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  • Europe - Several die as anthrax infects heroin users

    Source: http://www.independent.co.uk/news/uk...s-1843932.html

    Addict dies as anthrax infects heroin users

    By Lucy Christie, Press Association

    Thursday, 17 December 2009

    A heroin addict who died in hospital has tested positive for anthrax, health officials said today.

    He died at the Victoria Infirmary in Glasgow yesterday. NHS Greater Glasgow and Clyde said blood tests had shown the presence of the deadly bacteria.

    Health officials said another heroin user being treated at the same hospital has also tested positive for anthrax. And a third patient, who is being treated at Glasgow Royal Infirmary, is being tested for anthrax. All three had infections in areas of the body they injected with heroin.

    The health board confirmed that the dead drug user was male as is the patient at the Royal Infirmary, while the patient at the Victoria Hospital is a woman.

    It is not known if the three cases are directly linked.

    The victim is believed to have died from the anthrax infection.

    Consultant epidemiologist Dr Colin Ramsay, of Health Protection Scotland, told a press conference in Glasgow: "The evidence is that heroin is prepared in non-sterile circumstances and therefore it is conceivable it could be contaminated by a variety of organisms which could happen naturally if they occur in the environment in which the heroin is prepared.

    "We are not suggesting that there is any evidence that someone deliberately added it.

    "I think the evidence is that heroin comes from countries where anthrax is more likely in the animal population so the chances of it being in the environment in these countries is higher.

    "It's highly conceivable that it could have been contaminated either from the source in the origin country or it could have been contaminated as a consequence of subsequent cutting when it arrived in this country."

    Dr Ahmed said: "One of the possibilities is that this bonemeal is used, bonemeal being produced from animals, that could be one of the sources but this is speculation.

    "We have no way of knowing how it might have got contaminated."

    The outbreak team dealing with the infection will meet again tomorrow to discuss the situation, the health board said.

    NHS Greater Glasgow and Clyde said its Public Health Protection Unit was now working with the Procurator Fiscal and Strathclyde Police to identify the source of the anthrax.

    One possibility being investigated is that contaminated heroin, or an agent used to cut the drug, may be to blame.

    Dr Syed Ahmed, consultant in public health medicine, said the risk to the general public was "negligible".

    He said: "I urge all drug-injecting heroin users to be extremely alert and to seek urgent medical advice if they experience an infection.

    "While this section of the community need to be on their guard, the risk to the rest of the population, including close family members of the infected cases, is negligible.

    "It is extremely rare for anthrax to be spread from person to person and there is no significant risk of airborne transmission from one person to another."

    Any heroin users admitted to hospital with serious soft-tissue infections now or during the last four weeks will now be investigated for anthrax.

    Anthrax was suspected of being responsible for a spate of deaths among Scottish heroin addicts in 2000.

    New Scientist magazine reported that tests at the UK biological defence lab in Porton Down found signs of infection in dead addicts.

    But health officials in Glasgow, where several of the deaths took place, insisted at the time that the drug users were not infected by anthrax.

    The last two known anthrax-related deaths in Britain were both of men who made drums.

    In 2006 Christopher Norris, 50, from Stobs, near Hawick, died after inhaling anthrax.

    Mr Norris made artworks and musical instruments, including drums.

    A report from NHS Borders said Mr Norris is likely to have caught the disease after playing or handling anthrax-contaminated West African drums at a drumming workshop.

    Last November, drum-maker Fernando Gomez, who is thought to have inhaled anthrax spores while handling imported animal skins, died in hospital in London.

    The 35-year-old Spanish folk musician had been in the intensive care unit for several days.

    Five people died and 17 others were ill in a series of anthrax attacks in the US in 2001.

  • #2
    Anthrax found in Glasgow heroin users

    Anthrax found in Glasgow heroin users

    Health agencies across Scotland have been placed on alert after a drug user who died in a Glasgow hospital tested positive for anthrax.

    A woman who injected heroin is also being treated for the effects of the infection.
    Tests are also being carried out on a third drug user and a number of other cases are being investigated.

    Health officials believe the two may have taken contaminated heroin and an outbreak control team has been set up.
    The woman is being treated at the Victoria Infirmary, where the man died two days ago and doctors are waiting for the results of tests carried out on a third drug user at the city's Royal Infirmary.

    At the moment, the cases are not being linked, though it is known all three had infections in areas of the body they had injected with heroin.

