Infections In Intravenous Drug Users Research Articles

HTLV-1/2 infection in Italy: a narrative review of epidemiological studies.

The human T-cell leukemia virus type 1 (HTLV-1) was first described in 1980. It is spread in highly endemic regions in the world, such as the Southwestern part of Japan, sub-Saharan Africa and South America, Caribbean, Middle East, and Australo-Melanesia regions. HTLV-1 causes adult T cell leukemia and is associated with many inflammatory conditions, most notably HTLV-1-associated myelopathy/tropic spastic paraparesis. HTLV-2, first isolated in 1982, was recognized as a common infection in intravenous drug users, but a clear association with disease remains elusive. The first estimate of HTLV-1-positive individuals worldwide, in 1993, was around 10-20 millions. Due to the lack of global population-based prevalence studies, this is considered an underestimate at the moment. Furthermore, HTLV-1 prevalence in Europe is impacted by changing migration flows. Particularly, no data on HTLV-1 prevalence in the general population in Italy are available. Here, we report a systematic literature review of studies conducted in Italy on HTLV-1/2 from 1980 to 2023. Based on the criteria we adopted a total of 426 publications were found (64 reviews, 99 epidemiological, and 263 translational studies). The contents of some representative publications are summarized and discussed. Moreover, an approximate estimation of about 26,000 HTLV-1 positive foreigners living in Italy was obtained from updated data of foreigners from each single country officially registered as resident in Italy and from data on HTLV-1 prevalence among the general population in the corresponding countries.

Infections in Intravenous Drug Users in the Perspective of Infectious Emergencies

Introduction; An increasing number of intravenous drug users are seen in now days. Intravenous drug users (IDUs) are a group of subjects who inject different drugs, generally in the extremities. This way of taking drugs, apart from leading to an addiction, on the other hand also serves as the possibility of taking or spreading infections.
 The aim of this paper is to provide a brief overview of IDUs patients, who were presented to the emergency department of the infectious diseases service, and required further hospitalization, during the period January 2012 - December 2015.
 Material and methods: The study is retrospective and was carried out in the emergency department of the infectious disease service and the infectious disease service as well. During the period January 2012 – December 2015, 26 patients were hospitalized in our hospital as IDUs. There were 20 male patients. The average age of the patients was 32 years. The main clinical symptoms were fever, dyspnea, chest pain, pain in the extremities, edema of the extremities, necrotic ulcers at the injection site, jaundice in the sclera, confusional state. The resulting diagnoses were viral infections (HIV/AIDS infection, viral hepatitis), septic conditions (endocarditis, fasciitis), skin infections (cellulitis, S. aureus infections), pulmonary infections.
 Conclusions: Viral, bacterial and fungal infectious diseases are quite frequent among the people of this community. This is related to the way of life (poor social economic conditions, poor hygiene), risky sexual behaviors and the use of syringes from one person to another. The screening of this community is important to prevent any infectious disease.

Increasing Incidence of Sternoclavicular Joint Infections in Intravenous Drug Users.

Sternoclavicular joint septic arthritis is rarely seen in the general population. The majority of cases are seen in intravenous drug users. Given the lack of reported cases in the literature, there is no standardized treatment algorithm for this disease. Described treatment methods range from medical management to wide local debridement. The incidence of sternoclavicular joint septic arthritis will likely continue to increase with rising usage of intravenous drugs in the United States. Within the past year, our institution treated four cases.

Daptomycin Pharmacokinetics and Pharmacodynamics in Patients on Methadone Substitution Therapy.

