Myonecrosis in injection drug users (a clinical case)

Abstract


Myonecrosis remains one of the severest manifestations of skin and soft tissue infections. Clostridia (C. perfringens, C. novyi, C. septicum, C. sordellii, C. histolyticum) are dominant and Staphylococcus aureus, Streptococcus pyogenes, Bacillus cereus, and Bacteriodes fragilis are much less in the etiology of myonecrosis. Cases of gas gangrene have recently become more frequent among injection drug users all over the world. Russia has become the largest opiate market in Europe and consumption of these narcotic drugs is annually growing. In the Russian Federation, a larger number of injection drug users uniquely results in a rise of cases of Clostridium- and mixed flora-induced myonecrosis. Gas gangrene in HIV-positive drug abusers seems to rapidly progress to multiple organ failure and to show high death rates, rather than to develop a localized form. The analyzed case of mixed flora-induced gas gangrene is of interest to physicians of any specialties who can encounter this wound infection in HIV-positive patients.

About the authors

Irina Viktorovna Shestakova

Email: shes.irin@mtu-net.ru

Nikolay Dmitrievich Yushchuk

Oleg Aleksandrovich Tishkevich

Email: shes.irin@mtu-net.ru

I V Shestakova

Moscow State University of Medicine and Dentistry

Moscow State University of Medicine and Dentistry

N D Yushchuk

Moscow State University of Medicine and Dentistry

Moscow State University of Medicine and Dentistry

O L Tishkevich

Infectious Diseases Hospital Two

Infectious Diseases Hospital Two

References

  1. Brown P. D., Ebright J. R. Skim and soft tissue infections in injection drug users. Curr. Infect. Dis. Rep. 2002; 4(5): 415- 419.
  2. Хирургические инфекции кожи и мягких тканей: Рос. нац. рекомендации. М., 2009.
  3. McGregor J. A., Soper D. E., Lovell G., Todd J. K. Maternal deaths associated with Clostridium sordellii infection. Am. J. Obstet Gynecol. 1989; 161: 987-995.
  4. C. Unexplained illness and death among injecting-drug users-Glasgow, Scotland; Dublin, Ireland; and England, April-June 2000. Morbid. Mortal. Wkly Rep. 2000; 49: 489-492.
  5. Stevens D. L., Rood J. I. Histotoxic clostridia. In: Fischetti V. A., ed. Grampositive pathogens. Washington, DC: American Society for Microbiology; 2000. 563-572.
  6. Dancer S. J., McNair D., Finn P., Kolsto A. B. Bacillus cereus cellulitis from contaminated heroin. J. Med. Microbiol. 2002; 51: 278-281.
  7. Friedman H., Pross S., Klein T. W. Addictive drugs and their relationship with infectious diseases. FEMS Immunol. Med. Microbiol. 2006; 47(3): 330-342.
  8. Smith-Slatas C. L., Bourque M., Salazar J. C. Clostridium septicum infections in children: a case report and review of the literature. Pediatrics 2006; 117(4): 796-805.
  9. Stevens D. L. Invasive group A streptococcus infections. Clin. Infect. Dis. 1992; 14: 2-11.
  10. Bisno A. L., Stevens D. L. Streptococcal infections of skin and soft tissues. N. Engl. J. Med. 1996; 334: 240-245.
  11. Currie B. J. Group A streptococcal infections of the skin: molecular advances but limited therapeutic progress. Curr. Opin. Infect. Dis. 2006; 19: 132-138.
  12. Венцель Р., Бревер Т., Бутцлер Ж.-П. (ред.) Руководство по инфекционному контролю в стационаре: Пер. с англ. Смоленск: МАКМАХ; 2003.
  13. Murray B. E. Vancomycin-resistant enterococci. Am. J. Med. 1997; 101: 284-293.
