title: Clostridial myonecrosis cluster among injection drug users: a molecular epidemiology investigation.
abstract: A molecular epidemiologic investigation was performed on a cluster of severe necrotizing Clostridium infections in 5 injection drug users admitted to an urban community hospital. Interviews with survivors suggested a point source of infection. Pulsed-field gel electrophoresis of SmaI restriction digests was performed to determine the molecular relatedness of clinically obtained isolates and isolates obtained from heroin samples and the home environment. A common clonal strain was found in Clostridium sordellii isolates from 2 socially unrelated patients and from drug paraphernalia. Clonality of a Clostridium perfringens strain from another patient isolate was identical to an isolate from a syringe found in her home. Other C perfringens isolates from patients, heroin, and the environment were determined to be polyclonal. We postulate that rapid recognition and public health notification led to rapid resolution of the outbreak.
authors.affiliation: Epidemiology and Prevention Interventions Center, Box 1372, Room 301, Bldg 100, San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110, USA. db@epi-center.ucsf.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Judith I
authors.initials: JI
authors.lastname: Rosen
authors.forename: Tomás
authors.initials: T
authors.lastname: Aragón
authors.forename: Andre
authors.initials: A
authors.lastname: Campbell
authors.forename: Lucy
authors.initials: L
authors.lastname: Weir
authors.forename: Francoise
authors.initials: F
authors.lastname: Perdreau-Remington
mesh_terms: D000328:Adult; D003015:Clostridium Infections / Q000453:epidemiology* / Q000601:surgery; D003016:Clostridium perfringens / Q000235:genetics; D003646:Debridement; D004196:Disease Outbreaks; D005260:Female; D003932:Heroin; D006801:Humans; D008297:Male; D017720:Molecular Epidemiology; D009336:Necrosis; D012495:San Francisco / Q000453:epidemiology; D018461:Soft Tissue Infections / Q000453:epidemiology* / Q000601:surgery; D015819:Substance Abuse, Intravenous
chemical_list: D003932:Heroin