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9 : Unexplained Severe Illness and Death among Injecting Drug Users in Scotland, Ireland, and England from April to August 2000
Unexplained Severe Illness and Death among Injecting Drug Users in Scotland, Ireland, and England from April to August 2000, Page 1 of 2< Previous page Next page > /docserver/preview/fulltext/10.1128/9781555816995/9781555812423_Chap09-1.gif /docserver/preview/fulltext/10.1128/9781555816995/9781555812423_Chap09-2.gif
On 5 May 2000, public health authorities in Glasgow, Scotland, learned that two injecting drug users (IDUs) who resided at the same hostel had died in the previous week following similar acute illnesses. By the end of May, active surveillance identified 31 cases of severe unexplained illness among IDUs in Glasgow, including 14 (45%) deaths. This chapter summarizes a collaborative effort among public health authorities in Scotland, Ireland, England, Wales, and the United States to (i) describe the clinical and epidemiologic features of the case patients, (ii) identify the cause of their unexplained illness, and (iii) define a potential source of the outbreak. Active surveillance was conducted through inquiries to area emergency departments, intensive care units, and coroners’ offices. The most common clinical finding was marked edema of the soft tissue (79%). Necrosis (36%), frank pus or abscess (22%), gas production (9%), and foul odor (1%) of the injection site were less common. The localized inflammatory process affecting skin or muscle combined with systemic toxicity characterized by a leukemoid reaction suggested a chemical contamination or toxin-mediated infection due to Bacillus anthracis, Staphylococcus aureus, group streptococci, or histotoxic clostridia. Surgical intervention was emphasized in the management of possible cases, including debridement and culture of samples from the area of any injection-site infection. Cultures that were toxic were neutralized with specific antitoxin and retested. Clostridium isolates were also subtyped and compared to a set of background strains by amplified fragment length polymorphism (AFLP) analysis.