When administered for severe infections in intravenous drug users (IDUs) at a daily dose of 6 mg/kg, daptomycin displayed abnormal pharmacokinetic parameters compared with those seen in healthy volunteers; specifically, decreased trough and maximum concentrations (Ctrough; Cmax) and increased clearance (CL). The objective of this study was to evaluate the pharmacokinetics and pharmacodynamics of daptomycin administered at a daily dosage of 12 mg/kg for Staphylococcus aureus infective endocarditis (IE) in patients concomitantly treated with methadone, and to compare the results with those published in the literature for healthy controls treated with the same daily dose. Antibiotic treatment included daptomycin (12 mg/kg daily) in combination with an antistaphylococcal β-lactam (cefazolin 2 g three times a day). The minimum inhibitory concentration (MIC) of Staphylococcus aureus isolated through blood cultures was used to calculate pharmacokinetic and pharmacodynamic parameters such as the ratio of the area under the concentration-time curve over 24 h to the MIC (AUC0-24/MIC) and Cmax/MIC. Five IDUs hospitalized for IE were enrolled. The mean measured daptomycin Cmax and Ctrough were 54.1μg/mL (CV: 0.32) and 8.7 μg/mL (CV: 0.59), respectively; the mean calculated AUC0-24 was 742.7 μg×h/mL (CV: 0.31). The estimated average volume of distribution at the steady state (Vd,ss) and the half-life (t1/2) were 316.5 mL/kg (CV: 0.53) and 14.4 h (CV: 0.30), respectively. The mean daptomycin clearance from plasma normalized for body weight (CLwp) was 17.3 mL/(h×kg) (CV: 0.33). The calculated average Cmax and AUC0-24 (183.7 µg/mL and 1277.4 µg×h/mL, respectively) were lower than and statistically significantly different from (p<0.001 and p=0.001, respectively) those expected for healthy volunteers. Treatment of Staphylococcus aureus IE in IDUs on methadone treatment requires the use of high daptomycin daily doses in order to achieve satisfactory pharmacodynamic parameters. Close monitoring of the daptomycin plasma concentration is suggested.

Prevalence and Genotype Distribution of Hepatitis C Virus among Intravenous Drug users (IDUs) in Surabaya, Indonesia

Every year, there is an increase in the number Intravenous Drug Users (IDUs) in Indonesia, in which they have a greater risk of getting Hepatitis C Virus (HCV) infection. This study was aimed to determine HCV prevalence and genotypes among IDUs in Surabaya. A total 25 IDUs were tested for anti-HCV. Reverse-transcription PCR in the NS5B region and 5'UTR was carried out on serum with positive anti-HCV, continued with sequencing and HCV genotype/subtype determination. The prevalence of HCV infection in IDUs in Surabaya based on positive anti-HCV was 96%(24/25). Sequencing analysis showed that 92%(22/24) could be determined their genotypes and subtypes. 40.9% (9/22) samples had genotype 1 with subtype 1a 31.82%(7/22) and subtype 1c 9.09%(2/22). 40.9%(9/22) samples had genotype 3, with subtype 3a 18.18%(4/22) and 3k 22.73%(5/22). 13.64%(4/22) samples had genotype 4 with subtype 4a, and 4.55% (1/22) sample had genotype 6 subtype 6n. The prevalence of HCV infection was high among IDUs in Surabaya. In this study, genotypes 6 was found in which it is rarely found in Indonesia, so there is a possibility that there are different HCV genotype patterns in each region of Indonesia.

Hand and Upper Extremity Infections in Intravenous Drug Users: Epidemiology and Predictors of Outcomes

Injectable drug use (IDU) is a national epidemic, public health problem, and common cause of hand and upper extremity (UE) infections. This study assesses the epidemiology of the IDU patient population presenting to a Midwestern academic medical center emergency department (ED) and examines predictors influencing morbidity and outcomes. A retrospective review was performed using International Classification of Diseases, Ninth Revision (ICD-9) codes to identify all adult patients presenting to the ED with hand/UE infections, with and without concurrent IDU diagnoses, over a period of 2.5 years. Demographics and clinical factors were examined utilizing bivariate and multivariable analyses to identify predictors of outcomes, including not completing outpatient follow-up and leaving against medical advice (AMA). A total of 1,482 patients with 1,754 ED visits for hand/UE infections were identified, including 308 patients with IDU-acquired infections (396 visits) and 1,174 patients with non-IDU infections (1,358 visits). Psychiatric comorbidities and hepatitis C were common in the IDU group (51% and 39%, respectively), and 31% of IDU patients were uninsured. Heroin use was identified in 96% of visits. The IDU infections were more likely to have surgical intervention than those in non-IDU patients (16% vs 6%), and a longer mean length hospital stay (2.4 vs 0.9 days). The IDU patients were more likely than non-IDU patients to leave AMA. In multivariable analysis, IDU, psychiatric comorbidity, and insurance status were independent predictors (P < .05) for leaving AMA. In the setting of a national epidemic, hand/UE infections due to IDU are a common problem seen by hand surgeons. This study characterizes the growing IDU patient population at an urban academic medical center, examining the largest cohort of these patients to date. Prognostic IV.

