ANTHRAX is now a prime suspect in a spate of deaths among heroin addicts in
Europe. Tests at Britain鈥檚 lab for dangerous pathogens at Porton Down have found
signs of anthrax infection in two Scottish victims. Nine more Scots are ill, and
doctors fear the disease鈥攚hich is hard to monitor among drug
users鈥攎ay be far more widespread.
鈥淗eroin can contain almost anything in small amounts,鈥� says Les King of the
Forensic Science Service, which analyses seized heroin in Britain. But no one
checks it for infectious agents, he notes. 鈥淭here could be a long history of
this, and we just haven鈥檛 observed it till now.鈥�
Ten addicts in Glasgow and Aberdeen have died over the past few weeks after
injecting the drug into muscle, rather than their veins. They developed a
painless, pus-free lesion at the injection site, then died hours after the
appearance of more general symptoms including severe oedema, leakage of fluids
around the heart and lungs, and soaring white blood cell counts.
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No one knew of a possible contaminant in heroin that could be to blame. But
now the spotlight is on anthrax, following the appearance of an anthrax case
history on ProMED, the Internet forum for emerging diseases. Per Lausund of the
Norwegian Army Medical School posted details of an Oslo addict who died in April
after injecting heroin into muscle. He developed an abscess, then fell into a
coma 10 days later. After antibiotics failed to save him, tests showed anthrax
bacilli in his spinal fluid, which was confirmed by DNA analysis.
Now scientists at Porton Down have tested blood samples from five Scottish
victims. Two tested positive for 鈥減rotective antigen鈥�, the main anthrax toxin.
鈥淣othing else would give that result,鈥� says Phil Hanna, an anthrax expert at the
University of Michigan at Ann Arbor, who says the symptoms are also typical of
anthrax.
Anthrax bacilli have not shown up in any of the blood samples, but that does
not rule out infection. 鈥淎ntibiotics can wipe out circulating anthrax bacilli,
making diagnosis very difficult,鈥� says Martin Hugh-Jones of Louisiana State
University, who investigated a 1979 anthrax outbreak in Russia. The circulating
toxins can still kill patients, even though the bacteria have gone.
Chris McGuigan of the Greater Glasgow Health Board adds that at least one
sufferer in Scotland, who is still alive, has the black scab typical of
localised anthrax infection.
The link with injecting into muscles, rather than veins, is also consistent
with an anthrax diagnosis, says Hanna. Infection spreads only when anthrax
spores are consumed by macrophages, the roving white blood cells that eat
bacteria. They do this much more effectively in muscle than in blood. Hanna adds
that intravenous users may succumb later if spores encounter macrophages in the
spleen.
As 快猫短视频 went to press, the Glasgow Health Board was still
undecided. 鈥淲e do not discount anthrax, but we have so far failed to find the
bacilli,鈥� says Syed Ahmed of the Health Board. It is also considering
necrotising fasciitis, or 鈥渇lesh-eating disease鈥�, as some of its symptoms are
similar. While investigations continue, addicts have been advised to smoke
heroin rather than inject it. No one else is at risk, as neither disease passes
from person to person.
Anthrax is endemic in Pakistan, Afghanistan and Iran, where most of Europe鈥檚
heroin originates. Hugh-Jones says animal-derived material from the region, such
as gelatin or bone meal, may well be contaminated with spores. Such material
could have found its way into heroin.
The National Institute of Public Health in Oslo warns that further cases may
occur elsewhere. But addicts might not come forward for treatment, says
Hugh-Jones. Many cases may not even be noticed, he adds, because deaths among
heroin users are relatively commonplace.