Epidemiology and Infection

Review Article

Soft tissue infections caused by spore-forming bacteria in injecting drug users in the United Kingdom

M. M. BRETT a1, J. HOOD a2, J. S. BRAZIER a3c1, B. I. DUERDEN a4 and S. J. M. HAHNÉ a5
a1 Food Safety Microbiology Laboratory, Health Protection Agency Specialist and Reference Microbiology Division, London, UK
a2 Department of Clinical Microbiology, Glasgow Royal Infirmary, Glasgow, UK
a3 Anaerobe Reference Laboratory, NPHS Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, UK
a4 Department of Medical Microbiology, University of Wales, College of Medicine, Heath Park, Cardiff, UK
a5 Communicable Disease Surveillance Centre, Health Protection Agency, London, UK

Article author query
brett mm   [PubMed][Google Scholar] 
hood j   [PubMed][Google Scholar] 
brazier js   [PubMed][Google Scholar] 
duerden bi   [PubMed][Google Scholar] 
hahne sj   [PubMed][Google Scholar] 


From 2000 to May 2004 there has been a marked increase in illness resulting from spore-forming bacteria in injecting heroin users in the United Kingdom. Clostridium novyi caused 63 cases of severe illness in 2000 and seven further cases from 2001. Wound botulism first occurred in 2000 (six cases) with 51 further cases to March 2004. Tetanus occurred in 20 cases between late 2003 and March 2004. Infections with C. histolyticum (nine cases), C. sordellii (one case) and Bacillus cereus (one case) were also reported. The reasons for the increase in illness are unclear. The major risk factor was skin- or muscle-popping. The problem appears to be here to stay. This review describes the causative organisms, pathogenesis, clinical presentation, epidemiology and treatment of cases. Clinical vigilance and a high standard of anaerobic microbiology are essential. Clinicians and laboratories must report such cases (or likely cases) rapidly so that clusters can be rapidly identified, in order to control disease. Prevention relies on tetanus immunization.

(Accepted December 22 2004)

c1 Anaerobe Reference Laboratory, NHPS Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, Wales, UK. (Email: Brazier@cardiff.ac.uk)