waarschuwing aanwezigheid anthrax in heroine

From: Dbsyd@aol.com [mailto:Dbsyd@aol.com] Sent: Tuesday, May 30, 2000 9:14 AM Dear Judit and Ton This looks like some important information for heroin users. It's about the recent spate of unexplained deaths of drug users in Scotland and Norway. Anthrax is very scary stuff. Please ensure it gets circulated. Cheers Dave Burrows >From New Scientist 20 May 2000 Vital Signs - Editorial ANTHRAX and heroin. Could there be a more sensational mix of modern-day nightmares? Yet there really are anthrax spores in some heroin in Norway. They have killed at least one man and could be to blame for the worst year the country's seen for deaths among addicts. Anthrax may also be killing Scottish drug users(p 4). And, since virtually all Europe's supplies come from Asian countries where anthrax is endemic, spore-laced heroin might be scattered right along the drug's trade routes. And yet some will say, so what? Junkies die young anyway. Anthrax is not communicable, so the addicts are only harming themselves. Try telling that to the six-year-old orphaned by the latest death in Scotland. All these deaths are personal tragedies. But there is another reason to care about them: they tell us whether we are alert to new diseases, and yes, even biological weapons. So the news is not all bad. We caught this outbreak. South-West Asia has been supplying Europe with heroin for more than a decade. Why should anthrax only appear now? Most heroin comes from Afghanistan, home to some of the Western world's arch-enemies. Maybe they have suddenly started infecting their prime export, even if killing addicts does seem a bizarre form of terrorism. More likely, pure heroin was cut with a powder that included some material from infected animals, which means this could have been happening for years. But who bothers to autopsy dead addicts? Every few months there is a surge in deaths which is blamed on overdosing with unusually pure heroin, and no one looks further. Except that this time someone did. Norwegian doctors decided to autopsy a heroin addict who had died of a strange septicaemia, and were surprised at what they found. Next came a series of events outside official channels. In an informal Internet newsletter one doctor asked if anyone else had found anthrax in heroin. At the same time, Glasgow hospitals noticed more dead addicts than usual--with similarly strange symptoms. The penny dropped. Otherwise, no one would have suspected anthrax. So let us have more openness between people with information about infectious diseases. True it's not always easy to share details when the police call for silence while they track down suppliers and traffickers. But as events over the past few weeks show, the more people talk, the easier it is to spot patterns of disease. Other European countries should check for infection. And let us continue to investigate. Samples should be sent to American labs with the wherewithal to tell us precisely where the anthrax strain came from. Maybe it was an escapee from a weapons lab. Paying more attention to what addicts die of will help to show which pathogens are moving around the world, and how. Next time it might be something even more malevolent. ******************************************************************** >From New Scientist 20 May 2000 (Page 4) Lethal Injection by Debora MacKenzie The deaths of heroin addicts have sparked an anthrax scare 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.

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