Parenteral Drug Abusers Research Articles

Bacterial infections in adult patients with the acquired immune deficiency syndrome (AIDS) and AIDS-related complex

Sixty-four episodes of bacterial infection were identified over a 44-month period in 16 of 28 patients with the acquired immune deficiency syndrome (AIDS) and 14 of 31 patients with AIDS-related complex. Nineteen of the 30 infected patients were parenteral drug abusers, 10 were from Caribbean Islands and had no identified risk factor, and one was a homosexual male. Fourteen patients had 21 episodes of community-acquired pneumonia: Streptococcus pneumoniae (10), Haemophilus influenzae (three), other Haemophilus species (three), group B beta-hemolytic streptococci (one), Staphylococcus aureus (one), Branhamella catarrhalis (one), Legionella pneumophila (one), and Mycoplasma pneumoniae (one). Seven patients had eight episodes of nosocomial pneumonia caused by gram-negative bacilli. Twenty-five episodes of community-acquired bacteremia and nine episodes of nosocomial bacteremia were associated with specific sites of infection. Other infections included meningitis (two), urinary tract infection (one), and abscesses involving subcutaneous and deep tissues (12). Sixteen patients had recurrent infections; 11 of these had or eventually had AIDS. Community-acquired bacterial infections in patients with AIDS or AIDS-related complex are common and may be recurrent but have low fatality rates. In comparison, nosocomial bacterial infections occur primarily in patients with AIDS and have high fatality rates.

Recurrent streptococcus mutans endocarditis

Recurrent bacterial endocarditis is associated with several risk factors including parenteral drug abuse, past valvular heart disease, and periodontitis. Recurrence rates vary from 2 to 18 percent for a single recurrence, and 1 to 5 percent for two recurrences. An unusual case study of a patient experiencing three episodes of bacterial endocarditis following dental work is described. The episodes occurred at least one year apart and were characterized by biochemically identical strains of Streptococcus mutans.

The changing epidemiology of adult botulism in the United States.

All forms of botulism are rare in the United States, and, as a result, descriptions of the pertinent epidemiologic features and clinical spectrum of illness are limited. This review describes the epidemiologic characteristics of the 355 cases of botulism in adults reported in the United States between 1976 and 1984, outlines current therapy, and emphasizes newly recognized features of the disease. Evaluation of recent data for botulism demonstrates several new associations and trends. These include the occurrence of large restaurant-associated outbreaks, several newly identified vehicles for foodborne botulism, wound botulism in parenteral drug abusers, and botulism from an unknown source in patients with underlying gastrointestinal disease. Recognition of these unusual features can lead to more effective preventive measures and to early diagnosis, which is essential for effective treatment.

Seroprevalence of hepatitis B virus and delta agent in parenteral drug abusers. Immunogenicity of hepatitis B vaccine

The seroprevalence of hepatitis B virus (HBV) markers and antibody to the delta agent (anti-delta) was determined for 112 parenteral drug abusers entering a methadone maintenance program. Markers of HBV infection were found in 87.5 percent of the group, and seropositivity was significantly associated with duration of drug abuse (p = 0.02). Antibody to the hepatitis B core antigen (anti-HBc) was present in all seropositive subjects; three (2.7 percent) were hepatitis B surface antigen-positive, and 16 (14.2 percent) had only anti-HBc. Five (10.6 percent) of 47 subjects with HBV markers had anti-delta. Anti-delta was more common in subjects who reported multiple symptomatic episodes of hepatitis (p = 0.02) and fewer than three daily drug injections (p = 0.05). Ten susceptible subjects received hepatitis B vaccine, and seroconversion rates at one, three, and six months were 20.0, 88.8, and 100 percent, respectively. The data indicate that hepatitis B vaccine is immunogenic in this population, and that anti-HBc is the optimal prevaccination screening test. Recent outbreaks of fulminant HBV and delta co-infection among drug abusers emphasize the need for early immunization in this group.

