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Soft tissue infections caused by spore-forming bacteria in injecting drug users in the United Kingdom

Published online by Cambridge University Press:  07 April 2005

M. M. BRETT ,
J. HOOD ,
J. S. BRAZIER ,
B. I. DUERDEN  and
S. J. M. HAHNÉ
M. M. BRETT
Affiliation:
Food Safety Microbiology Laboratory, Health Protection Agency Specialist and Reference Microbiology Division, London, UK
J. HOOD
Affiliation:
Department of Clinical Microbiology, Glasgow Royal Infirmary, Glasgow, UK
J. S. BRAZIER
Affiliation:
Anaerobe Reference Laboratory, NPHS Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, UK
B. I. DUERDEN
Affiliation:
Department of Medical Microbiology, University of Wales, College of Medicine, Heath Park, Cardiff, UK
S. J. M. HAHNÉ
Affiliation:
Communicable Disease Surveillance Centre, Health Protection Agency, London, UK
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Abstract

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From 2000 to May 2004 there has been a marked increase in illness resulting from spore-forming bacteria in injecting heroin users in the United Kingdom. Clostridium novyi caused 63 cases of severe illness in 2000 and seven further cases from 2001. Wound botulism first occurred in 2000 (six cases) with 51 further cases to March 2004. Tetanus occurred in 20 cases between late 2003 and March 2004. Infections with C. histolyticum (nine cases), C. sordellii (one case) and Bacillus cereus (one case) were also reported. The reasons for the increase in illness are unclear. The major risk factor was skin- or muscle-popping. The problem appears to be here to stay. This review describes the causative organisms, pathogenesis, clinical presentation, epidemiology and treatment of cases. Clinical vigilance and a high standard of anaerobic microbiology are essential. Clinicians and laboratories must report such cases (or likely cases) rapidly so that clusters can be rapidly identified, in order to control disease. Prevention relies on tetanus immunization.

Type
Review Article
Information
Epidemiology & Infection , Volume 133 , Issue 4 , August 2005 , pp. 575 - 582
Copyright
2005 Cambridge University Press