people who inject drugs during transition from acute to outpatient care: narrative review with clinical checklist

“…Injection drug use is associated with a range of infectious complications, 76–80 which can be reduced through safe injection techniques: Filters : Cotton balls or cigarette filters are often used as filters to trap particulate matter when injecting. 77 They are subject to skin or oral contamination prior to use and if reused.…”