Effect of human pegivirus route of transmission on the genetic distribution of the virus: an institution based cross-sectional study

IntroductionHuman pegivirus (HPgV), formally called GB virus C (GBV-C), is a member of the pegivirus genus in Flaviviridae family. High prevalence of HPgV infection is seen among sex workers, blood transfusion recipients and intravenous drug users (IDUs). So far, there are seven genotypes and many subtypes identified in different countries. The predominant genotype in Asia including China is genotype 3, although genotype 7 has been reported recently in China. The aim of this study was to evaluate the effect of the transmission routes of HPgV infection on the genotype distribution of the virus, to determine the prevalence rate, and identify the dominant genotype among men who have sex with men (MSM) and IDUs co-infected with human immunodeficiency virus type one (HIV-1) in Guangzhou, China.MethodsA total of 131 MSM and 70 IDUs co-infected with HIV-1 were randomly selected in Guangdong Dermatology Hospital. HPgV RNA was detected by nested reverse transcriptase polymerase chain reaction (RT-PCR) using primers. The PCR products were sequenced and phylogenetically analyzed by using MEGA6.06 version software to determine the genotypes. Chi-square and Fisher exact test were implemented for comparing the proportion between different variables.ResultsThe prevalence of HPgV infection was 32.9% among IDUs and 18.3% in MSM with a statistically significant difference between the two groups (p = 0.02). In IDU group, 82.6% infected with genotype 3 and the rest (17.4%) were categorized to genotype 7. Similarly, in MSM group, 83.3% belonged to genotype 3, and the remaining 16.7% were classified as sub-genotype 2a and 2b.ConclusionIn Guangzhou, China, the prevalence rate of HPgV infection in IDUs was higher than MSM. The dominant genotype in the two groups was genotype 3. Our results indicated that routes of transmission did not affect the genotype distribution but did affect the prevalence rate of HPgV infection.

HIV INFECTION;

Background: Human immune deficiency virus ( HIV) infection was a major healthproblem all over the world. The infection had become pandemic and no country was immune.The main burden of disease was shared by developing countries and their crippled economieswere unable to deal with it. As a result the number of HIV patients were increasing day by day.Treatment was expensive and preventive measures were not effective. The intravenous drugusers (IDUs) were major contributors in its spread. Objectives: To assess the prevalence ofHIV infection by determining the frequency of HIV infection in intravenous drug users. StudyDesign: Cross-sectional study. Place and duration of study: Rehabilitation center for IDU,sin District Headquarter Hospital Faisalabad (DHQ), a Tertiary Care Hospital, Affiliated withPunjab Medical College during Jan.2013 to Dec.2013. Subjects and Methods: All I. V. drugusers attending the rehabilitation center of D.H.Q. hospital were included in the study. All weresubjected to be screened for HIV/AIDS infection. Total 352 patients attended the center. Eachpatient was given a code number to hide the identity and results of tests were kept secret.The blood samples were collected and labeled with respected code on it. Results: Total 352intravenous drug users were enrolled at rehabilitation center and 96 were tested positive forHIV infection. Another 62 belonged to urban area and 34 belonged to rural area. About 80were living with their families and 16 were living out of their families. The 78% were not havingsufficient earnings for their living. Conclusions: Intravenous drug users were threat to publichealth in transmitting HIV infection by sharing needles.