Leads from the MMWR. Hepatitis B among parenteral drug abusers--North Carolina

Leads from the MMWR. Hepatitis B among parenteral drug abusers--North Carolina

Bacteremia Caused by Group G Streptococci in Parenteral Drug Abusers: Epidemiological and Clinical Aspects

Journal Article Bacteremia Caused by Group G Streptococci in Parenteral Drug Abusers: Epidemiological and Clinical Aspects Get access Donald E. Craven, Donald E. Craven Department of Medicine, Division of Infectious Diseases, Boston City Hospital, Boston University School of Medicine, Boston, Massachusetts; and Department of Medicine, Division of Infectious Diseases, University of Tennessee College of Medicine, Memphis, Tennessee Please address requests for reprints to Dr. Donald E. Craven, Hospital Epidemiology Section, Maxwell Finland Laboratory for Infectious Diseases, Boston City Hospital, Boston, Massachusetts 02118. Search for other works by this author on: Oxford Academic PubMed Google Scholar Ann I. Rixinger, Ann I. Rixinger Department of Medicine, Division of Infectious Diseases, Boston City Hospital, Boston University School of Medicine, Boston, Massachusetts; and Department of Medicine, Division of Infectious Diseases, University of Tennessee College of Medicine, Memphis, Tennessee Search for other works by this author on: Oxford Academic PubMed Google Scholar Alan L. Bisno, Alan L. Bisno Department of Medicine, Division of Infectious Diseases, Boston City Hospital, Boston University School of Medicine, Boston, Massachusetts; and Department of Medicine, Division of Infectious Diseases, University of Tennessee College of Medicine, Memphis, Tennessee Search for other works by this author on: Oxford Academic PubMed Google Scholar Theresa A. Goularte, Theresa A. Goularte Department of Medicine, Division of Infectious Diseases, Boston City Hospital, Boston University School of Medicine, Boston, Massachusetts; and Department of Medicine, Division of Infectious Diseases, University of Tennessee College of Medicine, Memphis, Tennessee Search for other works by this author on: Oxford Academic PubMed Google Scholar William R. McCabe William R. McCabe Department of Medicine, Division of Infectious Diseases, Boston City Hospital, Boston University School of Medicine, Boston, Massachusetts; and Department of Medicine, Division of Infectious Diseases, University of Tennessee College of Medicine, Memphis, Tennessee Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 153, Issue 5, May 1986, Pages 988–992, https://doi.org/10.1093/infdis/153.5.988 Published: 01 May 1986 Article history Received: 03 September 1985 Revision received: 16 December 1985 Published: 01 May 1986

T lymphocyte subsets in parenteral and non-parenteral heroin abusers in Britain.

SummaryParenteral drug abusers comprise the second largest group of patients with the acquired immune deficiency syndrome (AIDS). To determine whether heroin abusers in Britain had immunologic abnormalities similar to those seen in AIDS, we determined T lymphocyte subsets in 14 parenteral heroin abusers and 10 non‐parenteral heroin abusers. No significant differences were found in T4/T8 ratios or in the absolute numbers of T3, T4, or T8‐positive cells. These results suggest that neither narcotic drugs nor repeated exposure to unsterile injectable substances are responsible for low T4/T8 ratios in parenteral drug abusers with AIDS.

Leukopenia and Anergy as Predictors of AIDS-Reply

<h3>In Reply.—</h3> Cohen and associates, in their accompanying letter, have collected WBC counts on more than 11,000 adult inmates of a division of the New York City jail and determined that approximately 2.5% were leukopenic. This is certainly consistent with our historical data.¹They have also determined that less than 10% of those who were leukopenic were also anergic. All 22 anergic inmates had a history of parenteral drug abuse. No data on human T-cell lymphotropic virus type III (HTLV-III) antibody appear to be available. Leukopenia, per se, does not seem to be predictive of anergy or other prodromal signs and symptoms associated with AIDS. The development of testing procedures for HTLV-III antibody permits identification of those who have been exposed to the virus associated with AIDS, of whom only a portion are either prodromal or overtly ill.²Antibodies against HTLV-I, HTLV-II, and HTLV-III are prevalent among intravenous

Delta hepatitis: another concern for dentistry

Delta hepatitis is a defective virus dependent on hepatitis B virus for replication and transmission. Delta hepatitis infection is becoming more prevalent in the United States, especially in parenteral drug abusers; several outbreaks have occurred. Infection control procedures and the hepatitis B vaccine can protect the dental staff from infection and transmission.

Lymphocyte subpopulations in Spanish parenteral drug addicts.

