Outbreak of necrotizing Fasciitis due to Clostridium sordellii among black-tar heroin users
Outbreak of necrotizing Fasciitis due to Clostridium sordellii among black-tar heroin users
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DOI：
10.1086/383471
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发表时间：
2004-05-01
影响因子：
11.8
通讯作者：
Vugia, DJ
中科院分区：
文献类型：
--
作者：
Kimura, AC;Higa, JI;Vugia, DJ
在加州，注射吸毒者使用黑焦油海洛因（BTH）导致肉毒梭菌引起的伤口肉毒中毒、破伤风梭菌引起的破伤风和各种梭菌引起的坏死性软组织感染病例增加。1999年12月至2000年4月，加州文图拉县有9名注射吸毒者发生坏死性筋膜炎，4人死亡。6例患者伤口标本培养均为索氏梭菌。一些患者出现了先前报道的毒素介导的C。Sordellii感染，其特征为低血压、显著白细胞增多和血液浓缩。这次爆发的疑似来源是皮下或肌肉注射（“皮肤爆裂”）的受污染BTH。这次C. Sordellii感染是BTH如何可能作为传播严重且通常致命的梭菌感染的媒介的另一个例子，并加强了教育IDUs和临床医生与BTH皮肤爆裂相关的风险的必要性。
In California, black tar heroin (BTH) use among injection drug users (IDUs) has resulted in an increased number of cases of wound botulism due to Clostridium botulinum, tetanus due to Clostridium tetani, and necrotizing soft-tissue infections due to a variety of clostridia. From December 1999 to April 2000, nine IDUs in Ventura County, California, developed necrotizing fasciitis; 4 died. Cultures of wound specimens from 6 case patients yielded Clostridium sordellii. Some of the patients appeared to have the toxic shock syndrome previously reported to be characteristic of toxin-mediated C. sordellii infection, which is characterized by hypotension, marked leukocytosis, and hemoconcentration. The suspected source of this outbreak was contaminated BTH that was injected subcutaneously or intramuscularly ("skin popped"). This outbreak of C. sordellii infection serves as another example of how BTH can potentially serve as a vehicle for transmitting severe and often deadly clostridial infections, and reinforces the need to educate IDUs and clinicians about the risks associated with skin popping of BTH.