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91 - Infectious complications in the injection and non-injection drug user
- from Part XI - The susceptible host
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- By Carlo Contoreggi, Johns Hopkins Bayview Medical Center
- Edited by David Schlossberg, Temple University, Philadelphia
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 April 2015
- Print publication:
- 23 April 2015, pp 591-596
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- Chapter
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Summary
Drug abuse is a widespread public health problem because many of its medical complications are infectious due to the transmission of bloodborne, environmental, and respiratory infectious agents. Availability of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV)-infected substance abusers has reduced the severity and frequency of opportunistic infections seen in the intravenous drug users (IVDUs) and other drug users (DUs). That said DUs/IDUs remain the groups least likely to access care and to maintain adherence for optimal benefit. Recent studies find social and access factors related to criminalization are major barriers to care including HAART for these individuals. Increasing treatment options and societal acceptance of harm reduction efforts have been demonstrated to improve outcomes in countries that have undertaken them.
Endocarditis
Endocarditis, a life-threatening infection of the heart valves and/or endocardium, is associated with septic parenteral injections. Right-sided valvular infections are very frequent in IDUs because of septic inoculations. Intravenous injection with low-pressure venous return increases the susceptibility of right-sided valvular and other structures to infection. Concurrent pulmonary hypertension from drug adulterants, such as talc, may also predispose to right-sided disease.
Despite the high prevalence of endocarditis, the offending pathogens are not specific to injectors. Staphylococcus aureus, often methicillin-resistant S. aureus (MRSA), is the most commonly identified organism, but other pathogens are seen. These include Pseudomonas, Serratia, enterococci, Streptococcus groups A and B, and Streptococcus viridans. Increasingly, fungal pathogens are seen with and without immunodeficiency.
89 - Infectious Complications in the Injection Drug User
- from Part XI - The Susceptible Host
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- By John Schmittner, National Institutes of Health, Carlo Contoreggi, National Institute on Drug Abuse
- Edited by David Schlossberg
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 March 2013
- Print publication:
- 12 May 2008, pp 631-636
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- Chapter
- Export citation
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Summary
Intravenous drug abuse is a widespread public health problem because many of its medical complications (Table 89.1) are infectious due to the transmission of bloodborne infectious agents.
ENDOCARDITIS
Endocarditis, a life-threatening infection of the heart valves and/or endocardium, is associated with septic parenteral injections. Right-sided valvular infections are very frequent in injection drug users (IDU) because of septic inoculations. Intravenous injection with low-pressure venous return increases the susceptibility of right-sided structures to endocarditis. Concurrent pulmonary hypertension from drug adulterants, such as talc, may also predispose to right-sided valvular disease.
Despite the high prevalence of endocarditis, the offending pathogens are not specific to injectors. Staphylococcus aureus is the most commonly identified organism, but other pathogens are seen. These include Pseudomonas, Serratia, Streptococcus groups A and B, and Streptococcus viridans. Increasingly, fungal pathogens are seen with immunodeficiency.
Clinical diagnosis of endocarditis in the drug abuser can be difficult. The hallmark symptom is fever. Other constitutional symptoms such as chills, sweats, and arthralgia are less specific, but they are commonly observed in opiate-dependent patients during withdrawal. The physical signs associated with left-sided endocarditis are seldom present. Coexistent immunodeficiency appears to predispose to more severe systemic infections among human immunodeficiency virus (HIV-1)-infected IDU. Blood cultures may identify the offending pathogen and antimicrobial sensitivities.
Because clinical diagnosis alone presents challenges, echocardiographic findings have developed into the primary mechanism to diagnose and treat endocarditis.