Lymphocyte subpopulations were studied in 29 symptom-free Spanish prisoners who were active parenteral drug abusers. In 16/29 drug addicts (55%) the helper-inducer/suppressor-cytotoxic ratio (Leu 3a/Leu 2a) was less than 1. None of these 16 patients had lymphopenia and only 2 had a reduction in the number of Leu 3a cells. In drug addicts the number of lymphocytes (p less than 0.01) and the number and percentage of Leu 2a cells (p less than 0.001) were significantly raised. The addicts also had a higher absolute number of T cells when measured by their ability to react with the Leu 4 antibody (p less than 0.01). However, the E-rosette forming cells were significantly reduced. Thus the E-rosette test may lead to an overestimation of "null" cells. Furthermore drug addicts had a higher percentage (p less than 0.001) of Leu 7 positive cells (NK and K cells), but a normal percentage of B and phagocytic cells. Five drug addicts had generalized persistent lymphadenopathies, and 2 had skin anergy. We believe that most of the immunologic abnormalities seen in these apparently healthy drug abusers can be explained by an antigenic overload.

Mycotic Endophthalmitis Caused by Penicillium sp. After Parenteral Drug Abuse

A 30-year-old man developed endophthalmitis three weeks after an intravenous injection of hydromorphone hydrochloride. Penicillium species was recovered from a vitreous aspirate. Treatment with amphotericin B and flucytosine resulted in documented sterilization of the vitreous. At a six-month follow-up examination, the visual acuity of the involved eye was still limited to light perception.

Soft tissue infections in parenteral drug abusers

Soft tissue infections in parenteral drug abusers

Blood Counts in Male Parenteral Drug Users

<h3>To the Editor.—</h3> The acquired immune deficiency syndrome (AIDS) is characterized by a deficit in cellular immunity consistent with impaired helper T-lymphocyte function and is associated with infection by the human T-cell lymphotropic virus, HTLV-III.¹Groups at particular risk of AIDS include homosexual men, parenteral drug users, and hemophiliacs. Lymphocytopenia frequently develops in patients with AIDS. The significance of leukopenia in parenteral drug users has been unclear. A review of the literature determined that historical normative complete blood cell (CBC) count data for parenteral drug abusers were not available. During 1975-1976, the National Institute on Drug Abuse evaluated CBCand differential cell counts in 898 American male drug abusers who reported at least two years of regular intravenous opioid use. Predetermined reference ranges for each test were specified by the clinical laboratories and were consistent with generally accepted norms.^2-3 Both anemia and lymphocytosis were substantially more prevalent (≥11%)

Parasitic diseases in immunocompromised hosts

In patients with compromised host defenses, diseases caused by protozoans and nematodes appeared, a few years ago, to be declining in importance. However, the outbreak of the acquired immunodeficiency syndrome (AIDS) among homosexual men, parenteral drug abusers, and other groups has made it necessary for physicians to familiarize themselves again with the manifestations of these diseases in abnormal hosts. The groups of patients at greatest risk, the usual clinical syndromes in abnormal hosts, and current approaches to diagnosis, treatment, and prevention of infections due to Pneumocystis carinii, Toxoplasma gondii, Strongyloides stercoralis, and organisms of the genus Cryptosporidium are reviewed. Because so many cases of these infections have recently occurred among patients with AIDS, recent experience with these diseases in AIDS patients at Memorial Sloan-Kettering Cancer Center is summarized.

Glomerulonephritis in bacterial endocarditis.

For a modern assessment of the clinical and morphologic features of glomerulonephritis accompanying bacterial endocarditis, postmortem and renal biopsy files were reviewed for the years 1965 to 1979, a period of changing epidemiology, etiology, and therapeutic regimens in infective endocarditis. The incidence of glomerulonephritis in 107 patients examined at postmortem was 22.4%; focal glomerulonephritis was present in 8.4%, diffuse glomerulonephritis in 14%. Glomerulonephritis occurred as frequently in acute as in subacute bacterial endocarditis. Staphylococcus aureus, which has replaced Streptococcus viridans as the predominant etiology of fatal bacterial endocarditis, was frequently associated with glomerulonephritis, especially in parenteral drug abusers. Renal functional impairment due to focal glomerulonephritis did not necessitate dialysis or contribute to the death of any patient. Presentation with advanced renal insufficiency due to diffuse glomerulonephritis was associated with both failure of antibiotic therapy to eradicate infection and failure to recover renal function. In patients with diffuse glomerulonephritis and less severe impairment of renal function, antibiotic therapy was successful in achieving bacteriologic cure, and complete recovery of renal function occurred in the majority. Features of persistent glomerular disease were frequent in patients with diffuse glomerulonephritis long after bacteriologic cure of endocarditis.

Kaposi's Sarcoma and Immunoblastic Sarcoma in the Acquired Immune Deficiency Syndrome

<h3>To the Editor.—</h3> The acquired immune deficiency syndrome (AIDS) is being recognized with increasing frequency. The epidemiology of this syndrome suggests a horizontally transmissible agent. The spectrum of opportunistic infections observed in these patients is well documented.¹A higher incidence of Kaposi's sarcoma as well as squamous carcinoma of the oral cavity, cloacogenic carcinoma of the rectum, primary lymphomas of the brain, and systemic Burkitt's-like lymphomas has been noted.^2,3We now describe a patient with AIDS who experienced both Kaposi's sarcoma and B-cell immunoblastic sarcoma. <h3>Report of a Case.—</h3> A 31-year-old homosexual man was admitted to UCLA Medical Center with a two-month history of an enlarging right mandibular mass. The patient denied parenteral drug abuse. Medical history included an episode of localized varicella zoster, syphilis, and multiple episodes of gonorrhea. Eight months before admission, the patient noted the eruption of multiple, raised, reddish-brown lesions on his extremities, face,

Soft tissue infections in parenteral drug abusers.

Thirty-four parenteral drug abusers admitted with soft tissue infections underwent bacteriologic and immunologic evaluation. Staphylococcus aureus and beta hemolytic streptococci were the most common organisms recovered. Enteric gram negative aerobes and oral flora were common and enteric anaerobes rare. Absolute lymphopenia and elevations in the IgA, IgG and IgM fractions of the immunoglobulins were common as were false positive VDRL examinations. Cutaneous anergy was found in 83% of the group and 70% of a simultaneously noninfected addict group. Staphylococcal carriage was frequent. Because of variation in the flora between this and other reported groups, ongoing bacteriologic surveillance could be a useful guide to initial antibiotic therapy. Differences in the pattern of immune reaction in this group when compared to different addict groups suggest a difference in antigenic stimulation, possibly as a result of differences in bacteriologic exposure.

Sensitive enzyme immunoassay for the detection of delta antigen and anti-delta, using serum as the delta antigen source.

A sensitive enzyme-linked immunosorbent assay (ELISA, EIA) was developed for the detection of delta antigen in serum treated with Tween 20. The serum delta antigen so derived was used in an ELISA for anti-delta. Both tests were specific and more sensitive than radioimmunoassay (RIA) when applied to testing parenteral drug abusers. It is concluded that the different sources of delta-antigen used may account for the different sensitivities noted, and that delta antigenaemia in acute infection may be more frequently detectable than was first thought, amounting to 71% of those with delta infection in this study and that these sera are a convenient alternative source of antigen.

Infections in parenteral drug abusers: Further immunologic studies

In our previous study of soft tissue infections in parenteral drug abusers, two thirds of the infections were polymicrobial. Oral and enteric organisms were frequently recovered. These patients and a group of uninfected addicts showed frequent cutaneous anergy, lymphopenia, and hypergammaglobulinemia. An additional group of uninfected addicts was studied. The mean levels of IgA, IgG, and IgM were higher in the uninfected addicts. In the addict and control groups, elevations in IgA (17 percent of total), IgG (65 percent), and IgM (19 percent) levels were found. Zinc levels were within normal limits. T-cell populations below 70 percent were seen in five of the seven addicts and two of the four control subjects. Reversed helper to suppressor cell ratios were found in three of the seven addicts and control subjects. No consistent pattern of immunologic abnormalities emerged. The interrelationship of the abnormalities in the addict and their relationship to AIDS is unclear.

Viral hepatitis among parenteral drug addicts attending a Danish addiction clinic.

100 parenteral drug abusers attending an addiction clinic were studied for past or present infection with hepatitis A and B virus (HAV and HBV) by sensitive serological assays for hepatitis B surface and e-antigen and antibodies to HBsAg, HBeAg, HBcAg and HAV. 44% of the individuals had past HAV infection, which is 4 times as high compared to the general population in Denmark. 83% had evidence of past or present HBV infection with no difference between men and women. This is 30 times higher than in the general population in Denmark. 18% of the subjects studied were positive for HBsAg and/or anti-HBc alone, but only 3 of these were positive for HBeAg (3%). Serum transaminase values were often elevated but this finding could not differentiate between patients with or without HBV infection. Infection with HBV appeared to take place during the first year of the drug addict's career, and to eliminate this major reservoir of HBV infection the main objective will be to prevent new susceptible individuals in getting addicted.