Quick Consult

shoulder, pain: shoulder, painFigureFigureA 30-year-old woman presented to the emergency department with isolated right shoulder pain. The pain started gradually two to three days before. She denied any history of trauma or pain to her shoulder. She appeared in pain, and was seated with her shoulder adducted and internally rotated. Focused exam of her shoulder demonstrated tenderness at the acromioclavicular joint. No swelling, redness, or warmth was appreciated. She was unable to actively or passively abduct her arm because of pain. A shoulder x-ray did not demonstrate any acute pathology. The patient revealed that she regularly used heroin, and had last used that morning. Track marks were noted on her feet. Labs were ordered to evaluate for inflammation or infection. Labs were notable for a WBC of 9.8, ESR of 28, and CRP of 70.1. An MRI was ordered given the elevation in labs, history of being an intravenous drug user (IVDU), and severe nontraumatic joint pain. MRI showed marrow edema and enhancement at the acromial process of the scapula suspicious for osteomyelitis and fluid within the subacromial bursa. She left the ED against medical advice, but went to a different hospital with worsening infection and blood cultures positive for Streptococcus mitis. Her history as an IVDU made her ineligible for a PICC line or home health, and she required a six-week hospitalization with IV antibiotics. Find the diagnosis and case discussion on p. 10. Diagnosis: Acromioclavicular Joint Septic Arthritis Skin and soft tissue infectious at injection sites are a common complication of intravenous drug use. Injury and disease related to injections also include infections of other sites, including joints. A systematic review of bone and joint infections in intravenous drug users found a one to two percent self-reported prevalence of septic arthritis and a 0.5 percent prevalence of osteomyelitis. (Drug Alcohol Depend 2017;171:39.) Intravenous drug use, joint surgery, systemic infection, and alcoholism are risk factors for joint infections, which can also arise spontaneously. (Am J Emerg Med 2016;34[5]:934.e5.)FigureOsteoarticular infections can occur through the parenteral transmission of pathogens inoculated through intravenous drug use. The shoulder and ankle joints are affected in 17.5 percent of cases of septic arthritis in intravenous drug abusers. (Clin Ter 2017;168[1]:e8.) Other commonly infected joints include sternocostal, sternoclavicular, sacroiliac, pubic symphysis, hip, and knee. Acromioclavicular joint septic arthritis is rare. A literature review found that only 15 cases have been described to date, although it is suspected to be underdiagnosed. (Reumatol Clin 2014;10[1]:37.) Early diagnosis can be made with ultrasound and MRI, while x-rays can show late changes such as erosions. Ultrasound can also be used to guide arthrocentesis, and is the diagnostic test of choice. Treatment includes antibiotic therapy, initially intravenous, with duration of therapy of at least four weeks. Cases that do not respond to medical therapy may require joint lavage or surgical drainage. It is important for EPs to keep a higher index of suspicion for septic arthritis and osteomyelitis when encountering patients with a history of IVDU and nontraumatic joint pain and to ask patients about IV drug use. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at [email protected].

Biochemical predictors of necrotising soft tissue infection in intravenous drug users

Biochemical predictors of necrotising soft tissue infection in intravenous drug users

Common haplotypes in CD209 promoter and susceptibility to HIV-1 infection in intravenous drug users

IntroductionCD209 is a receptor expressed in the dendritic cells involved in recognition of oligosaccharides present in several pathogens with a relevant impact on human health. SNPs located in the promoter region have been associated with HIV-1 susceptibility, although this finding has not been replicated in other populations. The objective of this study is to evaluate the association of CD209 promoter haplotypes with risk of HIV-1 infection in a cohort of Spanish male intravenous drug users (IDU) infected with hepatitis C virus (HCV) and to characterize the phenotypic effects of the associated variants. MethodsWe genotyped 4 SNPs of CD209 promoter in 295 HCV males exposed to HIV-1 infection by IDU, 165 HIV-1-infected and 130 exposed uninfected (EUI) and 142 healthy controls (HC). We have cloned the promoter variants in a reporter vector and evaluated the promoter activities in a cell culture model. CD209 mRNAs were measured in PBMC. ResultsSingle-marker analysis revealed no significant allelic association with the risk of HIV-1 infection by parenteral route. Nevertheless, one haplotype was significantly overrepresented in EUI compared with HIV-1 positive patients and was associated with HIV-1 status (P=0.0008; OR: 0.43). Functional experiments suggested that the protective haplotype displayed lower transcriptional activity in vitro (P<0.05) and this was correlated with lower CD209 mRNA expression in PBMC (P=0.014). ConclusionsThis study suggests that the promoter haplotypes of CD209 influence the risk of HIV-1 acquisition in IDU and that this association is correlated with the mRNA expression level.

