Home > Epidemiological findings and medical, legal, and public health challenges of an investigation of severe soft tissue infections and deaths among injecting drug users: Ireland, 2000.

Murray-Lillibridge, K and Barry, Joseph and Reagan, S and O'Flanagan, D and Sayers, G and Bergin, C and O'Briain, S and Plunkett, P and McMahon, G and Keane, C and O'Sullivan, P and Igoe, Derval and Mullen, Louise and Ward, Mark and Smith, A and Fischer, M (2006) Epidemiological findings and medical, legal, and public health challenges of an investigation of severe soft tissue infections and deaths among injecting drug users: Ireland, 2000. Epidemiology and Infection , 134 , (4) , pp. 894-901.

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In May 2000, public health authorities in Dublin, Ireland, identified a cluster of unexplained severe illness among injecting drug users (IDUs). Similar clusters were also reported in Scotland and England. Concurrent investigations were undertaken to identify the aetiology and source of the illnesses. In Dublin, 22 IDUs were identified with injection-site inflammation resulting in hospitalization or death; eight (36%) died. Common clinical findings among patients with severe systemic symptoms included leukaemoid reaction and cardiogenic shock. Seventeen (77%) patients reported injecting heroin intramuscularly in the 2 weeks before illness. Of 11 patients with adequate specimens available for testing, two (18%) were positive by 16S rDNA PCR for Clostridium novyi. Clinical and laboratory findings suggested that histotoxic Clostridia caused a subset of infections in these related clusters. Empiric treatment for infections among IDUs was optimized for anaerobic organisms, and outreach led to increased enrolment in methadone treatment in Dublin. Many unique legal, medical, and public health challenges were encountered during the investigation of this outbreak.


Item Type:Article
Date:August 2006
Page Range:pp. 894-901
Publisher:Cambridge University Press
Volume:134
Number:4
Keywords:AODR mortality, disease mortality, Dublin, infection, intravenous drug user, Ireland
EndNote:View
Accession Number:HRB 3040 (Electronic Only)
Related URLs:
Subjects:G Health and disease > Disorder by cause > Communicable disease
VA Geographic area > Europe > Ireland
G Health and disease > State of health > Physical health
P Demography, epidemiology, and history > Population dynamics > Drugs and alcohol related mortality / death
G Health and disease > Public health
G Health and disease > Disorder by cause > Communicable disease > Bacterial disease

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