INTRODUCTION

It is estimated that 3 million Americans have used heroin in their lifetime, and that there were 400,000 active heroin users in the United States in the year 2000, many of whom inject the drug. There are about half as many cocaine and methamphetamine injection drug users (IDUs). Emergency departments (EDs) serve as a regular source of medical care for this patient population, and at some urban hospitals, as many as 10% of admissions are related to injection drug use (IDU).

The list of infections resulting from IDU spans the entire spectrum of infectious disease – from common viral infections, such as hepatitis C, to rare bacterial infections. This chapter will describe the infectious diseases that are commonly encountered in the acute care setting in patients who are IDUs. These include infectious endocarditis, cutaneous abscess, necrotizing fasciitis, septic arthritis and osteomyelitis, spinal epidural abscess, wound botulism, and tetanus.

Common to many of the infections discussed in this chapter is the difficulty of making a correct diagnosis and the high risk of morbidity. IDU-associated soft-tissue infections include not only simple subcutaneous abscess and cellulitis, but also necrotizing fasciitis, which may be fatal if not rapidly diagnosed and treated. Wound botulism related to IDU is easily misdiagnosed, and failure to initiate specific therapy can lead to respiratory failure.