Special Infections of Intravenous Drug Users

QUESTION: Is it true that drug users can become infected with special
infections? What are they? What makes infections in intravenous drug abusers
differ from those in the general population?
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ANSWER: Infections in intravenous drug abusers can differ from those in the
general population in a number of ways. The type of infection or the
infecting organism itself can vary, as can the signs and symptoms.
One of the most common infections associated with drug abuse is soft
tissue infection, usually found at the site of injection. If superficial,
soft tissue infections appear to be very similar to patients who do not abuse
drugs, but in more serious cases, gram-negative bacteria tends to be present.
Swelling and tenderness in the extremities, fever, and signs of systemic
illness may then develop. Mortality rates can be fairly high, and treatment
requires aggressive culturing of the blood, administration of broad-spectrum
antibiotics, and possible surgery. Gram-negative bacteria is rarely present
in soft tissue infection in the general population.
Lung abscesses, tuberculosis, and aspiration pneumonia are other serious
infections in narcotic addicts. They can develop as the result of acute
overdose, injection of talc, or from drug-induced stupor or coma. In many
cases, there are complicating infections in the bronchial tree. Poor dental
hygiene, common in addicts, increases the bacterial content in oral
secretions, and contributes to aspiration pneumonia. Such infection differs
in addicts in that the lower lobes of the lungs are involved more than the
upper ones, and the right side is affected more than the left.
Cardiac problems amongst drug abusers can be distinguished from those in
the general population by the type of infecting organisms and the valves that
are involved. Intravenous drug abusers have a high incidence of staph aureus
infection, not usually found in nonabusers, which attacks right-sided cardiac
valves. This, and the acute onset of infection, are peculiar to drug-related
endocarditis.
Hepatitis, the leading cause of hospitalization among drug abusers,
differs in addicts and nonaddicts in the type that develops. Hepatitis B,
delta hepatitis, and non-A, non-B hepatitis are most common in drug addicted
patients, with delta hepatitis found almost exclusively in drug abusers in the
United States.
AIDS, tetanus, septic arthritis, and various strains of bacteremia are
other infections which plague drug abusers and each exhibits symptoms that
vary from the general population. For example, one-fourth of all AIDS
patients are drug abusers who have no other risk factors for the disease.
It's clear that I.V. drug abusers expose themselves to risks beyond their
imagination. As if addiction was not problem enough, we now find that the
entire area of infectious disease presents new, special problems for the
addict. Although many infections may be mild and without acute episode, it is
also true that many infections can be life threatening, requiring the utmost
in prompt, intensive care to cure. Because narcotic addiction is so
prevalent, infectious problems in these patients need careful detection and
management. Unfortunately these are just the patients that avoid medical
attention, until it is too late.