    Police and health officials are investigating whether contaminated heroin or a contaminated cutting agent may be responsible.

    Dr Syed Ahmed, consultant in public health medicine, said: "I urge all drug injecting heroin users to be extremely alert and to seek urgent medical advice if they experienced an infection.

    "While this section of the community need to be on their guard the risk to the rest of the population - including close family members of the infected cases - is negligible.

    "It is extremely rare for anthrax to be spread from person to person and there is no significant risk of airborne transmission from one person to another."

    'Extremely rare'
    The health board said it would investigate cases of drug injecting heroin users with serious soft tissue infections now or during the last four weeks.

    Strathclyde Police said it was vital that if there was a contaminated batch of heroin on the streets that it was traced and recovered.

    A spokesman added: "Our number one priority is the safety and wellbeing of everyone in our communities.

    "We would appeal to drug users to come forward if they have any information that may enable us to trace its source.

    "We would like to reassure people that our purpose is to recover this substance in the interests of public safety. It is not about targeting drug users."

    Anthrax is an acute bacterial infection most commonly found in hoofed animals such as cattle, sheep and goats.

    It normally infects humans when they inhale or ingest anthrax spores, but cannot be passed from person to person.

    The last death from anthrax in Scotland was in 2006 when Christopher Norris died after inhaling the spores.

    The 50-year-old craftsman, from Stobs, near Hawick, made drums with materials such as untreated animal hides.

    Last November, drum-maker Fernando Gomez, who is thought to have inhaled anthrax spores while handling imported animal skins, died in hospital in London.
    The 35-year-old Spanish folk musician had been in the intensive care unit for several days.

    Five people died and 17 others were ill in a series of anthrax attacks in the US in 2001.

    BBC, News, BBC News, news online, world, uk, international, foreign, british, online, service
    ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
    Richard Horton, Editor-in-Chief The Lancet

    ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

    Comment


    • #3
      Re: UK: Addict dies as anthrax infects heroin users

      Almost anywhere in the world, a single cutaneous anthrax case is news, and usually winds up on FT, RSOE EDIS, and ProMed. There is no place where anthrax is so widespread as to accidentally wind up in heroin. IMO, the anthrax had to have been put in the heroin intentionally. I believe we are about to have a murder mystery, at the very least.

      Comment


      • #4
        Re: UK: Addict dies as anthrax infects heroin users

        And we quickly get a ProMed post.



        Archive Number 20091217.4270
        Published Date 17-DEC-2009
        Subject PRO/AH/EDR> Anthrax, human - UK: (Scotland) heroin users


        ANTHRAX, HUMAN - UNITED KINGDOM: (SCOTLAND) HEROIN USERS
        ************************************************** ******
        A ProMED-mail post
        <http://www.promedmail.org>
        ProMED-mail is a program of the
        International Society for Infectious Diseases
        <http://www.isid.org>

        ******
        [1]
        Date: 17 Dec 2009
        Source: BBC [edited]
        <http://news.bbc.co.uk/2/hi/uk_news/scotland/glasgow_and_west/8419113.stm>


        Anthrax found in dead heroin user from Glasgow
        ----------------------------------------------
        Anthrax has been found in 2 heroin users from Glasgow -- one of whom has
        died in hospital. NHS Greater Glasgow and Clyde said the man died in the
        city's Victoria Infirmary on Wednesday [16 Dec 2009]. A woman being treated
        there has also tested positive. A 2nd man with "serious soft tissue
        infections" is being tested at Glasgow Royal Infirmary. Police believe
        contaminated heroin or a contaminated cutting agent may be responsible for
        the infections.

        Dr Syed Ahmed, consultant in public health medicine, said: "I urge all drug
        injecting heroin users to be extremely alert and to seek urgent medical
        advice if they experience an infection. While this section of the community
        need to be on their guard the risk to the rest of the population --
        including close family members of the infected cases -- is negligible. It
        is extremely rare for anthrax to be spread from person to person and there
        is no significant risk of airborne transmission from one person to another."

        The health board said it would investigate cases of drug injecting heroin
        users who present with serious soft tissue infections now or [have done so]
        during the last 4 weeks.

        "We would appeal to drug users to come forward if they have any information
        that may enable us to trace its source. We would like to reassure people
        that our purpose is to recover this substance in the interests of public
        safety. It is not about targeting drug users." Strathclyde police said it
        was vital that if there was a contaminated batch of heroin on the streets
        that it was traced and recovered. A spokesman added: "Our number one
        priority is the safety and wellbeing of everyone in our communities."

