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Doctors test injecting drug victims for anthrax

BMJ 2000; 320 doi: (Published 27 May 2000) Cite this as: BMJ 2000;320:1428
  1. Bryan Christie
  1. Edinburgh

    Doctors trying to trace the source of an infection that in recent weeks has killed 11injecting drug users in Scotland have tested tissue samples for the presence of anthrax after reports of a similar case in Norway.

    Although two samples tested at the Centre for Applied Microbiology and Research at Porton Down in England have shown a weak positive reaction, anthrax has not been detected in further, extensive tests on samples taken from the 25 people who have so far been affected by the infection.

    The team leading the investigation said it seems “very unlikely” that anthrax is the source of the problem. It was alerted to the possibility by a case reported by doctors in Oslo who isolated the anthrax bacillus from a drug user who died from multiorgan failure last month.

    The Norwegian doctors believe that the heroin injected was contaminated with anthrax and have warned that further cases may occur in Norway and elsewhere. The Norwegian case has similarities to the pattern of infection in Scotland. All of those affected have developed serious abscesses after injecting into muscle, and the deaths have resulted from multiorgan failure.

    Dr Laurence Gruer, a public health consultant in Glasgow who is leading the investigation, said that the anthrax link was one of a several possibilities that had been pursued. He said that the most likely explanation was that there had been an unusual contaminant in a batch of heroin.

    When that was mixed with citric acid (used to dilute the drug before injection) it resulted in severe infection. “A range of organisms can be found in heroin, and further tests are ongoing for conclusive results,” he added.

    While efforts are continuing to trace the source, drug injectors have been warned to avoid injecting into muscle and to seek urgent medical attention if they develop a serious abscess or tissue inflammation.

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