The Poison Review

The Independent (U.K.) reported today that two drug users Glasgow have died of anthrax infection, and a third death is thought to be anthrax-related.  Two additional drug users in Scotland have been diagnosed with the disease but are responding to treatment.

This is not unprecedented.  In 2000, physicians from Oslo Norway described a 49-year-old heroin skin popper who died after a soft tissue infection in his right buttock spread and developed into hemorrhagic meningitis.  Both wound and CSF cultures grew Bacillus anthracis (Lancet 2000;356:1574).  The authors of that report pointed out that anthrax is common in regions that supply much of the world’s heroin supply.  That same year, there was a cluster of more than 30 deaths from infection in more thant 30 heroin users in Scotland, Ireland, Great Britain, and Wales. (Science 2000;288:1941). This turned out not to be related to anthrax, but most likely caused by Clostridia species.  All of these cases point out the pitfalls in managing soft tissue infections in drug abusers. especially skin poppers.  While many of these infections and abscesses will be caused by the usual suspects (staph, strep) one must also consider the possibility of wound botulism, tetanus, gangrene, and now anthrax.