ANTHRAX MAY BE KILLING EUROPE'S HEROIN ADDICTS
Lethal injection The deaths of heroin addicts have sparked an anthrax scare http://www.newscientist.com/news/news.jsp?id=ns223929
ANTHRAX is now a prime suspect in a spate of deaths among heroin addicts in Europe. Tests at Britain's 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--which is hard to monitor among drug users--may be far more widespread.
"Heroin can contain almost anything in small amounts," says Les King of the Forensic Science Service, which analyses seized heroin in Britain. But no one checks it for infectious agents, he notes. "There could be a long history of this, and we just haven't observed it till now."
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.
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 "protective antigen", the main anthrax toxin. "Nothing else would give that result," 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. "Antibiotics can wipe out circulating anthrax bacilli, making diagnosis very difficult," 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 New Scientist went to press, the Glasgow Health Board was still undecided. "We do not discount anthrax, but we have so far failed to find the bacilli," says Syed Ahmed of the Health Board. It is also considering necrotising fasciitis, or "flesh-eating disease", 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's 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.
Debora MacKenzie
