* Anthrax and heroin … what’s going on?
Posted by DXer on February 6, 2010
anthrax spores
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CASE CLOSED
is a novel which answers the question
… Why did the FBI fail to solve the 2001 anthrax case?
* buy CASE CLOSED at amazon *
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Anthrax and heroin … what’s going on?
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http://stopthedrugwar.org/chronicle/619/anthrax_heroin_death_toll_at_ten
- The death toll from anthrax-tainted heroin in Europe has risen to 10 as Health Protection Scotland confirmed that a heroin user who died in the Glasgow area on December 12 was infected with anthrax. Nine of the 10 deaths occurred in Scotland; the other occurred in Germany.
- The latest announced death is actually the earliest. Prior to the announcement of this death, the earliest known death took place December 16.
- At least 19 drug users — 18 of them Scottish — have been diagnosed with anthrax since the outbreak began. A pair of heroin deaths in Sweden turned out to be unrelated, and a cluster of deaths in Portugal has not been confirmed as being linked to anthrax.
- While Scottish authorities have yet to find any anthrax-tainted heroin, they believe either the heroin itself or cutting agents have been contaminated with anthrax spores. They said there is no evidence of person-to-person infection.
http://visitbulgaria.info/12548-german-s-death-linked-anthrax-outbreak
- A drug user’s death in Germany is being linked by the Health Protection Agency and German scientists to the anthrax outbreak that killed nine heroin users in Scotland, as tests show the infection to be indistinguishable from the Scottish cases.
- These results indicate that anthrax contamination in both Scotland and Germany comes from a common source.
- There have been 19 confirmed anthrax infection cases in Scotland, so far, with the outbreak beginning when cases were identified in NHS Greater Glasgow and Clyde in December.
- While, the same strain of anthrax has been found in fourteen of the confirmed cases in Scotland, the others are under investigation.
- Health Protection Scotland said the German patient who died mid-December has the same strain, with the agency confirming another case of anthrax in London, with the patient having a history of heroin use, though he developed symptoms end-January 2010. While, investigations continue, no connection to Scotland has been identified, yet.
CASE CLOSED ... what really happened in the 2001 anthrax attacks? 
DXer said
European injectional anthrax cases linked to strains from 2009 outbreak
Hanczaruk M. Emerg Infect Dis. 2014;20:322-323.
February 3, 2014
http://www.healio.com/infectious-disease/emerging-diseases/news/online/%7B131d4f21-e553-4faf-a93a-7f04defdb940%7D/european-injectional-anthrax-cases-linked-to-strains-from-2009-outbreak
New cases of injectional anthrax reported in Western Europe appear to be genetically related to strains seen in a previous drug-related anthrax outbreak, recent study data found.
Additionally, the resurfacing of drug abuse-related anthrax suggests that heroin use may act as an ongoing means of transmission for Bacillus anthracis in Western Europe, according to researchers from Germany and Arizona who collaborated on this project funded by the US Department of Homeland Security Science and Technology Directorate.
The researchers obtained culture-positive samples from some of the patients affected by the 2009-2010 outbreak of drug abuse-related anthrax that occurred in the United Kingdom and Germany. These samples were collaboratively genotyped using a high-resolution molecular approach. This analysis was aimed at determining the epidemiology and geographic origin of the strains, according to the study findings published recently as a letter in Emerging Infectious Diseases.
All cases in this outbreak were related to a single B. anthracis strain type belonging to a large Trans-Eurasian B. anthracis group, Ba4599. Strains related to those identified in association with European drug use, which belong to the A.Br. 008/011 canSNP cluster, have been found to originate in Turkey. However, the researchers continue to investigate additional isolates from other relevant areas to determine their geographic origins.
After the 2012 appearance of two new cases of heroin-related injection anthrax in Bavaria, subsequent cases were reported in Germany, Denmark, France and the United Kingdom. As of August 2013, there were 26 deaths resulting from this resurgence.
The study researchers used phylogenetic methods to assess the relationship between these strains and Ba4599. Genotyping results established that these strains were along the branch A.Br.008 within the Trans-Eurasian group of B. anthracis. Additional fine-scale typing of these isolates determined that all isolates were identical at the single nucleotide polymorphisms (SNPs). Further evaluation by multiple locus variable number tandem repeats indicated that all strains differed at just two markers and were closely related. The researchers hypothesized that all of the injectional anthrax isolates likely originated from the same location.
