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Skin and soft tissue infections in injection drug users

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Abstract

Skin and soft tissue infections (SSTIs) are common among injection drug users (IDUs). Subcutaneous and intramuscular injection ("skin-popping") and the injection of "speedballs" (a mixture of heroin and cocaine) are important risk factors for SSTIs in this patient population. Female IDUs appear to be at greater risk of SSTIs than male IDUs, probably because of more difficult venous access. There are conflicting data regarding the impact of HIV and human T-cell lymphotrophic virus II infection on the risk of SSTIs in IDUs; however, an expanding body of evidence suggests that immunosuppressive effects of the drugs themselves may play a role. Most information regarding the microbiology of SSTIs in IDUs comes from data on skin and subcutaneous abscesses, where Staphylococcus aureus and organisms that originate from the oral flora predominate. Clonal outbreaks and uncommon infections including tetanus, wound botulism, and a sepsis/myonecrosis syndrome due to Clostridium species have been recently reported in IDUs.

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References and Recommended Reading

  1. Binswanger IA, Kral AH, Blutenthal RN, et al.: High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco. Clin Infect Dis 2000, 30:579–581.

    Article  PubMed  CAS  Google Scholar 

  2. Palepu A, Tyndall MW, Leon H, et al.: Hospital utilization and costs in a cohort of injection drug users. Can Med Assoc J 2001, 165:415–420.

    CAS  Google Scholar 

  3. CDC: Soft tissue infections among injection drug users-San Francisco, California, 1996–2000. MMWR 2001, 50:381–384.

    Google Scholar 

  4. Murphy EL, Devita D, Liu H, et al.: Risk factors for skin and soft-tissue abscesses among injection drug users: A casecontrol study. Clin Infect Dis 2001, 33:35–40. Although the association between injection drug use and SSTIs has been recognized for a long time, this is one of the few case-control studies to examine the risk factors for SSTIs in these individuals.

    Article  PubMed  CAS  Google Scholar 

  5. Spijkerman IJB, van AmeijdenEJC, Mientjes GHC, et al.: Human immunodeficiency virus infection and other risk factors for skin abscesses and endocarditis among injection drug users. J Clin Epidemiol 1996, 49:1149–1154.

    Article  PubMed  CAS  Google Scholar 

  6. Bassetti S, Hoffmann M, Bucher HC, et al.: Infections requiring hospitalization of injection drug users who participated in an injection opiate maintenance program. Clin Infect Dis 2002, 34:711–713.

    Article  PubMed  Google Scholar 

  7. Robert-Guroff M, Weiss SH, Giron JA, et al.: Prevalence of antibodies to HTLV-I, -II, and -III in intravenous drug abusers from an AIDS endemic region. JAMA 1986, 255:3133–3137.

    Article  PubMed  CAS  Google Scholar 

  8. Feigal E, Murphy EL, Vranizan K, et al.: HTLV-I/II in intravenous drug users in San Francisco: risk factors associated with seropositivity. J Infect Dis 1991, 164:36–42.

    PubMed  CAS  Google Scholar 

  9. Modahl LE, Young KC, Varney KF, et al.: Are HTLV-IIseropositive injection drug users at increased risk of bacterial pneumonia, abscess, and lymphadenopathy? J Acqir Immune Defic Syndr 1997, 16:169–175.

    CAS  Google Scholar 

  10. Safaeian M, Wilson LE, Taylor E, et al.: HTLV-II and bacterial infections among injection drug users. J Acquir Immune Defic Syndr 2000, 24:483–487.

    PubMed  CAS  Google Scholar 

  11. Makman MH: Morphine receptors in immunocytes and neurons. Neuroimmunol 1994, 4:69–82.

    Article  CAS  Google Scholar 

  12. Risclahl JM, Khanna KV, Peterson PK, et al.: Opiates and infection. J Neuroimmunol 1998, 83:4–18. An excellent overview of what is currently known regarding the effects of opiods on the immune system.

    Article  Google Scholar 

  13. Bergstein JM, Baker IV EJ, Aprahamian C, et al.: Soft tissue abscesses associated with parenteral drug abuse: Presentation, microbiology, and treatment. Am Surg 1995, 61:1105–1108.

    PubMed  CAS  Google Scholar 

  14. Summanen PH, Talan DA, Strong C, et al.: Bacteriology of skin and soft-tissue infections: Comparison of infections in intravenous drug users and individuals with no history of intravenous drug use. Clin Infect Dis 1995, 20(Suppl 2):S279-S282.

