title: Soft tissue infections caused by spore-forming bacteria in injecting drug users in the United Kingdom.
abstract: From 2000 to May 2004 there has been a marked increase in illness resulting from spore-forming bacteria in injecting heroin users in the United Kingdom. Clostridium novyi caused 63 cases of severe illness in 2000 and seven further cases from 2001. Wound botulism first occurred in 2000 (six cases) with 51 further cases to March 2004. Tetanus occurred in 20 cases between late 2003 and March 2004. Infections with C. histolyticum (nine cases), C. sordellii (one case) and Bacillus cereus (one case) were also reported. The reasons for the increase in illness are unclear. The major risk factor was skin- or muscle-popping. The problem appears to be here to stay. This review describes the causative organisms, pathogenesis, clinical presentation, epidemiology and treatment of cases. Clinical vigilance and a high standard of anaerobic microbiology are essential. Clinicians and laboratories must report such cases (or likely cases) rapidly so that clusters can be rapidly identified, in order to control disease. Prevention relies on tetanus immunization.
authors.affiliation: Food Safety Microbiology Laboratory, Health Protection Agency Specialist and Reference Microbiology Division, London, UK.
authors.forename: M M
authors.initials: MM
authors.lastname: Brett
authors.forename: J
authors.initials: J
authors.lastname: Hood
authors.forename: J S
authors.initials: JS
authors.lastname: Brazier
authors.forename: B I
authors.initials: BI
authors.lastname: Duerden
authors.forename: S J M
authors.initials: SJ
authors.lastname: Hahné
mesh_terms: D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003013:Clostridium / Q000145:classification* / Q000302:isolation & purification; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D012720:Severity of Illness Index; D017678:Sex Distribution; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D013171:Spores, Bacterial; D015819:Substance Abuse, Intravenous / Q000150:complications*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents