Intended for healthcare professionals


Tetanus in injecting drug users

BMJ 2005; 330 doi: (Published 27 January 2005) Cite this as: BMJ 2005;330:208
  1. Nick J Beeching, senior lecturer (,
  2. Natasha S Crowcroft, consultant epidemiologist
  1. Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool L7 8XP
  2. Immunisation Department, Health Protection Agency, Communicable Disease Surveillance Centre, London NW9 5EQ

The latest Clostridium infection to threaten injectors in Britain

Clostridium infections in injecting drug users are of continuing concern for clinicians in emergency departments and intensive care because infected patients may present unwell and deteriorate very quickly without appropriate management. In 2000, an epidemic of necrotising fasciitis resulting in overwhelming sepsis and sudden death in British and Irish injecting drug users was caused by organisms such as Clostridium novyi. These flourish in the anaerobic environment of wounds associated with injecting into skin or muscle (“popping”). This may be done inadvertently or deliberately by injecting drug users who cannot find a vein—women, older users, and those with a longer injecting history are at greatest risk.1 Botulism due to the systemic effects of toxin released from C botulinum in wounds in injecting drug users continues to be seen in Britain2 and elsewhere, particularly in California where it is linked with locally available “black tar” heroin.3 Patients typically present with diplopia, dysarthria, dysphagia, descending flaccid paralysis without …

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