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Published Date: 2012-06-21 18:37:51
Subject: PRO/AH/EDR> Anthrax - Germany (02): (BY) 2nd heroin case, RFI
Archive Number: 20120621.1175326

ANTHRAX - GERMANY (02): (BAVARIA) SECOND HEROIN CASE, REQUEST FOR INFORMATION
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Date: Wed 20 Jun 2012
From: Thomas Holzmann <Thomas.Holzmann@klinik.uni-regensburg.de> [edited]

Please find the following brief report of the 2nd case of human anthrax from Regensburg (Germany).

2nd case of anthrax found in a heroin user from Regensburg, Germany
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A 40-year old female drug injecting heroin user presented at the emergency department of the University Medical Centre Regensburg with fever and a purulent infection of the neck [18 Jun 2012]. She had injected heroin into the jugular vein 3 days before. One day later she developed a necrosis on the left upper limb.

She is now being treated in the ICU with antibiotic triple therapy (vancomycin, clindamycin, ciprofloxacin). Blood cultures turned positive showing Gram positive bacilli growing in chains [20 Jun 2012]. PCR targeting the rpoB-, pagA-, and capC-genes at the Institute of Medical Microbiology and Hygiene, University of Regensburg confirmed _Bacillus anthracis_ as the causative agent. Further confirmation will be performed by the Bundeswehr Institute of Microbiology in Munich.

The responsible Bavarian health and police authorities were informed immediately. Investigations by the German police authorities are in progress.

Although contaminated heroin or a contaminated cutting agents mixed with the heroin may be responsible for the infection, the exact source could not yet be identified.

This is the 2nd case within a month from the Region of Regensburg, Bavaria. All health professionals and health authorities across Europe should be aware of the possible beginning of a new outbreak of anthrax among heroin users.

It is of great interest to know whether other countries currently have cases of anthrax or suspected anthrax, especially in injecting drug users. The Robert Koch Institute (RKI) in Berlin is promoting the regional and international public health investigations as the coordinating German health authority.

--
Dr Thomas Holzmann MD
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 thanks to Thomas for this report. We are doubly in debt to him because, though we may well have missed it, we have not seen any reports in the European press and TV news of these events. He is our singular reporter on these cases.

The last time, the German case was just an incidental as the heroin shipment made its way to the UK and Scotland. So far this time there have been no other reports of contaminated heroin. We must all be on the alert for them, especially as heroin addicts have an unfortunate tendency to present themselves too late for successful treatment. Logically there is a large shipment of lethally contaminated heroin out there in the process of being broken up and sold.

Also, in the Scottish series no contaminated heroin was interrupted and therefore the nature of the contamination could not be defined. This is very important to do so that the intermediate processors can be identified and the cause(s) for this contamination described. - Mod MHJ

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2BZj.]

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