1887

Abstract

In 2000, an unusual increase of morbidity and mortality among illegal injecting drug users in the UK and Ireland was reported and was identified as the likely source of the serious infection, although infections due to and were also reported. Because heroin was a possibile source of infection, this study investigated the microflora of heroin samples seized in England during 2000 and 2002. Two methods were developed for the examination of the microflora of heroin. The first consisted of suspension of the drug in maximum recovery diluent (MRD) which was inoculated directly into Clostridium Botulinum Isolation Cooked Meat Broth (CBI). The second method rendered the heroin soluble in citric acid, concentrated particulate material (and bacterial cells) by filtration and removed heroin residues by washing with citric acid and phosphate-buffered saline before placing the filter in CBI broth. Duplicate CBI broths from both methods were incubated without heating and after heating at 60°C for 30 min. Subcultures were made after incubation for 7 and 14 days on to eight different solid media. The methods were evaluated with heroin samples spiked with either or spore suspensions; recovery of 10 spores in the original sample was demonstrated. Fifty-eight heroin samples were tested by citric acid solubilisation and 34 by the MRD suspension technique. Fifteen different gram-positive species of four genera were recognised. No fungi were isolated. Aerobic endospore-forming bacteria ( spp. and ) were the predominant microflora isolated and at least one species was isolated from each sample. was the most common species and was isolated from 95% of all samples, with isolated from 40%. Between one and five samples yielded cultures of , , , and spp. were isolated from 23 (40%) samples; and were the most common and were cultured from 13 (22%) and 6 (10%) samples respectively. One or two samples yielded cultures of , and . The remainder of the flora detected comprised two samples contaminated with and two samples with either or . Multiple bacterial species were isolated from 43 (74%) samples, a single species from the remaining 15. In 13 samples alone was isolated, in one alone and in one sample alone. and were not isolated from any of the heroin samples. Recommendations for the optimal examination of the microflora of heroin are given.

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2002-11-01
2019-11-18
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References

