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9 : Unexplained Severe Illness and Death among Injecting Drug Users in Scotland, Ireland, and England from April to August 2000

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Unexplained Severe Illness and Death among Injecting Drug Users in Scotland, Ireland, and England from April to August 2000, Page 1 of 2

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Abstract:

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 , , 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. isolates were also subtyped and compared to a set of background strains by amplified fragment length polymorphism (AFLP) analysis.

Citation: Fischer M, Whitney A, Ahmed S, Barry J, Jones J. 2004. Unexplained Severe Illness and Death among Injecting Drug Users in Scotland, Ireland, and England from April to August 2000, p 121-132. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch9
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Figures

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Figure 1

Cases of severe illness among IDUs by week of hospitalization or death, Scotland, Ireland, and England, 1 April to 31 August 2000.

Citation: Fischer M, Whitney A, Ahmed S, Barry J, Jones J. 2004. Unexplained Severe Illness and Death among Injecting Drug Users in Scotland, Ireland, and England from April to August 2000, p 121-132. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch9
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References

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Tables

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Table 1

Microbiologic findings among IDUs with severe illness or death, Scotland, Ireland and England, April to August 2000

Citation: Fischer M, Whitney A, Ahmed S, Barry J, Jones J. 2004. Unexplained Severe Illness and Death among Injecting Drug Users in Scotland, Ireland, and England from April to August 2000, p 121-132. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch9
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Table 2

Results of 16S rDNA PCR with wound-site tissue specimens from IDUs in Scotland and Ireland, by tissue type and outbreak site

Citation: Fischer M, Whitney A, Ahmed S, Barry J, Jones J. 2004. Unexplained Severe Illness and Death among Injecting Drug Users in Scotland, Ireland, and England from April to August 2000, p 121-132. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch9
Generic image for table
Table 3

Independent risk factors for severe illness or death among IDUs, Scotland, April to August 2000

Citation: Fischer M, Whitney A, Ahmed S, Barry J, Jones J. 2004. Unexplained Severe Illness and Death among Injecting Drug Users in Scotland, Ireland, and England from April to August 2000, p 121-132. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch9
Generic image for table
Table 4

Case-fatality ratio and WBC count for IDUs with evidence of infection due to , , or , Scotland and Ireland, April to August 2000

Citation: Fischer M, Whitney A, Ahmed S, Barry J, Jones J. 2004. Unexplained Severe Illness and Death among Injecting Drug Users in Scotland, Ireland, and England from April to August 2000, p 121-132. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch9

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