The researchers said the study demonstrates the utility of molecular genotyping in discovering the origins of infectious disease vehicles. In addition, the recent reappearance of injectional anthrax, which has particularly high death rates, could serve to impart an educational and cautionary message to the public.
“Ideally, this unfortunate deadly incident could offer an opportunity to sensitize heroin users to the risks for severe infection and educate public health officials to be vigilant for this rare disease,” the researchers wrote.
DXer said
Anthrax among heroin users in Europe possibly caused by same
Bacillus anthracis strain since 2000 2
by R Grunow, SR Klee, W Beyer, M George, D Grunow, A Barduhn, S Klar, D Jacob, M Elschner, P Sandven, A Kjerulf, JS Jensen, W Cai, R Zimmermann, L Schaade
Click to access V18N13.pdf
DXer said
What are the differences in distribution that explain why heroin users in Europe have been dying of anthrax but not heroin users in the US?
Rochester anthrax death mum Claire Skelton injected contaminated heroin, inquest told
by Alan McGuinness
http://www.kentonline.co.uk/medway_messenger/news/Anthrax-death-2503/
DXer said
ANTHRAX AMONG HEROIN USERS IN EUROPE POSSIBLY CAUSED BY SAME BACILLUS ANTHRACIS STRAIN SINCE 2000
R Grunow ()1, S R Klee1, W Beyer2, M George1, D Grunow1, A Barduhn1, S Klar1, D Jacob1, M Elschner3, P Sandven4, A Kjerulf5, J S Jensen5, W Cai6, R Zimmermann6, L Schaade1
• Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Berlin, Germany
• University of Hohenheim, Institute of Environmental and Animal Hygiene, Stuttgart, Germany
• Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Jena, Germany
• Norwegian Institute of Public Health, Department of Bacteriology and Immunology, Oslo, Norway
• Statens Serum Institut, National Institute for Health Data and Disease Control, Copenhagen, Denmark
• Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
Citation style for this article: Grunow R, Klee SR, Beyer W, George M, Grunow D, Barduhn A, Klar S, Jacob D, Elschner M, Sandven P, Kjerulf A, Jensen JS, Cai W, Zimmermann R, Schaade L. Anthrax among heroin users in Europe possibly caused by same Bacillus anthracis strain since 2000. Euro Surveill. 2013;18(13):pii=20437. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20437
Date of submission: 18 October 2012
Injection anthrax was described first in 2000 in a heroin-injecting drug user in Norway. New anthrax cases among heroin consumers were detected in the United Kingdom (52 cases) and Germany (3 cases) in 2009-10. In June 2012, a fatal case occurred in Regensburg, Bavaria. As of December 2012, 13 cases had been reported in this new outbreak from Germany, Denmark, France and the United Kingdom. We analysed isolates from 2009-10 and 2012 as well as from the first injection anthrax case in Norway in 2000 by comparative molecular typing using a high resolution 31 marker multilocus variable-number tandem repeat analysis (MLVA) and a broad single nucleotide polymorphism (SNP) analysis. Our results show that all cases may be traced back to the same outbreak strain. They also indicate the probability of a single source contaminating heroin and that the outbreak could have lasted for at least a decade. However, an additional serological pilot study in two German regions conducted in 2011 failed to discover additional anthrax cases among 288 heroin users.
DXer said
http://www.ncbi.nlm.nih.gov/pubmed/23374534
J Laryngol Otol. 2013 Feb 4:1-3. [Epub ahead of print]
Fatal cutaneous anthrax in a heroin user.
Meghji S, Judd O, Carr E.
Source
Medical School, University of Leicester, UK.
Abstract
Background and objective: Cutaneous anthrax usually has a mortality rate of less than 1 per cent. However, since December 2009 there have been more than 13 deaths in the UK due to anthrax-contaminated heroin. We therefore wish to raise clinical awareness of this treatable disease. Case report: We describe the case of a heroin user with an equivocal presentation of cellulitis in the neck. Within 36 hours, this led to death due to cutaneous anthrax. Conclusion: Whilst cutaneous anthrax remains rare, this case report aims to raise awareness of the fact that the symptoms and signs of this condition in intravenous drug users may not always fit the typical picture.
