Severe systemic sepsis in injecting drug users

Between 1 April and 1 August 2000, over thirty heroin injectors died from a serious rare infection.  Since June 2008, new cases have been identified and a further death has occured.  The leaflets below give advice around this latest event.

“Dangerous heroin bug” - Advice to injecting drug users (PDF, 31 KB)

Severe systematic sepsis related to soft tissue inflammation in injecting drug users (PDF, 68 KB)
Advice for doctors on diagnosis, management and reporting.

 

An outbreak of serious illness and death occurred among injecting drug users during 2000 in Scotland, Ireland and England. This illness was most probably due to Clostridium novyi infection of injection sites.

• Advice
• Guidelines
• References

 

CDR Articles

• Serious unexplained illness among drug injectors 2 June 2000 
• Serious unexplained illness among drug injectors 9 June 2000 
• Clostridium novyi is likely cause to 'serious unexplained illness' as cases continue to be reported 16 June 2000 
• Injecting drug user on England's south coast dies with Clostridium novyi infection 23 June 2000 

Last reviewed: 25 July 2008

Guidance for health professionals - Injecting drug users

1. Public Health Link:

Possible batch of contaminated heroin at risk of causing severe systemic sepsis in injecting drug users.

IDU-CEM/CMO/2001/8 (PDF, 12 KB)

 

2. Advice to doctors on diagnosis, management and reporting:
Severe systemic sepsis related to soft tissue inflammation in injecting drug users (PDF, 33 KB)

 

3. Specimen Collection and Examination Guidance:
Microbiological Investigation of Severe Systemic Sepsis related to Soft Tissue Infection Amongst Infecting Drug Users (PDF, 59 KB)

Microbiological Investigation of Severe Systemic Sepsis related to Soft Tissue Infection Amongst Infecting Drug Users (PDF, 59 KB)

 

4. Information for coroners:
Severe systematic sepsis related to soft tissue inflammation in injecting drug users (PDF, 17 KB)

 

 

Last reviewed: 22 January 2008

Advice to injecting drug users - "Dangerous heroin bug"

Public Health Laboratory Service - September 2000

• Between April 1st and August 1st 2000, over thirty heroin injectors died from a serious infection. Most of those who died have been in Dublin, Glasgow, and Manchester, but a few cases have occurred elsewhere in Britain e.g. Brighton.
• Doctors think that an infection (caused by a bug called "Clostridium") in the muscle tissue of these drug users gets steadily worse over a few days. Eventually the bacteria in the muscle release enough toxin into the bloodstream to cause a very severe illness which often leads to rapid death.
• The drug users affected have injected heroin into a muscle or under the skin (skin popping) and have had swelling, redness, and pain where they injected themselves.
• Although there have been fewer cases of this illness reported recently it is not certain whether only one batch of heroin was responsible, or if many supplies of heroin might have been affected.
• This infection can only be caught by injecting. It can't be caught by having sex with or living with a drug user who has the infection.

To reduce your risk of getting this infection, please remember;

• There is no way that you can tell if your heroin is likely to cause this infection.
• Smoke heroin instead of injecting.
• If you must inject, do not inject into muscle or under the skin: make sure you hit the vein - your blood is better at killing bacteria than your muscle.
• Don't share needles, syringes, cookers/spoons or other 'works' with other drug users.
• Use as little citric acid as possible to dissolve the heroin. A lot of citric acid can damage the muscle or the body under the skin, and this damage gives bacteria a better chance to grow.
• If you inject more than one type of drug, inject each at a separate place on your body and with clean works for each injection. This is important because certain drugs (e.g. cocaine) could give bacteria in heroin a better chance to grow.
• If you get swelling, redness, or pain where you have injected yourself, or pus collects under the skin, you should get a doctor to check it out immediately, especially if the infection seems different to others you may have had in the past.

 

 

Last reviewed: 22 January 2008

• Advice to injecting drug users - "Dangerous heroin bug"
  Added/updated: 22 January 2008
  
• Guidance for health professionals - Injecting drug users
  Added/updated: 22 January 2008