Clostridial Myonecrosis Cluster Among Injection Drug Users

Abstract

A molecular epidemiologic investigation was performed on a cluster of severe necrotizing Clostridium infections in 5 injection drug users admitted to an urban community hospital. Interviews with survivors suggested a point source of infection. Pulsed-field gel electrophoresis of SmaI restriction digests was performed to determine the molecular relatedness of clinically obtained isolates and isolates obtained from heroin samples and the home environment. A common clonal strain was found in Clostridium sordellii isolates from 2 socially unrelated patients and from drug paraphernalia. Clonality of a Clostridium perfringens strain from another patient isolate was identical to an isolate from a syringe found in her home. Other C perfringens isolates from patients, heroin, and the environment were determined to be polyclonal. We postulate that rapid recognition and public health notification led to rapid resolution of the outbreak.

Bacterial, Fungal, Parasitic, and Viral Myositis

“…Clostridial myonecrosis, better known as gas gangrene, is usually caused by C. perfringens. This infection occurs in a variety of settings, including traumatic wounds with soil contamination, surgery involving the bowel or biliary system or associated with septic abortions, vascular disease with arterial insufficiency often involving the extremities, and unhygienic injection of medications (e.g., epinephrine) or illicit drugs (e.g., heroin) (16). Common characteristics of inciting events include contamination of the site with Clostridium spp.…”

Microbial Infections, Immunomodulation, and Drugs of Abuse

“…Recent reports continue to discuss the problem of contaminated heroin or drug paraphernalia and infections (15,47). Numerous in-vestigators, however, have proposed that increased exposure is not the only factor that enhances microbial infections.…”

Isolation and identification of Clostridium spp. from infections associated with the injection of drugs: experiences of a microbiological investigation team

“…This organism has been reported in other IDUassociated infections [17] and recently has been implicated in a fatal post-knee transplant infection the USA [18]. Colonies are large, grey-white and irregular, sometimes with a 'fern-leaf ' edge.…”