PMID: 23374534 [PubMed – as supplied by publisher]
Comment: I believe Dr. Keim’s lab determined that the heroin was traceable to Turkey.
DXer said
http://jb.asm.org/content/194/21/5997.long#aff-1
Draft Genome Sequence of Bacillus anthracis UR-1, Isolated from a German Heroin User
• Christian Rückerta, et al.
• aCeBiTec, Bielefeld University, Bielefeld, Germany
• bLabcon-OWL GmbH, Bad Salzuflen, Germany
• cInstituto do Mar (IMAR-CMA), Universidade de Coimbra, Coimbra, Portugal
• dBundeswehr Institute of Microbiology, Munich, Germany
• eInstitute of Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
Next Section
ABSTRACT
We report the draft genome sequence of Bacillus anthracis UR-1, isolated from a fatal case of injectional anthrax in a German heroin user. Analysis of the genome sequence of strain UR-1 may aid in describing phylogenetic relationships between virulent heroin-associated isolates of B. anthracis isolated in the United Kingdom, Germany, and other European countries.
Previous SectionNext Section
GENOME ANNOUNCEMENT
The Gram-positive, spore-forming soil bacterium Bacillus anthracis is the causative agent of the zoonosis anthrax. Several virulence factors are required for successfully establishing infection in animal and human hosts. These include the binary toxins lethal toxin and edema toxin and a poly-γ-d-glutamic acid capsule for evading host immune response (4). In 2009 and 2010, the unorthodox manifestation of the disease termed injectional anthrax caused several cases among consumers of presumably endospore-contaminated heroin in the United Kingdom and Germany, resulting in 19 fatalities (2, 5). Now, after almost 2 years, additional cases of heroin-related injectional anthrax have emerged in Germany, France, Great Britain, and Denmark. In our ongoing efforts to elucidate the phylogenetic relationships between the isolates involved in the 2012 and 2009-2010 outbreaks, the genome of the strain from the first fatal case from Bavaria in June of 2012 (3) was sequenced.
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. The overall coverage levels suggest a chromosome/pXO1/pXO2 molecular ratio in UR-1 roughly correlating to the 1:3:2 ratio in the Ames Florida strain from the 2001 terrorist letter attack (6, 7). The genome contains 5,738 putative coding sequences (CDSs) (5,449, 189, and 100 on the chromosome, pXO1, and pXO2, respectively). The draft genome sequence contains four ribosomal RNA, two 5S rRNA, and 70 tRNA loci. For the CDSs, 69%, corresponding to 3,953 proteins, could be assigned to Cluster of Orthologous Groups (COG) families (8).
Availability of the B. anthracis UR-1 genome sequence will help to explain the taxonomic relationship between several isolates of the recent injectional anthrax cases in Europe and can be expected to provide novel insights into the epidemiology and microevolution of this group of organisms.
DXer said
J Bacteriol. 2012 Nov;194(21):5997-8. doi: 10.1128/JB.01410-12.
Draft Genome Sequence of Bacillus anthracis UR-1, Isolated from a German Heroin User.
Rückert C, Licht K, Kalinowski J, Espírito Santo C, Antwerpen M, Hanczaruk M, Reischl U, Holzmann T, Gessner A, Tiemann C, Grass G.
Source
CeBiTec, Bielefeld University, Bielefeld, Germany.
Abstract
We report the draft genome sequence of Bacillus anthracis UR-1, isolated from a fatal case of injectional anthrax in a German heroin user. Analysis of the genome sequence of strain UR-1 may aid in describing phylogenetic relationships between virulent heroin-associated isolates of B. anthracis isolated in the United Kingdom, Germany, and other European countries.
PMID: 23045504 [PubMed – in process]
DXer said
Poignant story –
‘Having anthrax didn’t make me think I should stop taking heroin’
As a second drug user dies of anthrax in Blackpool, a former addict explains why warnings about the disease are ignored
http://www.guardian.co.uk/world/2012/sep/14/anthrax-heroin-blackpool?newsfeed=true
DXer said
“A similar outbreak among injecting drug users occurred in 2009 and 2010, when 119 cases were identified in Scotland, five in England and two in Germany. ”
119 is a veritable epidemic. It would be an interesting empirical question whether it has led to a reduction in heroin use (and if so to what extent).
