Published Date: 2012-07-14 17:26:42
Subject: PRO/AH/EDR> Anthrax – France: (RA) conf. heroin case
Archive Number: 20120714.1201908

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: July 13, 2012
Source: Romandie [edited]

France: a case of anthrax diagnosed in a heroin addict 
A case of anthrax infection has been reported in a user of injectable heroin in France in the Rhone-Alpes, while four other cases, including two deaths, were reported in two other countries in the European Union, it was learned Friday from medical sources.

An outbreak of anthrax  related to injections of contaminated heroin occurred in 2009/2010, causing the infection of 119 people in Scotland, 5 in England and two in Germany.

The infection by the bacterium, _Bacillus anthracis_, was diagnosed in France on July 9 in an intravenous heroin user, aged of 27, who, after a stay in intensive care, is currently convalescing. "He is recovering," the Director of Public Health ARS-Sydney, Anne-Marie Durand told AFP. "There is [presently - Mod.MHJ] no known link between the four European cases (three in Germany with 1 death and one death in Denmark) and the French case," she said.

"No other cases have been reported to date in France," said the LRA.

The bacillus takes the form of spores that allows it to live in a hostile environment such as earth. In a supportive environment, i.e. inside the body, the bacterium becomes active and toxic, says Durand. Heroin users may reduce the risk by turning to substitute products . Any route of administration (injection or ingestion) does not eliminate the risk, and inhalants  who sniff the product do not protect themselves, she said 

Contamination of heroin by the spores cannot be seen with the naked eye.

Especially in case of fever, or local events such as injection - redness, pain, swelling, or which are swelling rapidly, a  physician should be consulted  stating that you are a drug user, she advises. The Regional Health Agency-Sydney and recommends calling or making an urgent visit to the hospital in the presence of these symptoms or an isolated fever of >38.5°.

For all these reported European cases, the onset of symptoms was between June 5 and July 5.

In France, [human] anthrax is a notifiable disease and is very rare, with five cases occurring since 2002; all related to infected animal contact unrelated to this alert for drug users, whether regular or occasional.

Associations and specialized organisations have been advised to relay prevention messages.
Communicated by
ProMED-mail from HealthMap alerts

[There are very few clinical details with this report but we can hope that the French were able to culture the strain involved, and submit it to DNA analysis. Then it can be seen if it is identical with the recent German isolates and whatever is discovered of the Denmark strain -- there was minimal DNA recovered from that patient. If it is the same it would suggest that the source drug was of a significant quantity and not just a happen-chance residue from the Scottish shipment of 2009/2010. And probably it came from the same processing site in ?Turkey. I think we can presume that the German, Danish, French & UK forensic agencies are in active conversation about these outbreaks.- Mod.MHJ]

See Also

Anthrax – Germany (08): (Berlin) ongoing investigations 20120713.1200646
Anthrax – Germany (07): (Berlin) early self treatment 20120710.1196322
Anthrax – Germany (06): (Berlin) new case 20120705.1191168
Anthrax – Germany (05) 20120705.1190288
Anthrax – Germany (03): strain identified 20120624.1179225
Anthrax – Germany (02): (BY) 2nd heroin case, RFI 20120621.1175326
Anthrax – Germany: (BY) fatal, heroin user 20120612.1165823
Anthrax, human – Denmark (03): fatal conf. heroin case 20120709.1195198]



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