Pubdate: Fri, 16 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 and Alex Bell


The answer to the medical mystery behind the rash of deaths among heroin 
users here and in Britain would appear to have come in Cardiff yesterday. A 
team lead by Prof Brian Duerden at the Public Health Laboratory Service 
unit (PHLS) in the Welsh capital identified the bug that has killed heroin 
users in Britain as clostridium novaea, a member of the clostridium family. 
Clostridium is an anaerobic bacterium, meaning it flourishes in the absence 
of oxygen.

It can exist, however, in a kind of "suspended animation" as spores in dust 
or soil. If heroin is cut with soil or dust containing the bacterium, once 
injected into the oxygen-free environment of body muscle, it can multiply 
and produce potentially fatal toxins which attack the body. However, a 
spokeswoman for the Eastern Regional Health Authority here said its 
department of public health was still trying to establish the cause of the 
illness here.

"The particular type of clostridium confirmed in the three cases in Glasgow 
has not been isolated in any case in Dublin," she said.

But Dr Laurence Gruer, of the Greater Glasgow Health Board (GGHB), said the 
illnesses here and in Scotland were "almost certainly linked". He said 
there was still some way to go in isolating the bacterium from heroin 
samples. "So far, the tests have been negative. We are at a serious 
disadvantage because we cannot be sure that the heroin we are testing is 
the same heroin that the patients had been injecting." The identification 
of clostridium novaea (type A) is not therefore a definitive answer to the 
mystery behind the heroin deaths. Another case of the illness among heroin 
users was confirmed in Dublin yesterday, bringing the total here to 16. 
Anti-drugs workers welcomed the probable identification of the bacterium 
behind the illness, which has killed 26 IV drug users in this State and 
Britain since April 26th.

The Cardiff announcement would appear to confirm a report in Wednesday's 
Irish Times, which identified the clostridium strain. The PHLS has been 
working with the Centre for Disease Control in the United States. Doctors 
there are urging anyone with symptoms to get to hospital quickly - but warn 
that the infection is hard to treat, even with modern antibiotics. The 
novaea (type A) strain has been known to cause severe infection in domestic 
animals but was rarely seen in humans, said Prof Duerden at a press 
conference convened by the GGHB yesterday.

"It is commonly found in soil and may be present in animal faeces," he 
said. "As far as we know, this is the first time this bacterium has ever 
caused an infection in drug injectors."

Mr Tony Geoghan, director of the Merchant's Quay Centre in Dublin, said he 
was glad the probable cause had been identified but said "it doesn't hold 
out much hope" for the majority of users.

"What they need desperately is a better network of services and a better 
range of services," he said.
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