Contaminated Heroin Suspected in European Anthrax Outbreak
http://healthmap.org/news/contaminated-heroin-suspected-european-anthrax-outbreak-91212
DXer said
Britain warns heroin users after second anthrax death
http://in.reuters.com/article/2012/09/10/anthrax-britain-death-idINL5E8KAAND20120910
DXer said
British anthrax death sparks outbreak concern
http://in.reuters.com/article/2012/08/17/britain-anthrax-idINL6E8JH6OH20120817
LONDON | Fri Aug 17, 2012 6:34pm IST
***
From June 2012 there have been new cases of anthrax among heroin users in Europe – three in Germany, two in Denmark, one in France and one in Scotland, the HPA said.
“It is unclear as yet whether this (death) and a case in Scotland at the end of July are linked to the outbreak in Europe but the HPA will continue to monitor the situation,” it added.
***
DXer said
Denmark: Second anthrax case reported in heroin user
July 29, 2012
By: Robert Herriman
http://www.examiner.com/article/denmark-second-anthrax-case-reported-heroin-user
A second heroin drug addict has turned up positive for the deadly bacterium, Bacillus anthracis the cause of anthrax in Copenhagen, Denmark according to the State Board of Health Ritzau.
***
Elsewhere in Europe, anthrax in heroin users have been reported in Germany, France and most recently in Lanarkshire, Scotland.
DXer said
http://www.ncbi.nlm.nih.gov/pubmed/22840345
Emerg Infect Dis. 2012 Aug;18(8):1307-13. doi: 10.3201/eid1808.111343.
Molecular Epidemiologic Investigation of an Anthrax Outbreak among Heroin Users, Europe.
Price EP, Seymour ML, Sarovich DS, Latham J, Wolken SR, Mason J, Vincent G, Drees KP, Beckstrom-Sternberg SM, Phillippy AM, Koren S, Okinaka RT, Chung WK, Schupp JM, Wagner DM, Vipond R, Foster JT, Bergman NH, Burans J, Pearson T, Brooks T, Keim P.
Abstract
In December 2009, two unusual cases of anthrax were diagnosed in heroin users in Scotland. A subsequent anthrax outbreak in heroin users emerged throughout Scotland and expanded into England and Germany, sparking concern of nefarious introduction of anthrax spores into the heroin supply. To better understand the outbreak origin, we used established genetic signatures that provided insights about strain origin. Next, we sequenced the whole genome of a representative Bacillus anthracis strain from a heroin user (Ba4599), developed Ba4599-specific single-nucleotide polymorphism assays, and genotyped all available material from other heroin users with anthrax. Of 34 case-patients with B. anthracis-positive PCR results, all shared the Ba4599 single-nucleotide polymorphism genotype. Phylogeographic analysis demonstrated that Ba4599 was closely related to strains from Turkey and not to previously identified isolates from Scotland or Afghanistan, the presumed origin of the heroin. Our results suggest accidental contamination along the drug trafficking route through a cutting agent or animal hides used to smuggle heroin into Europe.
DXer said
http://www.wired.co.uk/magazine/archive/2012/08/features/anthrax-has-hit-glasgow
Anthrax has hit Glasgow: the story of a desperate hunt for its source
By Yudhijit Bhattacharjee19 July 12
The doctors at Victoria — as at other Glasgow hospitals — were used to seeing heroin addicts show up with lesions in the arms, legs and other parts of the body where the users had been plunging a needle into their flesh. Such infections, the doctors knew, are typically caused by a bacterium called Bacillus cereus that is often behind food poisoning. But, when pathologists examined some of Donny’s blood under a microscope, they saw a far more deadly germ. It was anthrax.
***
The emerging pattern of cases was similar to an outbreak of Clostridium novyi — another spore-forming microbe — that occurred among Scottish heroin users in the year 2000….
DXer said
http://www.wired.co.uk/magazine/archive/2012/08/features/anthrax-has-hit-glasgow?page=3
Excerpt:
About a month after the outbreak began, scientists shipped samples of Bacillus anthracis cultured from the first victims to Keim. After extracting DNA, Keim’s group began running assays. The researchers were quickly able to rule out all the known bioweapon strains, including one that the British military spread on Gruinard Island off the Scottish coast as part of a biowarfare experiment during the second world war. The researchers then screened the disease sample against strains from Afghanistan. No match there, either.
