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Europe - Several die as anthrax infects heroin users

Shiloh

Editor, Senior Moderator
Source: http://www.independent.co.uk/news/u...-as-anthrax-infects-heroin-users-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.
 
Anthrax found in Glasgow heroin users

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.

http://news.bbc.co.uk/2/hi/uk_news/scotland/glasgow_and_west/8419113.stm
 
Re: UK: Addict dies as anthrax infects heroin users

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.
 
Re: UK: Addict dies as anthrax infects heroin users

Re: UK: Addict dies as anthrax infects heroin users

And we quickly get a ProMed post.

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80519

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
 
Re: UK: Addict dies as anthrax infects heroin users

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.
 
Re: UK: Addict dies as anthrax infects heroin users

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.

http://hisz.rsoe.hu/alertmap/woalert_read.php?glide=EH-20091217-24200-GBR&cat=dis&lang=eng

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.


--------------------------------------------------------------------------------
 
Re: UK: Addict dies as anthrax infects heroin users

Re: UK: Addict dies as anthrax infects heroin users

http://hisz.rsoe.hu/alertmap/woalert_read.php?glide=EH-20091217-24200-GBR&cat=dis&lang=eng

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.
 
Re: UK: Addict dies as anthrax infects heroin users

Re: UK: Addict dies as anthrax infects heroin users

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

http://hisz.rsoe.hu/alertmap/woalert_read.php?glide=EH-20091217-24200-GBR&cat=dis&lang=eng

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.
 
Re: UK: Addict dies as anthrax infects heroin users

Re: UK: Addict dies as anthrax infects heroin users

very small amounts are lethal

(...) died from inhaling anthrax spores
 
Re: UK: Addict dies as anthrax infects heroin users

Re: UK: Addict dies as anthrax infects heroin users

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80579

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
 
Re: UK: Addict dies as anthrax infects heroin users

Re: UK: Addict dies as anthrax infects heroin users

http://hisz.rsoe.hu/alertmap/woalert_read.php?glide=EH-20091217-24200-GBR&cat=dis&lang=eng

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.
 
Re: UK: Addict dies as anthrax infects heroin users

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.

http://hisz.rsoe.hu/alertmap/woalert_read.php?glide=EH-20091217-24200-GBR&cat=dis&lang=eng

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.
 
Re: UK: Addict dies as anthrax infects heroin users

Re: UK: Addict dies as anthrax infects heroin users

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

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80606

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
 
Re: UK: Addict dies as anthrax infects heroin users

Re: UK: Addict dies as anthrax infects heroin users

This is the article referenced by the ProMed post above. I cannot post the comments on FT as they are way outside the bounds of appropriateness, but they do make interesting reading (they deal with the issue of legalizing drugs to prevent incidents like this).

http://www.timesonline.co.uk/tol/life_and_style/health/article6967068.ece

December 24, 2009

Heroin users warned as two die from anthrax-laced drug in GlasgowSteve Bird and Mary Bowers 21 Comments
Recommend? (9) Heroin laced with anthrax is being sold on the streets of Britain and has already killed two people in Glasgow, prompting warnings to addicts to be on their guard.

Tests on a third person are being carried out to see if he died from the same disease. A fourth and fifth are being treated for anthrax after injecting heroin from a batch contaminated with the lethal spores, doctors disclosed yesterday.

The two surviving patients were responding well to treatment, doctors said. One is being treated at the Victoria Infirmary in Glasgow, the other at Monklands District General Hospital in Lanarkshire.

It is believed that contaminated heroin or an agent mixed with the heroin is responsible for the infections.

Related Links
Fear of anthrax outbreak among heroin users
Irish cocaine cut with deadly toxins
Heroin-for-addicts scheme is 'ethically questionable'
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.?

Dr Ahmed added: ?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.?


Anthrax was suspected of being responsible for a series of deaths among Scottish heroin addicts in 2000. New Scientist magazine reported that tests at the UK biological defence laboratory in Porton Down found signs of infection in dead addicts, even though health officials in Glasgow, where several of the deaths occurred, dismissed the claims.

Anthrax is an acute bacterial infection most commonly found in cloven hoofed animals such as cattle, sheep and goats. There are three forms of the disease. Cutaneous infection is caused by contact with the skin and responsible for 95 per cent of cases. Infection by inhalation is rare, and intestinal anthrax, caused by consuming spores, is even rarer.

Anthrax, sometimes known as ?wool-sorters? disease?, is extremely rare in the UK, and no cases have ever been found in British livestock.

The disease is far more common in Central and South America, Asia, Africa and Southern and Eastern Europe. Though animal hides are inspected upon importation to the UK, there are no requirements for testing for traces of anthrax.

In November last year a Spanish musician, Fernando Gomez, 35, died in hospital in Hackney, East London after contact with anthrax spores. Also a drum-maker, he is thought to have been handling imported animal skins.

NHS Greater Glasgow and Clyde Health Board said yesterday that it was working with police and colleagues in Lanarkshire to trace the source of the outbreak.
 