        --
        communicated by:
        ProMED-mail
        <promed@promedmail.org>

        ******
        [2]
        Date: 17 Dec 2009
        Source: NHS Greater Glasgow and Clyde [edited]
        <http://www.nhsggc.org.uk/content/default.asp?page=s1192_3&newsid=10768&back>


        Anthrax alert for drug injecting heroin users
        ---------------------------------------------
        Blood tests from a drug injecting heroin user who died yesterday [16 Dec
        2009] at the Victoria Infirmary in Glasgow have shown the presence of anthrax.

        Another patient being treated at the same hospital has had a positive test
        for anthrax and NHS Greater Glasgow and Clyde's Public Health Protection
        Unit are now working closely with the Procurator Fiscal's Office and
        Strathclyde Police to identify the source of the anthrax.

        A 3rd patient, who is being treated at Glasgow Royal Infirmary, is being
        tested and we await the results early next week. All three potentially
        linked cases presented at hospital with serious soft tissue infections in
        areas of the body injected with heroin.

        One avenue being investigated by Public Health and Strathclyde Police is
        that contaminated heroin or a contaminated cutting agent mixed with the
        heroin may be responsible for the infections.

        --
        communicated by:
        ProMED-mail
        <promed@promedmail.org>

        [This news release has a useful series of informative questions and answers.

        There was a similar case in Oslo in April 2000, in which one person died.
        It is more common for heroin injectors to die of tetanus. It will be
        interesting to learn the results of any forensic police investigations into
        the common product used. As anthrax, whether in human or livestock, is now
        essentially absent in Scotland how the spores got into the product can only
        be a matter for speculation. However it should be remembered that Glasgow
        is a port. In the Oslo incident we did not learn the outcome of the
        Norwegian police investigation. - Mod.MHJ


        The interactive HealthMap/ProMED map for Glasgow is available at
        <http://healthmap.org/r/010W> - CopyEd.EJP]

        [see also:
        2000
        ---
        Anthrax, human - Norway: update 20000513.0747
        Anthrax, human - Norway: confirmation 20000510.0707
        Anthrax, human - Norway: RFI 20000506.0119]

        ....................sh/mhj/ejp

        Comment


        • #5
          Re: UK: Addict dies as anthrax infects heroin users

          Anthrax leaves drum-maker critically ill

          This article gives two UK cases of accidental anthrax infection so I am not sure we need look for deliberate intent - at least not at this stage.

          Comment


          • #6
            Re: UK: Addict dies as anthrax infects heroin users

            Those two cases imported anthrax infected hides into the UK from West Africa (and then dried them to make drum skins), resulting in accidental exposure. I don't know the details of heroin manufacture, but it seems to be that it is likely a fairly complicated process that involves some lab-type equipment and likely does not involve animal hides or parts. That does bring up another possible accidental exposure though - perhaps the manufacturer of the heroin used discarded lab equipment from a facility that handled anthrax without sterilizing it first - drug dealers typically aren't too concerned about sterility.

            But until they can determine where the anthrax came from, you're right - it's just speculation. But it just seems very unlikely to be natural to me.

            Comment


            • #7
              Re: UK: Addict dies as anthrax infects heroin users

              The red text below suggests another possible source of the anthrax. I was not aware of this procedure for cutting drugs (it seems to me there are a lot easier things available to cut with, such as cornstarch, than ground up animal bone), but that would certainly do it.

              I still wonder about the possible use of unsterile lab equipment when cooking up the drugs.