Their work continued into March, when Keim travelled to Porton Down to attend an unrelated meeting and to update the outbreak-investigation team. While he was there, he received an email from an undergraduate in his lab doing some of the DNA fingerprinting. She had found a match. The Glasgow strain was virtually indistinguishable from two anthrax isolates that had been sent to the repository a few years earlier by veterinarians in Turkey, collected from a couple of goats. “My heart rate went up,” Keim says.
In a closed-door session with Brooks, Ramsay and law-enforcement officials, Keim started by drawing a diagram on the blackboard, a multipronged tree that showed the relationships among different anthrax strains. “I told them all the things that it wasn’t,” Keim says. The sense of relief in the room was palpable as he checked off bioweapons strains. A homegrown bioterror attack was effectively ruled out. Then, Keim revealed the match with the Turkish strains. The discovery of the Turkish connection led Ramsay’s team to form a hypothesis. Drug users in Scotland, England and Germany were being infected by heroin that was contaminated while being smuggled through Turkey in an infected goat-hide.
DXer said
UK – Heroin addicts warned over claim batch of the drug could be laced with anthrax
Jul 25 2012 By Christine Lavelle
http://www.dailyrecord.co.uk/news/health-news/2012/07/25/heroin-addicts-warned-over-claim-batch-of-the-drug-could-be-laced-with-anthrax-86908-23912789/
DXer said
http://www.thebureauinvestigates.com/2012/07/12/the-battle-to-track-anthrax-outbreak-in-glasgows-heroin-supply/
The battle to track anthrax outbreak in Glasgow’s heroin supply
July 12th, 2012 | by Alice Ross
In the August edition of Wired, Yudhijit Bhattacharjee gives a gripping account of the urgent investigation that brought together epidemiologists, public health officials and the police in a search for an invisible but deadly enemy that spanned Europe. By early January, a further 12 heroin users had been infected, five of whom had died, and the cases were starting to spread beyond the initial hub in the rough Gorbals neighbourhood to surrounding suburbs and towns.
***
This was a story that flared briefly in the headlines before fading to obscurity. And as Wired shows, in offices, laboratories, tower blocks and drug-smuggling trails, there was more to the tale than ever reached the papers.
The August issue of Wired is out now.
DXer said
Epidemiological expert MHJ post on Pro-Med:
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: 9 Jul 2012
From: Soren Thybo [edited]
A 55-year-old HCV and HIV positive IV drug user was hospitalized at the university hospital Rigshospitalet, Copenhagen on 5 Jul 2012 with what was perceived as an infected, possibly extravascular, injection of heroin in the left groin.
Initially, his CRP was normal, and he had no fever, but on the following day (6 Jul 2012), he became septic, febrile, and suffered a cardiac arrest. He was immediately resuscitated, intubated, and transferred to the ICU. During the day, the swelling of his left thigh increased, and his abdomen also became very swollen and hard. Although without any intestinal sounds, he had no aspirates, and an ultrasound and CT only showed considerable edema of the retroperitoneum, and an attempt of a peritoneal tap from what was believed to be ascites was dry. The patient was hypotensive and did not respond adequately to either noradrenalin or fluid, and he [was] oxygenating his blood insufficently on 100 percent O2.
Initial antibiotic treatment was with meropenem and ciprofloxazine, but the patient remained obviously septic. Ultrasound of the left leg did not reveal compartment syndrome nor abscess formation. On the suspicion that he might have anthrax, clindamycin was added.
Blood culture revealed on 7 Jul 2012 typical gram positive bacteria in chains, confirmed later to be _Bacillus anthracis_. The patient later that same day died from an irreparable shock.
This is the 1st confirmed case of injection related anthrax in Denmark, and the relevant authorities are now trying their best to prevent further cases among the i.v. addict community.
