Published Date: 2012-06-12 19:35:06
Subject: PRO/AH/EDR> Anthrax - Germany: (BY) fatal, heroin user
Archive Number: 20120612.1165823

ANTHRAX - GERMANY: (BAVARIA) FATAL, HEROIN USER
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Date: Tue 12 Jun 2012 16:16:34 +0200
From: Thomas Holzmann <Thomas.Holzmann@klinik.uni-regensburg.de> [edited]


Please find the following brief report of a human anthrax case from Regensburg (Germany). _Bacillus anthracis_ was found in a dead heroin user. This case reminds us of the cases reported 2 years ago from Scotland. We think it is highly important to inform physicians.

Report: Anthrax found in an dead heroin user from Regensburg, Germany
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Blood cultures from a drug injecting heroin user who died last week [5 Jun 2012] at a hospital in Regensburg have shown the presence of _Bacillus anthracis_. The patient was hospitalized due to acute septic disease and died on the day of admission. Initial diagnostics tests were performed using PCR targeting the rpoB-, pagA-, and capC-genes at the Institute of Medical Microbiology and Hygiene, University of Regensburg pointing to _Bacillus anthracis_ as the causative agent. The results were confirmed using additional chromosomal markers by the Bundeswehr Institute of Microbiology in Munich. Further molecular typing of the strain is in progress.

The responsible Bavarian health authorities are involved in the management of the case in close contact with the diagnostic institutions and the police authorities. Health officials believe that contaminated heroin or a contaminated cutting agent mixed with the heroin may be responsible for the infection. Investigations by the German police authorities are in progress.

Doctors and diagnostic laboratories should consider anthrax as a possible disease in injecting heroin users presenting with fever or sepsis at the emergency room.

--
Dr. Thomas Holzmann, M.D.
University of Regensburg
Faculty of Medicine
Institute of Medical Microbiology and Hygiene Franz-Josef-Strauss-Allee 11
D-93053 Regensburg
Germany
<thomas.holzmann@klinik.uni-regensburg.de>
http://www.uni-regensburg.de
http://www.rimmh.de

[Our heartfelt thanks to Dr. Holzmann for this report. This is a typical history of a heroin drug addict coming in when definitely ill and dying virtually on arrival. One of the problem with heroin associated (injection) anthrax is to get the affected addicts to come in promptly and not delay. Early and they can be successfully treated. Delayed and they are soon dead.

Also the Scottish experience pointed up the need to keep the injection site as drained of fluids as possible thereby minimising the impacts of the toxins (oedema toxin and lethal toxin) on the patient. This is very important. - Mod.MHJ

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1zJl.]

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