Re: UK: Several Addicts die as anthrax infects heroin users

Re: UK: Several Addicts die as anthrax infects heroin users

I believe this would have been a sixth case, but he is negative.

http://news.bbc.co.uk/2/hi/uk_news/england/cumbria/8431576.stm

Anthrax test on Cumbria heroin user proves negative

Two drug users in Scotland have died from anthrax
Tests for anthrax poisoning on a heroin user who was suspected of having the condition have proved negative.

The patient, who was admitted to Carlisle's Cumberland Infirmary on Christmas Day, has skin lesions - a typical symptom of the condition.

It is feared that contaminated batches of the drug are in circulation after two anthrax deaths in Scotland.

A spokesman for NHS Cumbria said initial tests on the patient had not shown the presence of the disease.

Dr John Ashton, director of public health at NHS Cumbria, said: "This is encouraging news but injecting drug users in Cumbria should not let their guard down.

"Anyone who injects drugs and experiences any unusual symptoms such as swelling or pain at the injection site should seek medical help immediately as anthrax can be lethal."

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 spores from the bacillus anthracis bacterium.
 
Re: UK: Several Addicts die as anthrax infects heroin users

Re: UK: Several Addicts die as anthrax infects heroin users

This is the confirmation of the third death. We now have five confirmed, and no suspect cases. Three of the five confirmed cases have died.

http://news.bbc.co.uk/2/hi/uk_news/scotland/glasgow_and_west/8434109.stm

Third heroin user anthrax death

Anthrax is a bacterial infection usually found in hoofed animals
Health officials have confirmed that a third heroin user who died in hospital in Glasgow last week has tested positive for anthrax.

The patient was being treated at the city's Royal Infirmary, where a second anthrax-related death also occurred last week.

A man with the infection also died in Glasgow's Victoria Infirmary.

Five heroin users have tested positive for anthrax - two of whom are said to be responding well to treatment.

They are being treated at the Victoria Infirmary and Monklands General Hospital in Wishaw.

Police and NHS Greater Glasgow and Clyde are continuing to investigate whether contaminated heroin or a contaminated cutting agent may be responsible.


Dr Syed Ahmed, consultant in public health medicine, said: "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.

Medical advice

"I urge all drug injecting heroin users to be extremely alert and to seek urgent medical advice if they experienced an infection."

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.
 
Re: UK: Several Addicts die as anthrax infects heroin users

Re: UK: Several Addicts die as anthrax infects heroin users

So this is a sixth confirmed case, and now a seventh suspect case. Three of the six confirmed cases have died.

http://news.bbc.co.uk/2/hi/uk_news/scotland/8436495.stm

Another anthrax case confirmed in Glasgow

A further heroin user in Glasgow has tested positive for anthrax
A further heroin user in Glasgow has tested positive for anthrax.

The man is said to be responding well to treatment at Monklands District General Hospital in Lanarkshire.

NHS Greater Glasgow and Clyde said this took the total number of confirmed anthrax-linked cases to six, which included three people who have died.

The health board said they are continuing to investigate whether contaminated heroin or a contaminated cutting agent may be responsible.

A spokesman for the health board said that two other confirmed patients, continue to respond well to treatment.


They include a male at Glasgow's Victoria Infirmary and a male at Monklands District General Hospital in Lanarkshire.

The health board is awaiting confirmation of results on a seventh patient, a woman, who is being treated for the infection at the Southern General.

Extremely risky

Consultant in Public Health Medicine, Dr Syed Ahmed, said: "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.

"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."

"As part of ongoing inquiries, any drug injecting heroin users who present with serious soft tissue infections now or during the last four weeks is being investigated
 
Re: UK: Several Addicts die as anthrax infects heroin users

Re: UK: Several Addicts die as anthrax infects heroin users

And one of the above articles generates a ProMED posting.

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80726

Archive Number 20100101.0011
Published Date 01-JAN-2010
Subject PRO/AH/EDR> Anthrax - UK: (Scotland)

ANTHRAX - UK: (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: Thu 31 Dec 2009
Source: NHS Greater Glasgow and Clyde Media Centre [edited]
<http://www.nhsggc.org.uk/content/default.asp?page=s1192_3&newsid=10798&back=s1192>


A further male heroin injector has tested positive for anthrax. The
patient is responding well to treatment at Monklands District General
Hospital in Lanarkshire. This takes the total number of confirmed
anthrax-linked cases to 6, which includes the 3 individuals who have
died.

The other 2 surviving confirmed patients continue to respond well to
treatment -- a male at Glasgow's Victoria Infirmary and a male at
Monklands District General Hospital in Lanarkshire.

A 7th patient, a female, who is being treated at the Southern
General, is being tested and we await the results.

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 continues to be 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: "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. 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."

As part of ongoing inquiries any drug injecting heroin user who
presents with serious soft tissue infections now or during the last 4
weeks is being investigated.

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

[Dr Syed Ahmed is to be congratulated on the speed and completeness
of these reports. Members should note the last sentence of this
release and the results of such an investigation in ProMED-mail
posting 20091227.4363. - Mod.MHJ]

[see also:
2009
----
Anthrax, human - UK (05): (England) NOT 20091227.4363
Anthrax, human - UK (04): (Scotland) 20091224.4333
Anthrax, human - UK (02): (Scotland) 20091219.4288
Anthrax, human - UK: (Scotland) heroin users 20091217.4270
...................................mhj/mj/lm
 
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