—
Dr. Soren Thybo, consultant
Department of Infectious Diseases
M 5132 Rigshospitalet Blegdamsvej 9,
2100 Copenhagen
Denmark
[We are very grateful to Dr. Thybo for notifying us. It is greatly appreciated. Now we must wait to see what the PCR investigations reveal as to the possible origin of this anthrax strain and for the forensic/police investigation as to where this contaminated heroin came from. The pathology of this case is not what we normally expect with such injection related lesions. – Mod.MHJ
DXer said
Dead Danish drug user tests positive for anthrax
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The Associated Press
Published: Monday, Jul. 9, 2012 – 6:39 am
COPENHAGEN, Denmark — Danish authorities say an intravenous drug user who injected heroin and died has tested positive for anthrax.
The Health Ministry suspects the drug was contaminated with the bacillus anthracis strain of anthrax. The 55-year-old addict died Sunday.
Terrorism is not suspected, and the health ministry says there is no risk of contagion because the bacteria cannot be passed from person to person.
Anthrax is a deadly disease that can be treated with antibiotics if caught early.
Officials said Monday they will compare the case to two similar deaths in Germany in June.
Last week, German officials said there may be a link between contaminated heroin found in Germany and an anthrax outbreak in Scotland in 2009 and 2010, which left 10 people dead.
Read more here: http://www.sacbee.com/2012/07/09/4618403/dead-danish-drug-user-tests-positive.html#storylink=cpy
DXer said
Sweden warns heroin users after anthrax death
Published: 9 Jul 12
http://www.thelocal.se/41918/20120709/
He also credited needle exchange programmes in southern Sweden for helping health authorities spread the word among users, but added that there are no signs as of yet that any anthrax-contaminated heroin has made its way to Sweden.
Earlier in the summer, there were three cases of anthrax in Germany, which was in turn connected to an earlier outbreak in Great Britain in 2010.
However, no connection has been found to tie the cases in Germany to the recent anthrax death in Denmark.
Ali H. Haider said
Odd, indeed….
“As anthrax has rarely been associated with severe infection among drug users, clinicians may not consider anthrax in the differential diagnosis of severe infections in this population and this consequently may result in undiagnosed cases. Clinical awareness in healthcare settings of the risk of injection-related infection with rare pathogens among the IDU population is therefore crucial.
“Based on current information (similar strain and clustered in time and space), it is very likely that the two cases in Regensburg are linked through exposure to heroin contaminated by a most likely identical strain of B. anthracis. The third case reported from Berlin is also likely associated to this contaminated heroin, but molecular typing of the infecting strain of B. anthracis, if possible from the limited amount of material, will have to confirm this hypothesis.
“The geographical distribution of contaminated heroin is unknown at this time, but it is possible that it has the same source as the contaminated heroin incriminated in the 2009/2010 outbreak. The risk of exposure for heroin users in Germany and other countries is still present and therefore additional cases among IDUs may occur in the future.”
http://www.ecdc.europa.eu/en/publications/Publications/Forms/ECDC_DispForm.aspx?ID=921
The role of Haqqanis and Hezbis in heroin trafficking is long standing, and both are long allied with AQ and Taliban — and both are currently hard pressed by U.S. and coalition forces, and unable to respond to drone strikes. I can’t see how anyone could possibly conclude that terrorism is not a possibility.
DXer said
A friend of mine, of Iranian descent, who had worked under Ken Alibek, had the insight years ago that the same labs in Southern Afghanistan (along the Iranian border) that were used to make heroin could make anthrax. I don’t know anything about Afghanistan and have passed on the current reports to get his opinion. He wrote his PhD thesis on Al Qaeda and anthrax. I consider him a highly quotable expert on this issue. I suppose he would want to know the genetic strain involved in the occurrences in three different countries. For that, though, it seems that Martin Hugh-Jones or Paul Keim would be key experts. Paul Keim as to the typing and MHJ as to the epidemiology. What strain were they? Were they a match?
DXer said
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20204
Fatal anthrax infection in a heroin user from southern Germany
————————————————————–
TT Holzman (Institute of Medical Microbiology and Hygiene, University Hospital of Regensburg, Regensburg, Germany) et al., Eurosurveillance, Volume 17, Issue 26, 28 June 2012 Rapid communications
Abstract: Blood cultures from a heroin user who died in June 2012, a few hours after hospital admission, due to acute septic disease, revealed the presence of _Bacillus anthracis_. This report describes the extended diagnosis by MALDI-TOF and real-time PCR and rapid confirmation of the anthrax infection through reference laboratories. Physicians and diagnostic laboratories were informed and alerted efficiently through the reporting channels of German public health institutions, which is essential for the prevention of further cases.
