Septic pulmonary embolism in intravenous drug users

Abstract

Objective: to study septic pulmonary embolism in intravenous drug users (IDUs). Materials and Methods: Septic pulmonary embolism (SPE) was diagnosed in 53 of 117 IDUs, admitted for observation for the period 2014-2016 with signs of acute thrombophlebitis of the proximal veins. Out of 53 IDUs (41 were males, mean age was 33,6 ± 4,9 years, range - from 18 to 49 years), 43 (81%) were diagnosed with HIV, 41 (77%) - with HCV and 14 (26%) - with tuberculosis (TB). The main types of using drugs are opiates, amphetamine. Results: The most frequent clinical manifestations were febrile illness (89%), dyspnea (83%), pleuritic chest pain (68%). Chest CT showed multiple peripheral nodules in both lungs (n=49), cavitation (n = 23), focal or wedge-shaped infiltrates (n = 28) and pleural effusion (n=26).Methicillin-resistant Staphylococcus aureus (MRSA) (n = 14), methicillin-sensitive Staphylococcus aureus (MSSA) (n =12 ) and Candida (n = 6) has grown in blood cultures. The presence of HIV, CD4 +> 500 cells / μl, respiratory dysfunction with DLCO ≤60% was detected in 25 (47%) patients - IDUs. In the presence of HIV infection, immunosuppression at a high viral load (CD4 + 100,000 per ml) and leukopenia, cytomegalovirus infection was diagnosed in 11 (21%) drug-addicted patients. Conclusion: SPE in IDUs manifests with variable and often nonspecific clinical and radiographic features. For high-risk groups, such as IDUs, fever, acute thrombophlebitis of the proximal veins, and imaging findings of multiple nodules or local infiltrates, with or without cavitation, are highly suggestive of SPE. Association of the SPE and HIV leads to an unfavorable outcome.