  14. Bishoff W. E., Reynolds T. M., Hall G. O. et al. Molecular epidemiology of vancomycin-resistant enterococcus faecium (VREF) in a large urban hospital over a five-year period. J. Clin. Microbiol. 1999; 37: 3912-3916.
  15. Edmond M. B. Multidrug-resistant enterococci and the threat of vancomycin-resistant staphylococcus aureus. In: Wenzel R. P., ed. Prevention and control of nosocomial infections. 3-rd ed. Baltimore: Williams and Wilkins; 1997. 339-355.
  16. Огурцов П. П., Мазурчик Н. В. Лечение хронического гепатита C у лиц с наркотической зависимостью. Гепатол. форум 2007; 3: 16-20.
  17. Егоров А. Ю., Софронов А. Г. Эпидемиология и клинические особенности наркоманий и токсикоманий подростков и молодежи. Вопр. псих. здоровья детей и подростков 2009; 9(1): 22-34.
  18. Киржанова В. В. Основные показатели деятельности наркологической службы в РФ в 2007-2008 годах (анализ данных федерального статистического наблюдения). Соц. аспекты здоровья населения. Информ.-аналит. вестн. 2009; 3(11):
  19. Williamson N., Archibald C., Van Vliet J. S. Unexplained deaths among injection drug users: a case of probable Clostridium myonecrosis. Can. Med. Assoc. J. 2001; 165(5): 609-611.
  20. Bangsberg D. R., Rosen J. I., Aragon T. et al. Clostridial myonecrosis cluster among injection drug users: a molecular epidemiology investigation. Arch. Intern. Med. 2002; 162: 517- 522.
  21. Assadian Q., Assadian A., Senekowitsch C. et al. Gas gangrene due to Clostridium perfringens in two injecting drug users in Vienna, Austria. Wien. Klin. Wschr. 2004; 116(7-8): 264- 267.
  22. Friedman H. Drugs of abuse as possible co-factors in AIDS progression: summary of panel discussion. Adv. Exp. Med. Biol. 1996; 402: 225-228.
  23. Doherty M. C., Garfein R. S., Monterroso E. et al. Correlates of HIV infection among young adult short-term injection drug users. AIDS 2000; 14: 717-726.
  24. Alicea C., Belkowski S., Eisenstein T. K. et al. Inhibition of primary murine macrophage cytokine production in vitro following treatment with the kappa-opioid agonist U50, 488H. J. Neuroimmunol. 1996; 64: 83-90.
  25. Baldwin G. C., Roth M. D., Tashkin D. P. Acute and chronic effects of cocaine on the immune system and the possible link to AIDS. J. Neuroimmunol. 1998; 83: 133-138.
  26. Klein T. W., Lane B., Newton C. A., Friedman H. The cannabinoid system and cytokine network. Proc. Soc. Exp. Biol. (N. Y.) 2000; 225: 1-8.
  27. McCarthy L., Wetzel M., Sliker J. K. et al. Opioids, opioid receptors, and the immune response. Drug Alcohol Depend. 2001; 62: 111-123.
  28. Roth M. D., Tashkin D. P., Choi R. et al. Cocaine enhances human immunodeficiency virus replication in a model of severe combined immunodeficient mice implanted with human peripheral blood leukocytes. J. Infect. Dis. 2002; 185: 701- 705.
  29. Friedman H., Newton C., Klein Th. W. Microbial infections, immunomodulation, and drugs of abuse. Clin. Microbiol. Rev. 2003; 16(2): 209-219.
  30. Cabral G. A. J. Drugs of abuse, immune modulation, and AIDS. Neuroimmune Pharmacol. 2006; 1(3): 280-295.
  31. Cline K. A., Turnbull T. L. Clostridial myonecrosis. Ann. Emerg. Med. 1985; 14: 459-466.

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Copyright (c) 2010 Shestakova I.V., Yushchuk N.D., Tishkevich O.A., Shestakova I.V., Yushchuk N.D., Tishkevich O.L.

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