In early June 2012, a case of anthrax infection was identified in an injecting drug user in Germany. Anthrax wasn’t suspected initially and the patient died on the day of hospital admission. 2 days later anthrax was confirmed and the relevant authorities were informed. This report underlines the importance of considering anthrax as a possible diagnosis in injecting heroin users presenting with fever or sepsis at emergency rooms and of the rapid management of such cases.
***
Conclusions:
Health professionals and diagnostic laboratories should consider anthrax as a possible diagnosis in injecting heroin users presenting with fever or sepsis at the emergency room. The observed re-emergence of drug-related anthrax in Germany supports the hypothesis that heroin may provide a continuing entry route of _B. anthracis_ into western Europe.
DXer said
Date: Thu, 5 Jul 2012 14:52:10 -0400 (EDT)
From: ProMED-mail
Subject: PRO/AH/EDR> Anthrax – Germany (06): (Berlin) new case
ANTHRAX – GERMANY (06): (BERLIN) NEW CASE
*****************************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Wed 4 Jul 2012
Source: Robert Koche Institute [in German, trans. & summ. submitter SZ, edited]
A 3rd case of cutaneous anthrax has been confirmed in a drug user (at the heroin injection site) in Berlin.
The patient responded to treatment and as there is no history of travel to Bavaria or of obtaining drugs from the region of the earlier cases, it is now assumed that circulation of contaminated heroin is more widespread than previously thought.
– —
communicated by:
Sabine Zentis
Castleview Pedigree English Longhorns
Gut Laach
52385 Nideggen
Germany
[As we feared. Further information on this, the 3rd German heroin addict with injection anthrax in the present series, has been requested from our German colleagues.
DXer said
http://www.npr.org/blogs/health/2011/10/17/141426343/disease-detective-hot-on-the-trails-of-anthrax-and-cholera?ps=sh_stcathdl
Lingering questions in the Ivins case aside, Keim has managed to solve a string of medical mysteries, thanks to the revolution in genetic-sequencing technologies, which make comparisons of tiny organisms affordable and precise.
In 2009, Keim and his team were called in to investigate a string of anthrax deaths among heroin users in Europe. As drug users in Scotland, England and Germany fell ill, the Scottish Times wondered: “Although it’s likely that the heroin was infected with anthrax somewhere en route from the poppy fields of Afghanistan, there is no way that police and medics can rule out that the drug was deliberately infected once it arrived in the UK.” The contamination killed 17 people among the approximately 200 suspected cases.
The scientists knew that the heroin in Europe was produced in Afghanistan and smuggled in over land.
“We were very interested in knowing what kind of anthrax was coming from Afghanistan,” Keim told Shots. But the lab ruled out Afghanistan as a source because the anthrax in the heroin didn’t match the four major strains found there. This was possible in part because of Keim’s work with DNA fingerprinting on an entire anthrax genome.
Instead, they found a genetic match for the anthrax strain in Turkey and concluded that the heroin was “probably accidentally” contaminated there, on its way north.
Comment: Jdey and Boussara reportedly entered Turkey in 2002. Have they been located?
Lew Weinstein said
CONCORD, N.H. (AP – 2/12/10) ― A woman who contracted a rare form of anthrax two months ago is able to get up and walk around but likely will remain hospitalized for some time, a state health official said Friday. The young woman began feeling ill a day after attending a drum circle gathering in Durham on Dec. 4 and later was hospitalized in critical condition with gastrointestinal anthrax. Authorities believe she swallowed naturally occurring anthrax spores propelled into the air by vigorous drumming.
Lew Weinstein said
The Herald Scotland reports (2/10/10) …
A drug user has become the first person to die in England after testing positive for anthrax linked to heroin. The unnamed user, from Blackpool, is the second person to catch drug-related anthrax in England. Another case was confirmed in London last week. That person is currently receiving treatment in a London hospital.
Nine drug users have died in Scotland, which has seen a total of 19 anthrax cases linked to heroin, and one case has been seen in Germany.
Similarities between the cases suggest that the heroin, or a contaminated cutting agent mixed with the heroin, is the likely source of infection.