3 Single-Dose Oritavancin Treatment of Acute Bacterial Skin and Skin Structure Infections in Intravenous Drug Users: Results from SOLO Trials

3 Single-Dose Oritavancin Treatment of Acute Bacterial Skin and Skin Structure Infections in Intravenous Drug Users: Results from SOLO Trials

A SDF1 genetic variant confers resistance to HIV-1 infection in intravenous drug users in China

Despite repeated exposures to HIV-1, some individuals remain uninfected, suggesting that genetic factors confer host resistance to HIV-1 acquisition. The chemokine receptors CCR5, CXCR4 and the principal ligand SDF1 of CXCR4 play an important role for the entry of HIV-1 to target cells. To explore the relationship between genetic variants and HIV-1 infection, 11 common SNPs in CCR5, CXCR4 and SDF1 were genotyped in 921 male intravenous drug users (IDUs), of which 263 individuals were HIV-1-exposed seropositive (HESP) and 658 were HIV-1-exposed seronegative (HESN). According to the situation of syringe-sharing, the whole cohort was divided into two subgroups: syringe-sharing (SS) and syringe-not-sharing (SNS). We found that in the SNS subgroup rs17540465 of SDF1 showed significant difference of allele and genotype frequencies between HESP IDUs and HESN IDUs, but not in the SS subgroup. HESP with SNS carried significantly less allele A compared with HESN with SNS, indicating a protective role of allele A against HIV-1 infection. Syringe-sharing IDUs are supposed to be exposed highly to HIV-1 infection risk due to the direct transfer of HIV-1 infected blood to another. For syringe-not-sharing IDUs, sexual contact may be the major route of HIV-1 transmission. Considering the different route of HIV-1 transfection between two subgroups, we speculate that SDF1 may contribute susceptibility to HIV-1 infection in the route of sexual intercourse.

Necrotizing Soft Tissue Infections in Intravenous Drug Users: A Vascular Surgical Emergency

To assess the short and long-term outcomes of necrotizing soft tissue infection (NSTI) in intravenous drug users (IVDU) in a regional vascular centre. This was a retrospective analysis of all IVDUs with NSTI admitted to the regional vascular surgical unit between January 2009 and July 2014. Clinical outcome measures were interval between admission and surgery, length of ITU/HDU and hospital stays, post-operative complications, in hospital and one year mortality. 25 patients were admitted. The median age was 39 years (range 30-53 years) with a female to male ratio of 1:3.3. The median interval between admission and surgery was 23 hours (range 2-195 hours), however, this was significantly less when the admitting specialty was directly to vascular surgery (median 4 hours, range 2-7) compared with other specialties (median 38 hours, range 7-195 hours). Ten patients required HDU/ITU care with a median duration of 4 days (range 1-12 days). Five patients (20%) required amputation, of whom two (40%) had a prosthetic limb fitted. There was one in hospital death (4%). Another patient died while awaiting limb fitting 4 months post discharge, giving a 1 year mortality of 8%. NSTI in IVDUs carries high risk of amputation with a very low rate of limb fitting. Intervention is significantly delayed when the admitting specialty is not vascular surgery, and half of these patients require HDU/ITU care, with significant morbidity and mortality. Early diagnosis and referral to vascular surgery is crucial in management of these patients.

HIV epidemic in Russia and neighbouring countries.