              Situation Update No. 2
              On 18.12.2009 at 07:34 GMT+2

              A Scots heroin addict died yesterday after being infected with anthrax, another has tested positive and a third is suspected of having the deadly bug. The 37-year-old male victim died afte rbeing admitted to the Victoria Infirmary in Glasgow. Blood tests confirmed the presence of the deadly bacteria. A woman heroin user - not believed to be connected to the dead man - is being treated at the same hospital after also testing positive for anthrax. A third male patient being treated at Glasgow. Royal Infirmary, is also being tested for anthrax. All three had infections in areas of the body where they had been injecting heroin. Health chiefs believe more cases will come forward. They said their public health protection unit were now working with the procurator fiscal and police to identify the anthrax source. One line of inquiry is that another ingredient used to cut the drug may be to blame. Public health officials throughout the country had been ordered to stay vigilant for signs of the disease. Dr Syed Ahmed said: "I urge all drug-injecting heroin users to be alert and seek medical advice if they experience an infection. "While this section of the community need to be on guard, the risk to the rest of the population, including close family members of infected cases, is negligible. "It is extremely rare for anthrax to be spread from person to person and there is no significant risk of airborne transmission from one person to another . "Symptoms include local infection at the injecting site. "There can be a red pimple which gets swollen and turns black. "If it's not treated early the infection can spread to the blood and it may be too late." Any heroin users admitted to hospital with serious infections over the last four weeks will now be investigated for anthrax. Dr Ahmed said one possible source was bone meal - a powder made from ground bones used in cutting agents. However, there is no suggestion it was added in a deliberate attempt to kill users. Anthrax is often found in animals in Afghanistan, where the bulk of Scotland's heroin comes from. A batch of drugs contaminated by the flesh-eating bug necrotising fasciitis killed 43 addicts across the country in 2000.


              --------------------------------------------------------------------------------

              Comment


              • #8
                Re: UK: Addict dies as anthrax infects heroin users



                Situation Update No. 4
                On 21.12.2009 at 15:07 GMT+2

                No new cases of anthrax have arisen several days after two Glasgow heroin users tested positive for anthrax infections, health officials have said. Officials across the nation, however, are remaining vigilant for potential new cases. One heroin user at Glasgow's Victoria Infirmary has already died as a result of an anthrax infection. A female heroin user also tested positive and remains in stable condition. Results from tests carried out on a third drug user, who is listed in stable condition at Glasgow Royal Infirmary, are still pending. Post-mortem examination results for the deceased man are expected next week. All three cases are not currently being linked, though they do share the common theme of infections appearing in the area of the body that had been injected with heroin. Investigations by police and health officials are focusing on whether contaminated heroin or a contaminated cutting agent was responsible. Christopher Norris was the last person to die of an anthrax infection in Scotland. Norris, a 50-year-old craftsman, used untreated animal hides to make drums. Anthrax is most commonly found in hoofed animals, including cattle, sheep and goats, and Norris died from inhaling anthrax spores. A London drum maker also died last November from inhaled anthrax spores after handling imported animal skins.

                Comment


                • #9
                  Re: UK: Addict dies as anthrax infects heroin users

                  Related

                  The case from Oslo, april 2000

                  Folkehelseinstituttet http://www.fhi.no/eway/default.aspx?...:5625:35:::0:0

                  Comment


                  • #10
                    Re: UK: Addict dies as anthrax infects heroin users

                    So now we have three confirmed, and a fourth suspected.



                    Situation Update No. 5
                    On 21.12.2009 at 17:22 GMT+2

                    Health officials have confirmed that anthrax has been found in a third heroin user in Glasgow. The male patient is in a critical condition in the city's Royal Infirmary. Another patient there is also being tested for the infection. A man and woman in the city's Victoria Infirmary tested positive for anthrax last week. The man died on 16 December. Police and health officials believe contaminated heroin or a contaminated cutting agent may be responsible. Dr Syed Ahmed, consultant in public health medicine, said: "I urge all drug injecting heroin users to be extremely alert and to seek urgent medical advice if they experienced an infection. "Drug injecting is extremely risky and dangerous. The possible presence of a batch of heroin contaminated with anthrax makes drug injecting even riskier and even more dangerous. "While this section of the community need to be on their guard the risk to the rest of the population - including close family members of the infected cases - is negligible." Anthrax is an acute bacterial infection most commonly found in hoofed animals such as cattle, sheep and goats. It normally infects humans when they inhale or ingest anthrax spores, but cannot be passed from person to person. The last previous death from anthrax in Scotland was in 2006 when Christopher Norris died after inhaling the spores. The 50-year-old craftsman, from Stobs, near Hawick, made drums with materials such as untreated animal hides.

