Anthrax link to deaths of 11 Scottish heroin addicts

http://www.guardianunlimited.co.uk/uk_news/story/0,3604,222068,00.html

James Meek, science correspondent Thursday May 18, 2000

Government analysts said yesterday that evidence of anthrax had been found in victims of a mysterious disease that has killed 11 Scottish heroin addicts in recent weeks and left 15 more in hospital. Scientists at Porton Down, Wiltshire, confirmed a report in the forthcoming issue of New Scientist magazine that antibodies against anthrax spores have been found in blood samples from two of the victims. The anthrax theory is expected to be confirmed or ruled out by the end of the week after further tests.

If confirmed, the deaths suggest that a consignment of heroin contaminated with the deadly bacterium is loose on the streets of Europe.

However, Glasgow health officials yesterday played down the theory, saying the Porton Down findings were only weak, indirect evidence.

"I'm very sceptical," said Laurence Gruer, consultant in public health medicine on Greater Glasgow health board. "I can't 100% rule it out, but I would have expected a lot more evidence for anthrax."

Cases of dead and dying heroin users with similar and unusual symptoms began to pile up on Dr Gruer's desk at the end of last month. The 11th victim died on Tuesday.

All had injected the drug into their muscles, rather than their veins, either by accident or because scars from overuse of a needle meant that free-flowing blood could no longer be found in surface veins. Many of the victims have been women, whose veins tend to be less accessible than men's.

The anthrax connection was first mooted by scientists at the centre for applied microbiology and research, which is alongside the Ministry of Defence's biological warfare lab at Porton Down but is run by the Department of Health.

They noticed a report from Norway, posted on the internet, of an Oslo addict who died in April after injecting heroin into his muscle. A postmortem showed anthrax bacilli in his spinal fluid. Aware of the deaths in Scotland, CAMR asked the Glasgow health board to send some samples.

A CAMR spokesman, Phil Luton, said: "We got two very weak positives, which is not conclusive evidence of anthrax, but we can't rule it out and are continuing to test."

The victims' symptoms were indicative of anthrax, he said. Phil Hanna, an anthrax specialist at the University of Michigan at Ann Arbor, made the same observation in the New Scientist report.

The Scottish victims - 10 from Glasgow, one from Aberdeen - all died in a similar way: several hours after injecting they had accumulated symptoms including a heavy build-up of fluid, leakage of fluids round the heart and lungs, and rapidly rising white blood cell counts as their metabolism rallied to fight a major infection.

Dr Gruer said he hoped to get the further test results from CAMR today or tomorrow.

Besides the Porton Down tests, he said, Glasgow specialists had been culturing blood and tissue samples from the victims to see if anthrax spores could be detected through a microscope, but with negative results.

Other theories have included necrotising fasciitis, known as flesh-eating disease, or alternative contaminants in heroin, or the citric acid used by addicts to dissolve heroin in water to make an injectable solution.

The muscle-injecting addicts have complained that lately they have had to use more acid than usual, causing a burning sensation and, doctors speculate, severe muscle damage.

Dr Gruer said one possibility was that the muscle damage had combined with minor bacterial infections to cause the addicts' deaths.

Anthrax is not passed from person to person, so there is no risk of an epidemic outside the heroin-injecting community even if it turns out to be the cause.

It is not clear how it may have contaminated heroin, although the bacterium is endemic in livestock in prime heroin poppy growing regions such as Afghanistan.