Reports of HIV/AIDS cases attributed to sexual transmission from foreigners were published in the USSR in the mid of 80s. In the initial decade of the epidemic, the subtype B was found in men who have sex with men (MSM) population and several non-B subtypes were identified in heterosexual persons. The first case of HIV infection in intravenous drug users (IVDU) was reported in 1993 and since then a specific subtype A and its recombinants invaded the intravenous drug users (IVDU) populations of the region with the highest rate in Estonia, Russia and Ukraine. The concentrated HIV epidemic in IVDUs is still the main problem in the Eastern Europe; however, the rate of heterosexual transmission is increasing and many evidences of HIV prevalence rise in MSM are published. UNAIDS estimations for the number of HIV-positive persons living in the region range from 980,000 to 1,300,000 but distribution of HIV-cases is uneven and the prevalence rate of HIV infection in separate regions is over 1%. Mass seasonal labour migration from Central Asia and Caucasian republics to Russia transmits HIV to these countries. Prevention programs in the region are limited, and ART coverage is not more than 20% of the total HIV-positive population. The lack of concern about the epidemic, absence of effective national strategies and limited allocated resources are the main barriers to prevention and care in many countries. Local conflicts, rising religiosity and discrimination are adverse factors. The near-term forecast for the epidemic in the region is pessimistic and further international advocacy is needed to improve the situation.

Mycobacterium tuberculosis infection in intravenous drug users recently diagnosed with HIV/AIDS

Mycobacterium tuberculosis infection in intravenous drug users recently diagnosed with HIV/AIDS

Acute infections in intravenous drug users

Mortality in injecting drug users (IDUs) is up to 22 times higher than for the age-adjusted population.1 Despite increased provision of needle and syringe programmes, reduced needle and syringe sharing, and higher uptake of hepatitis B (HBV) vaccination,2 IDUs remain vulnerable to a range of infections with potentially life-threatening complications. In this paper, we describe the epidemiology, presentation, diagnosis and management of infections in IDUs who may present to acute physicians and the management of drug dependency on acute medical wards.

HCV infection in intravenous drug users: Results of the antiviral therapy and the questions of the compliance

Background: Intravenous drug use, tattoo and piercing are recently the most important pathways in the spreading of hepatitis C virus (HCV) infection. Screening for anti-HCV, hepatitis B virus and HIV in intravenous drug users (IDUs) are available in Hungarian Drug Outpatient Clinics. The prevalence of anti-HCV in IDUs is high (60–80%) worldwide and shows a relatively low (20–22%) value in Hungary.

Near Full-Length Genomic Characterization of a Novel HIV Type 1 CRF07_ BC/CRF08_ BC Recombinant Strain from Yunnan, China

Yunnan province was considered the HIV-1 epicenter of China, where many subtypes and CRFs of HIV-1 were circulating. CRF07_BC and CRF08_BC were two of the main circulating subtypes that caused more than 90% of the HIV-1 infections in intravenous drug users (IDUs) in this district. The cocirculation of these two CRFs in the same area and population predicted the emergence of new second-generation recombinants. This study presented a near full-length genomic analysis of a novel HIV-1 recombination (09YN072) involving CRF07_BC and CRF08_BC. The analyses of the sequence of 09YN072 showed that two CRF07_BC segments were inserted into the CRF08_BC backbone. The discovery of the novel recombinant strain complicates the HIV-1 epidemic in Yunnan, China, as well as the development of effective vaccines to limit the spread of HIV-1 in China.

Viral hepatitis B, C and HIV infection in Croatian prisons

Incarcerated persons comprise about 0.4% of the Croatian population, of whom 25-30% misuse drugs. We attempted to determine the structure of the prison population, prevalence of HBV, HCV, HIV markers, co-infections with HBV, HCV and HIV and acute HBV, HCV and HIV infection. In total, 25.9% of prisoners were positive for some markers for viral hepatitis (HBV 11.3%, HCV 8.3%, HBV/HCV 6.3%). Prevalence of HBV infection in intravenous drug users (IDUs) was 26.2% (highly promiscuous group 20.4%, individuals with psychiatric diseases and personality disorders 16.0%). HCV infection in IDUs was 52.0% and 4.9% in the highly promiscuous group. HBV/HCV co-infection was registered in 34.9% of prisoners positive for HBV markers (203/582). Acute HBV infection was detected in 0.5%, and HCV in 1.2%. Only 0.15% (5/3348) of prisoners were anti-HIV positive. It appears that individuals with psychiatric diseases and personality disorders could be an additional risk population for these viral infections.