Pubdate: Fri, 02 Jun 2000
Source: Irish Times, The (Ireland)
Copyright: 2000 The Irish Times
Contact:  11-15 D'Olier St, Dublin 2, Ireland
Fax: + 353 1 671 9407
Author: Kitty Holland


A bacterium called clostridium was the most likely cause of the deaths of 
eight heroin users in the State, the head of the investigation into similar 
deaths in Glasgow said yesterday.

Dr Laurence Gruer, consultant in public health medicine with the Greater 
Glasgow Health Authority, said: "Everything points to it [the cause of the 
infections] being one of the clostridium family."

However, the process of isolating the bacterium behind the illness could 
take several weeks.

Dr Joe Barry, consultant in public health medicine with the Eastern 
Regional Health Authority, said it was difficult to know whether 
clostridium was the cause, though he confirmed it was one of the "theories".

"Until we have definitively identified the cause of this illness, our 
approach is to say to drug users: `Regardless of the cause, something is 
wrong with the heroin, and anyone who is concerned about their symptoms 
should present for treatment'. "

The eight people have died in the Dublin, Wicklow and Kildare area since 
May 1st. A further seven cases of the illness have been confirmed. Five 
more reported cases are being investigated. The illness has killed 12 
addicts in Glasgow and two in Aberdeen. The most recent Scottish death was 
of a young Aberdeen man last Sunday.

The investigators have looked at similar drug deaths in Switzerland and the 
US where clostridium was found to be the cause.

The illness, which begins with severe abscesses and sores on the skin where 
the addict has been injecting, develops into an infection which attacks the 
blood and eventually engulfs the body's major organs.

Secondary infections such as pneumonia or streptococcal illnesses can also 

Habitual intravenous drug users have a weakened immune system and would be 
particularly vulnerable to infection.

Clostridium is an anaerobic bacterium, meaning it thrives in the absence of 
oxygen but is killed by it.

"Clostridia, however, can survive in suspended animation as a spore for 
months and years in dust," said Dr Gruer. "It is perfectly feasible, 
therefore, that if someone mixed pure heroin with an adulterant to increase 
profits, it could be contaminated with clostridia."

Recent seizures of heroin in Dublin and Glasgow have been up to 65 per cent 
pure, according to police sources. Because of this, addicts are using up to 
six times the usual amount of citric acid to dissolve the powder, which 
burns a hole in muscle tissue, Dr Gruer said. The majority of those who 
died had been injecting into muscle, as habitual injection can cause veins 
to collapse.

According to Dr Gruer, once clostridium-contaminated heroin has been 
injected, the bacterium thrives and grows in the oxygen free environment.

"It produces a toxin which can leach into the bloodstream. The difficulty 
is that there are more than 300 species of clostridium producing different 
toxins and it looks like this is not one of the common ones."

Identifying which clostridium is behind the illness involves examining 
blood and tissue samples from affected addicts. "The difficulty is that 
even the slightest whiff of oxygen kills it, so removing and examining the 
tissues is a very difficult and delicate procedure," Dr Gruer said. "Also, 
because many of these people will have been taking antibiotics, the 
bacterium has been killed, though the toxins remain."

Identification of the individual strain of clostridium would allow 
researchers to prescribe the correct treatment and begin work on an anti-toxin.
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