                    Comment


                    • #11
                      Re: UK: Addict dies as anthrax infects heroin users

                      very small amounts are lethal

                      (...) died from inhaling anthrax spores

                      Comment


                      • #12
                        Re: UK: Addict dies as anthrax infects heroin users



                        Archive Number 20091222.4317
                        Published Date 22-DEC-2009
                        Subject PRO/AH/EDR> Anthrax, human - United Kingdom (03): (Scotland)

                        ANTHRAX, HUMAN - UNITED KINGDOM (03): (SCOTLAND)
                        ************************************************
                        A ProMED-mail post
                        <http://www.promedmail.org>
                        ProMED-mail is a program of the
                        International Society for Infectious Diseases
                        <http://www.isid.org>

                        [1]
                        Date: Mon 21 Dec 2009
                        Source: BBC News [edited]
                        <http://news.bbc.co.uk/2/hi/uk_news/scotland/glasgow_and_west/8425313.stm>


                        Tests confirm 3rd anthrax case
                        ------------------------------
                        Health officials have confirmed that anthrax has been found in a 3rd
                        heroin user in Glasgow. The male patient is in a critical condition
                        in the city's Royal Infirmary. Another patient there is also being
                        tested for the infection.

                        A man and woman in the city's Victoria Infirmary tested positive for
                        anthrax last week [week of 14 Dec 2009]. The man died on 16 Dec 2009.
                        Police and health officials believe contaminated heroin or a
                        contaminated cutting agent may be responsible.

                        Dr Syed Ahmed, consultant in public health medicine, said: "I urge
                        all drug injecting heroin users to be extremely alert and to seek
                        urgent medical advice if they experience an infection. Drug injecting
                        is extremely risky and dangerous. The possible presence of a batch of
                        heroin contaminated with anthrax makes drug injecting even riskier
                        and even more dangerous. While this section of the community need to
                        be on their guard the risk to the rest of the population -- including
                        close family members of the infected cases -- is negligible."

                        The last previous death from anthrax in Scotland was in 2006 when [a
                        man] died after inhaling the spores. The 50-year-old craftsman, from
                        Stobs, near Hawick, made drums with materials such as untreated animal hides.

                        --
                        Communicated by:
                        ProMED-mail
                        <promed@promedmail.org>

                        ******
                        [2]
                        Date: Mon 21 Dec 2009
                        Source: WCJB [edited]
                        <http://www.wcjb.co.uk/third-glasgow-drug-user-has-anthrax-35220>


                        3rd Glasgow drug user has anthrax
                        ---------------------------------
                        Traces of anthrax have fund in the blood of a 3rd Scotsman at a
                        Glasgow hospital. [Last Wednesday (16 Dec 2009) a] man with almost
                        identical symptoms died. A woman, also reported to being a drug
                        addict, also had traces of anthrax found in her blood, although she's
                        currently in a stable condition at the Victoria Infirmary in Glasgow.

                        The 3 Anthrax cases were all found in Glasgow and medical staff
                        believe the infection stems from the use of contaminated heroin as
                        they all involved particular areas of the body which were injected
                        with the drug.

                        NHS officials for Greater Glasgow and Clyde said the man most
                        recently infected with anthrax is being currently treated at Glasgow
                        Royal Infirmary and is in a critical condition.

                        Doctors are also suspecting a 4th case, also admitted at Glasgow
                        Royal Infirmary, although confirmation needs to be done after tests.

                        According to a statement by NHS Greater Glasgow and Clyde, health
                        care officials are investigating all the cases of any important soft
                        tissue infections experienced in heroin injecting users from now or
                        in the last 4 weeks.

                        Heroin is often produced in regions of the world where anthrax is
                        rather common in animals. In order to manufacture the drug, animal
                        bone meal is occasionally used as a cutting substance. Bone meal,
                        made from crushed and coarsely ground animal bones, is predominantly
                        used as an organic fertiliser.

                        [Byline: Michael Harries]

                        --
                        Communicated by:
                        ProMED-mail
                        <promed@promedmail.org>

                        [The Glasgow authorities have now admitted the possibility of a 4th
                        case. They are being naturally taciturn about the existence of cases
                        awaiting diagnostic confirmation. The total possible number is
                        fortunately limited and the status of the few remaining is awaited.
                        Hopefully there will be no others.