  1. Horsburgh CR, Anderson JR, Boyko EJ. Increased incidence of infections in intravenous drug users. Infect Control Hosp Epidemiol 1989;; 10: 211–215.[CrossRef]
    [Google Scholar]
  2. Brettle RP. Infection and injection drug use. J Infect 1992;; 25: 121–131.
    [Google Scholar]
  3. Peat M, Budd J, Burns SM, Robertson R. Audit of blood borne virus infections in injecting drug users in general practice. Commun Dis Public Health 2000;; 3: 244–246.
    [Google Scholar]
  4. Martin C, Schaller MD, Lepori M, Liaudet L. Cranial nerve palsies and decending paralysis in a drug abuser resulting from wound botulism. Intensive Care Med 1999;; 25: 765–769.[CrossRef]
    [Google Scholar]
  5. Werner SB, Passaro D, McGee J, Schechter R, Vugia DJ. Wound botulism in California, 1951–1998: recent epidemic in heroin injectors. Clin Infect Dis 2000;; 31: 1018–1024.[CrossRef]
    [Google Scholar]
  6. Jensenius M, Lovstad RZ, Dhaenens G, Rorvik LM. A heroin user with a wobbly head. Lancet 2000;; 356: 1160. [CrossRef]
    [Google Scholar]
  7. Talan DA, Moran GJ. Tetanus among injecting drug users: California 1997. Ann Emerg Med 1998;; 32: 385–386.[CrossRef]
    [Google Scholar]
  8. Ringertz SH, Hoiby EA, Jensenius M.et al. Injectional anthrax in a heroin skin- popper. Lancet 2000;; 354: 1574–1575.
    [Google Scholar]
  9. Bloomfield SF, Arthur M. Mechanisms of inactivation and resistance of spores to chemical biocides. Soc Appl Bacteriol Symp Suppl 1994;; 23: 91S–104S.
    [Google Scholar]
  10. Christie B. Gangrene bug ‘‘killed 35 heroin users’'. BMJ 2000;; 320: 1690. [CrossRef]
    [Google Scholar]
  11. Anon. Serious unexplained illness among drug injectors. Commum Dis Rep CDR Wkly 2000;; 24: 195.
    [Google Scholar]
  12. Anon.Clostridium novyi is likely cause of ‘serious unexplained illness’ as cases continue to be reported. Commum Dis Rep CDR Wkly 2000;; 24: 213,216.
    [Google Scholar]
  13. Bellis MA, Beynon C, Millar T.et al. Unexplained illness and deaths among injecting drug users in England: a case control study using Regional Drug Misuse Databases. J Epidemiol Community Health 2001;; 55: 843–844.[CrossRef]
    [Google Scholar]
  14. Anon. Update: Clostridium novyi and unexplained illness among injecting drug users: Scotland, Ireland and England April–June 2000. MMWR Morb Mortal Wkly Rep 2000;; 49: 543–544.
    [Google Scholar]
  15. Ryan JM, Paul J, Curtis S, Patel NK. Clostridium novyi infection: a fatal association with injecting drug users. Emerg Med J 2001;; 18: 138–139.[CrossRef]
    [Google Scholar]
  16. McGuigan CC, Penrice GM, Black M.et al. Outbreak of infection with Clostridium novyi and other sporulating bacteria in Scottish injecting drug users. J Med Microbiol 2002;; 51: 971–977.
    [Google Scholar]
  17. Dancer SJ, McNair D, Finn P, Kolstot AB. Bacillus cereus cellulitis from contaminated heroin. J Med Microbiol 2002;; 51: 278–281.
    [Google Scholar]
  18. Athwal BS, Gale AN, Brett MM, Youl BD. Wound botulism in UK. Lancet 2000;; 356: 2001–2002.[CrossRef]
    [Google Scholar]
  19. Khan M, Chay S, Bonner S, Brett M. Wound botulism in injecting drug users: second case in England. Eurosurveillance Weekly 2000; 22 June.
  20. Hood J, Horne G, Sweeney G, Baird K. Third case of wound botulism in an injecting drug user. SCIEH Weekly Report 2000;; 34: 200.
    [Google Scholar]
  21. Mulleague L, Bonner SM, Samuel A.et al. Wound botulism in drug addicts in the United Kingdom. Anaesthesia 2001;; 56: 120–123.[CrossRef]
    [Google Scholar]
  22. Tuazon CU, Hill R, Sheagren JN. Microbiological study of street heroin and injection paraphernalia. J Infect Dis 1974;; 129: 327–329.[CrossRef]
    [Google Scholar]
  23. Shamsuddin D, Tuazon CU, Levy C, Curtin J. Bacillus cereus panophthalmitis: source of organism. Rev Infect Dis 1982;; 4: 97–103.[CrossRef]
    [Google Scholar]
  24. Alvarez M, Barturen B, Regulez P, Ponton J, Ezquerra JL, Cisterna R. Microbiological study of 30 samples of heroin. Enferm Infecc Microbiol Clin 1990;; 8: 231–233.
    [Google Scholar]
  25. Moustoukas NM, Nichols RL, Smith JW, Garey RE, Egan RR. Contaminated street heroin.Relationship to clinical infections. Arch Surg 1983;; 118: 746–749.[CrossRef]
    [Google Scholar]
  26. Tuazon CU, Miller H, Shamsuddin D. Antimicrobial activity of street heroin. J Infect Dis 1980;; 142: 944. [CrossRef]
    [Google Scholar]
  27. Mills DC, Midura TF, Aron SS. Improved selective medium for the isolation of lipase positive Clostridium botulinum from feces of human infants. J Clin Microbiol 1985;; 21: 947–950.
    [Google Scholar]
  28. Barr GD, Hudson MJ, Priddle JD, Jewell DP. Colonic bacterial proteases to IgA1 and sIgA in patients with ulcerative colitis. Gut 1987;; 28: 186–189.[CrossRef]
    [Google Scholar]
  29. Parry JM, Turnbull PCB, Gibson JR. A colour atlas of Bacillus species. London, Wolfe Medical Publications. 1983.
  30. Gordon RE, Haynes WC, Pang CHN. The genus Bacillus. Agricultural Research Station Agriculture Handbook 427. Washington, DC, US Department of Agriculture. 1973.
  31. Barrow GI, Feltham RKA. Cowan and Steel's manual for the identification of medical bacteria, 3rd edn. Cambridge, Cambridge University Press. 1993.
  32. Kloos W. Taxonomy and systematics of Staphylococci indigenous to humans. In: Crossley KB, Archer GL (eds) The staphylococci in human diasease. New York, Churchill Livingstone. 1997:; 113–137.
  33. McGuigan C, Roworth M. Clostridium novyi type A infection: a sporadic fatal case. Scand J Infect Dis 2002;; 34: 209–211.[CrossRef]
    [Google Scholar]
  34. McLauchlin J, Salmon J, Ahmed S.et al. Amplified fragment length polymorphism (AFLP) analysis of Clostridium novyi, C. perfringens and Bacillus cereus isolated from injecting drug users during 2000. J Med Microbiol 2002;; 51: 990–1000.
    [Google Scholar]
  35. Brazier JS, Duerden BI, Hall V.et al. Isolation and identification of Clostridium spp. from infections associated with the injection of drugs: experiences of a microbiological investigation team. J Med Microbiol 2002;; 51: 985–989.
    [Google Scholar]
  36. Tuazon CU, Murray HW, Levy C, Solny MN, Curtin JA, Sheagren JN. Serious infections from Bacillus spp. JAMA 1979;; 241: 1137–1140.[CrossRef]
    [Google Scholar]
  37. Ing MB, Baddour LM, Bayer AS. Bacteremia and infective endocarditis: pathogenesis, diagnosis and complications. In: Crossley KB, Archer GL (eds) The staphylococci in human disease. New York, Churchill Livingstone. 1997:; 331–354.
  38. Newton John HF, Wise K, Looke DFM. Role of lemon in disseminated candidiasis of heroin abusers. Med J Aust 1984;; 140: 780–781.
    [Google Scholar]
  39. Podzamczer D, Ventin M, Sauca G, Fernandez-Viladrich P, Martin R, Gudiol F. Contaminated lemons as possible source of infection in heroin abusers with disseminated candidiasis. Eur J Clin Microbiol 1986;; 5: 477. [CrossRef]
    [Google Scholar]
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