    PubMed  Google Scholar 

  15. Olopoenia LA, Mody V, Reynolds M: Eikenella corrodens endocarditis in an intravenous drug user: case report and literature review. J Natl Med Assoc 1994, 86:313–315.

    PubMed  CAS  Google Scholar 

  16. Swisher LA, Roberts JR, Glynn MJ: Needle licker’s osteomyelitis. Am J Emerg Med 1994, 12:343–346.

    Article  PubMed  CAS  Google Scholar 

  17. Armstrong O, Fisher M: The treatment of Eikenella corrodens soft tissue infection in an injection drug user. WV Med J 1996, 92:138–139.

    CAS  Google Scholar 

  18. Simmen HP, Giovanoli P, Battaglia H, et al.: Soft tissue infections of the upper extremities with special consideration of abscesses in parenteral drug abusers. J Hand Surg 1995, 20B:797–800.

    Google Scholar 

  19. Thomas III WO, Almand JD, Stark GB, et al.: Hand injuries secondary to subcutaneous illicit drug injections. Ann Plast Surg 1995, 34:27–31.

    Article  PubMed  Google Scholar 

  20. Böhlen LM, Mühlemann K, Dubuis O, et al.: Outbreak among drug users caused by a clonal strain of Group A Streptococcus. Emerg Infect Dis 2000, 6:175–179.

    Article  PubMed  Google Scholar 

  21. Fleisch F, Zbinden R, Vanoli C, et al.: Epidemic spread of a single clone of methicillin-resistant Staphylococcus aureus among injection drug users in Zurich, Switzerland. Clin Infect Dis 2001, 32:581–586.

    Article  PubMed  CAS  Google Scholar 

  22. Saravolatz LD, Markowitz N, Arking L, et al.: Methicillinresistant Staphylococcus aureus: Epidemiologic observations during a community-acquired outbreak. Ann Intern Med 1982, 96:11–16.

    PubMed  CAS  Google Scholar 

  23. Centers for Disease Control: Community-acquired methicillin-resistant Staphylococcus aureus infections: Michigan. MMWR 1981, 30:185–187.

    Google Scholar 

  24. Craven DE, Rixinger AI, Goularte TA, et al.: Methicillinresistant Staphylococcus aureus bacteremia linked to intravenous drug abusers using a "shooting galler". Am J Med 1986, 80:770–776.

    Article  PubMed  CAS  Google Scholar 

  25. Centers for Disease Control: Update on adult immunization. MMWR 1991, 40:RR-12.

    Google Scholar 

  26. Centers for Disease Control: Tetanus among injecting-drug users-California, 1997. MMWR 1998, 47:149–151.

    Google Scholar 

  27. Werner SB, Passaro D, McGee J, et al.: Wound botulism in California, 1951–1998: recent epidemic in heroin injectors. Clin Infect Dis 2000, 31:1018–1024. A comprehensive report of the experience in California (which has reported the majority of the wound botulism cases in the world), with an unprecedented epidemic of wound botulism among IDUs.

    Article  PubMed  CAS  Google Scholar 

  28. Werner SB, Passaro DJ, McGee J, et al.: "Shooter’s botulism": epidemic wound botulism in California. Paper presented at36th Interscience Conference on Antimicrobial Agents and Chemotherapy. New Orleans, LA. September 15–18, 1996.

  29. Williamson N, Archibald C, Van VlietJS: Unexplained deaths among injection drug users: a case of probable Clostridium myonecrosis. Can Med Assoc J 2001, 165:609–611.

    CAS  Google Scholar 

  30. Bangsberg DR, Rosen JI, Aragón T, et al.: Clostridial myonecrosis cluster among injection drug users. Arch Intern Med 2002, 162:517–522. Although this is a small case series, clinicians who care for IDUs should review this report in order to be familiar with this potentially fatal syndrome.

    Article  PubMed  Google Scholar 

  31. Chen JL, Fullerton KE, Flynn NM: Necrotizing fasciitis associated with injection drug use. Clin Infect Dis 2001, 33:6–15.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Infectious Diseases, Harper University Hospital, 4 Brush Center, 3990 John R, 48201, Detroit, MI, USA

    Patricia D. Brown MD

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  1. Patricia D. Brown MD
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  2. John R. Ebright MD
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Brown, P.D., Ebright, J.R. Skin and soft tissue infections in injection drug users. Curr Infect Dis Rep 4, 415–419 (2002). https://doi.org/10.1007/s11908-002-0008-0

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  • DOI: https://doi.org/10.1007/s11908-002-0008-0

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