                        While contaminated bone meal is a natural suspect, colleagues with
                        more knowledge of recreational drugs than myself say that any
                        non-soluble residue would be noticed by the users and generate very
                        negative attitudes towards their suppliers. Also if bone meal were
                        used further back in the processing chain, the probability would
                        exist of many more sick heroin addicts than just these in Glasgow.
                        The results of the ongoing international investigations are awaited. - Mod.MHJ]


                        [see also:
                        Anthrax, human - UK (02): (Scotland) 20091219.4288
                        Anthrax, human - UK: (Scotland) heroin users 20091217.4270
                        Anthrax, human, 2006 - UK (02): (Scotland), background 20090421.1499
                        2008
                        ----
                        Anthrax, human - UK (07): Eurosurveillance report 20081218.3990
                        2000
                        ----
                        Anthrax, human - Norway: update 20000513.0747
                        Anthrax, human - Norway: confirmation 20000510.0707
                        Anthrax, human - Norway: RFI 20000506.0119]
                        ...................................sb/mhj/mj/mpp

                        Comment


                        • #13
                          Re: UK: Addict dies as anthrax infects heroin users



                          Situation Update No. 6
                          On 23.12.2009 at 04:05 GMT+2

                          The man was last night fighting for his life - as a FOURTH patient was being tested for the killer bug at the same hospital. NHS Greater Glasgow and Clyde confirmed the male drug user - being treated in isolation at the city's Royal Infirmary - was suffering from the bacterial infection. All cases of junkies who suffered a severe soft tissue infection in the past four weeks will now be investigated as officials try to trace the drug's source. It's thought anthrax spores may have got into a batch of heroin as it was cut with animal bone meal. Last week we told how a 37-year-old addict died of the killer bug while the male junkie and another female victim were being treated in hospital. The woman, who earlier tested positive, yesterday remained "stable" at the city's Victoria Infirmary. Dr Syed Ahmed, Consultant in Public Health Medicine, said: "I urge all drug-injecting heroin users to be extremely alert."

                          ---

                          Health officials in Scotland have confirmed a third case of anthrax-contaminated heroin sickening a heroin user in Glasgow, Scotland. The man is now in critical condition at an area hospital. One man died last week from the anthrax contamination, and a woman was also infected. Officials are also now testing for a fourth possible infection. Health officials believe the anthrax may be from a cutting agent or from the heroin itself. They?re urging drug users and health providers throughout Great Britain to be extremely vigilant for symptoms of anthrax poisoning.

                          Comment


                          • #14
                            Re: UK: Addict dies as anthrax infects heroin users

                            Getting a bit difficult to track. I believe there are now two confirmed deaths. A third case is confirmed and still alive (the woman) in Glasgow. There is a fourth confirmed case, in Lanarkshire, and he is still alive. And there is a fifth case, a fatality in Glasgow that has not yet been confirmed. The spread outside Glasgow indicates that the contamination likely occurred upstream in the distribution, not locally in Glasgow.

                            The title of this thread should now read "Anthrax in heroin users, Scotland, 2009", as there has been a second death, and likely a third.



                            Situation Update No. 7
                            On 23.12.2009 at 18:03 GMT+2

                            Health officials have confirmed that a second heroin user, who tested positive for anthrax, has died. The man was being treated at Glasgow Royal Infirmary. Last week, a man with the infection died in the city's Victoria Infirmary. A woman who tested positive for anthrax is also being treated there. A further drug user has died but tests have yet to confirm the presence of anthrax. Meanwhile, a fourth case of anthrax has been confirmed in Lanarkshire. The patient, who is a drug-injecting heroin user, is being treated at Monklands District General Hospital. Dr Syed Ahmed, consultant in public health medicine, said: "There have been no new drug injecting heroin users with infections admitted to hospitals in the west of Scotland since the weekend. "I urge all drug injecting heroin users to be extremely alert and to seek urgent medical advice if they experience an infection. "Drug injecting is extremely risky and dangerous. The possible presence of a batch of heroin contaminated with anthrax makes drug injecting even riskier and even more dangerous." Anthrax is an acute bacterial infection most commonly found in hoofed animals such as cattle, sheep and goats. It normally infects humans when they inhale or ingest anthrax spores, but cannot be passed from person to person. The last previous death from anthrax in Scotland was in 2006 when Christopher Norris died after inhaling the spores. The 50-year-old craftsman, from Stobs, near Hawick, made drums with materials such as untreated animal hides.

                            Comment


                            • #15
                              Re: UK: Addict dies as anthrax infects heroin users

                              This thread should be renamed - there are at least three deaths.



