Sciences de la Santé
Using Drugs Or Using Germs?
Rihab FELLAH
Using drugs has become a burden that human societies bare daily. Persons Who Use Drugs( PWUD) are mostly young. Once they have entered the cycle of transition from craving euphoria to suffering from hellish withdrawal, they become captive of the substances they use. Not only does acquiring drugs causes their financial and social ruin, it represents an imminent danger on their lives. That risk is primarily dominated by the ever looming risk of overdose. It also adds to the many hazards on their well being in the long term. Infection is one of these hazards and is often encountered in this population. It accounts for devastating consequences and is generally overlooked by healthcare personnel as well as the general public. Thus we thought we might put it under your radar.
Opioid use disorder is defined in the DSM V * as a“ problematic pattern of opioid use leading to clinically significant impairment” and is diagnosed if 2 of 11 criteria were met in a period of 12 months.( cf. Mechanisms of addiction: p13)
Opioids are every substance, natural or synthetic, that can act on our brain’ s opioid receptors causing analgesia which accounts for their medical use, as well as euphoria explaining their“ recreational” one and their popularity among youngsters 1, 2.
However, delivering the occasional( and in most cases frequent) dose of happiness doesn’ t come without a cost and the cost is quite a filthy. Whether from the hosts commensal flora, the bacteria contaminating the drug, the drug adulterants( which are all substances added to the drug intentionally- facilitating its delivery or boosting volume for sale-or accidentally during the process of its making) or in the paraphernalia( tools such as syringes or pipes that permit drug use), consuming drugs whether by inhalation or injection is a gateway to inoculating germs 3.
Indeed, drug users have higher rates of Staphyloccocus aureus colonization in the nares and skin. It is thought that the damage ensued by drug consumption to the nasal septum and skin through inhalation and injection respectively is responsible of this portage. Poor hygiene is also an important risk factor 6, 7.
This increases the chances of Staphyloccocus aureus skin infection and abscesses and even of bacteremia 6, 7. Eventually, bacteremia would cause septic shock and fatal multiorgan failure 6.
Such a bacteremia could also cause the infection of sterile sites such as bone and joints. A condition known as hematogenous osteomyelitis. Its most common site is the vertebrae. Thus the presence of bacteria in the vertebral body( spondylitis) can cause inflammation, bone fragility and even fractures. The contiguous involvement of the intervertebral disc, or discitis, is quite common( note that the disc is avascular and couldn’ t be contaminated from the blood stream) and in the case of S. aureus spondylodiscitis, perivertebral abscesses are frequent too 3.
The gravity of this condition lies in the consequences of such inflammation or even compression( by the mass of the abscess or the mechanical complication of the infection itself) on the adjacent spinal cord which results in a radiculopathy( motor weakness and sensory changes) and ultimately paralysis. Surgical management is indicated in these cases 4.
Another“ fun” fact! It is reported that illicit drug syringes contain up to 10 8 organisms per mL 5, that some drug adulterants such as talc can directly damage valvular endothelium and that, as mentioned previously, drug users have poor hygiene and important nasal and skin S. aureus colonization and bacteremia 6. All of this put together predisposes to a particular form of disease and quite a grave one: INFECTIVE ENDOCARDITIS. This fancy term often confuses people and hides the gravity of the issue. When explaining to patients that they are suffering from an infection in their heart, you can only imagine the terror they must feel 8.
This heart infection is actually a cluster of fibrin, platelet and leucocytes that appendages itself to an already injured endocardium( the valves are the most involved). This cluster is secondarily colonized by
* DSM V: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Is a manuscript assembled by the American Psychiatric Association in which all Mental disorders had been classified and characterized by a number of criteria in order to help clinicians retain or revoke diagnoses more easily.
10 Été 2018