title: Epidemiological findings and medical, legal, and public health challenges of an investigation of severe soft tissue infections and deaths among injecting drug users -- Ireland, 2000.
abstract: In May 2000, public health authorities in Dublin, Ireland, identified a cluster of unexplained severe illness among injecting drug users (IDUs). Similar clusters were also reported in Scotland and England. Concurrent investigations were undertaken to identify the aetiology and source of the illnesses. In Dublin, 22 IDUs were identified with injection-site inflammation resulting in hospitalization or death; eight (36%) died. Common clinical findings among patients with severe systemic symptoms included leukaemoid reaction and cardiogenic shock. Seventeen (77%) patients reported injecting heroin intramuscularly in the 2 weeks before illness. Of 11 patients with adequate specimens available for testing, two (18%) were positive by 16S rDNA PCR for Clostridium novyi. Clinical and laboratory findings suggested that histotoxic Clostridia caused a subset of infections in these related clusters. Empiric treatment for infections among IDUs was optimized for anaerobic organisms, and outreach led to increased enrolment in methadone treatment in Dublin. Many unique legal, medical, and public health challenges were encountered during the investigation of this outbreak.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA. kristy.M.Lillibridge@uth.tmc.edu
authors.forename: K
authors.initials: K
authors.lastname: Murray-Lillibridge
authors.forename: J
authors.initials: J
authors.lastname: Barry
authors.forename: S
authors.initials: S
authors.lastname: Reagan
authors.forename: D
authors.initials: D
authors.lastname: O'flanagan
authors.forename: G
authors.initials: G
authors.lastname: Sayers
authors.forename: C
authors.initials: C
authors.lastname: Bergin
authors.forename: E
authors.initials: E
authors.lastname: Keenan
authors.forename: S
authors.initials: S
authors.lastname: O'briain
authors.forename: P
authors.initials: P
authors.lastname: Plunkett
authors.forename: G
authors.initials: G
authors.lastname: McMahon
authors.forename: C
authors.initials: C
authors.lastname: Keane
authors.forename: P
authors.initials: P
authors.lastname: O'sullivan
authors.forename: D
authors.initials: D
authors.lastname: Igoe
authors.forename: L
authors.initials: L
authors.lastname: Mullen
authors.forename: M
authors.initials: M
authors.lastname: Ward
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.forename: M
authors.initials: M
authors.lastname: Fischer
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology*; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018461:Soft Tissue Infections / Q000453:epidemiology*; D018709:Statistics, Nonparametric