                              Archive Number 20091224.4333
                              Published Date 24-DEC-2009
                              Subject PRO/AH/EDR> Anthrax, human - UK (04): (Scotland)

                              ANTHRAX, HUMAN - UNITED KINGDOM (04): (SCOTLAND)
                              ***********************************************
                              A ProMED-mail post
                              <http://www.promedmail.org>
                              ProMED-mail is a program of the
                              International Society for Infectious Diseases
                              <http://www.isid.org>

                              Date: 23 Dec 2009
                              Source: NHS Greater Glasgow & Clyde [edited]
                              <http://www.nhsggc.org.uk/content/default.asp?page=s1192_3&newsid=10791&back=s1192>


                              Tests from a 4th patient have now confirmed the presence of Anthrax.
                              Two of these 4 known confirmed cases have now died. A further heroin
                              drug injector has died, but tests to determine the presence of
                              anthrax have yet to be completed [Since this release was issued, this
                              5th case has been confirmed. - Mod.MHJ]. The 2 surviving confirmed
                              anthrax-linked patients are responding well to treatment, one at
                              Glasgow's Victoria Infirmary and one at Monklands District General
                              Hospital in Lanarkshire.

                              NHS Greater Glasgow and Clyde's Public Health Protection Unit are
                              continuing to work closely with NHS Lanarkshire, the Procurator
                              Fiscal's Office, and Strathclyde Police to identify the source of the anthrax.

                              One avenue which is still being investigated by Public Health and
                              Strathclyde Police is that contaminated heroin or a contaminated
                              cutting agent mixed with the heroin may be responsible for the infections.

                              Dr Syed Ahmed, Consultant in Public Health Medicine, said: "There
                              have been no new drug injecting heroin users with suspected or
                              confirmed infections admitted to hospitals in the west of Scotland
                              since the weekend. I urge all drug injecting heroin users to be
                              extremely alert and to seek urgent medical advice if they experienced
                              an infection. Drug injecting is extremely risky and dangerous. The
                              possible presence of a batch of heroin contaminated with anthrax
                              makes drug injecting even riskier and even more dangerous. While this
                              section of the community need to be on their guard, the risk to the
                              rest of the population -- including close family members of the
                              infected cases -- is negligible. It is extremely rare for anthrax to
                              be spread from person to person, and there is no significant risk of
                              airborne transmission from one person to another."

                              As part of ongoing inquiries, any drug-injecting heroin users who
                              present with serious soft tissue infections now or who have presented
                              such during the last 4 weeks are being investigated.

                              --
                              Communicated by:
                              ProMED-mail <promed@promedmail.org>

                              [One of the problems with cutaneous anthrax is the black escar, and
                              those not used to seeing cases take it as pathognomonic.
                              Unfortunately, staph skin infections can and do produce a similar
                              appearance, thus the necessity of getting laboratory confirmation.
                              Something else to keep very much in mind is that these heroin-related
                              infections from injecting a mess of soluble acidic chemicals result
                              in extensive deep tissue necrosis.

                              Injection infections are not uncommon with heroin addicts and usually
                              involve surface pathogens and clostridia. There is an awareness now
                              in the UK to think one step further on the assumption that singular
                              cases of anthrax may be occurring and are being missed. However these
                              bacillus spores get into the cut drug, it is probable that the mixing
                              is by hand. This will result in an uneven mix such that some addicts
                              will get no spores, others large acutely lethal doses, and the
                              majority something in between. When there is a cluster of cases,
                              their geographic and temporal proximity make it easy to recognize an
                              unusual event. But when they are strung out -- as in one here, one
                              there, a swollen injection site somewhere else, and maybe a number of
                              just happy addicts -- the existence of such a contaminated product
                              can be hard to perceive and observe.

                              If you add to that the empirical treatment with antibiotics by a GP
                              prior to the individual presenting himself or herself at their local
                              hospital, you have further reduced the chances of recognition.

                              At the start, the reports were optimistic about the survival of cases
                              after the index lethal case. To date, the lethality rate is 60
                              percent. Normally, cutaneous anthrax cases have a CFR of 0-10
                              percent. This should bring home the appreciation that these
                              heroin-related cases are not your usual occupational cutaneous
                              infections resulting from the contamination of a scratch.


                              There is a report in The Times of London, but it is essentially just
                              a rewrite of the NHS news release:
                              <http://www.timesonline.co.uk/tol/life_and_style/health/article6967068.ece>.
                              The comments are revealing.

                              The good news is that this outbreak is getting the attention and
                              investigation that it deserves in the UK. - Mod.MHJ]

                              [see also:
                              Anthrax, human - United Kingdom (03): (Scotland) 20091222.4317
                              Anthrax, human - UK (02): (Scotland) 20091219.4288
                              Anthrax, human - UK: (Scotland) heroin users 20091217.4270]
                              ............................................mhj/msp/mpp

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