Autopsy Findings in an Outbreak of Severe Systemic Illness in Heroin Users Following Injection Site Inflammation: An Effect of Clostridium novyi Exotoxin?

Abstract

Abstract Context.—An epidemic of unexplained illness among injecting drug users characterized by injection site inflammation and severe systemic toxicity occurred in Ireland and the United Kingdom from April to August 2000. One hundred eight persons became ill, and 43 persons died. In Dublin, 8 of 22 patients died. Six of the 8 fatal cases were epidemiologically linked to a source of heroin. Most had experienced local injection site lesions for 7 to 14 days before developing a rapidly fatal systemic illness characterized by hypotension, thirst, pulmonary edema, pericardial and pleural effusions, and leukocytosis. Objective.—To document the clinical course and autopsy findings of the fatal cases in Dublin. Design.—To study the clinical, autopsy, microbiologic, and toxicologic findings from the 8 fatal cases in Dublin. Results.—In Dublin, there were 6 men and 2 women who were fatally involved in the epidemic, with the mean age being 34 years (range, 22–51 years). The injection site inflammations involved th...