Osteomyelitis

Note: To read the complete article and not this abstract, please click here

Big Name, Big Infection

After noticing an increase in the numbers of IV drug users who have been diagnosed with osteomyelitis, BP thought some investigation was needed as it appears to be an infection most of us know very little about, but which can have some extremely serious consequences if left untreated. Osteomyelitis is a serious bone infection which can occur in virtually any bone in the body although it usually crops up in the spine, foot or in long tubular bones such as those in the arm or leg, even fingers.

osteomyelitis – an extremely painful infection inside the bone, and one that can affect injectors.

While quite rare in many countries, there has recently been a rise in the numbers of intravenous drug users (IVDUs) becoming infected and this is particularly disturbing considering its often vague initial signs and symptoms which can mean diagnosis is often delayed. This, coupled with the problems IVDUs often encounter when accessing health care can mean that many users are suffering unnecessarily through late diagnosis.

This is a particular concern as some forms of the disease, such as vertebral (spinal) osteomyelitis can, if left untreated, lead to permanent paralysis, significant spinal deformity or even death. It can be an extremely painful infection of the bone and can take some time to heal so it is important for all of us to be aware of osteomyelitis and its symptoms so we know what to look out for. People with compromised immune systems such as cancer or HIV/AIDS, need also be very aware of this debilitating condition as it is often more likely to appear in people whose immune systems are not functioning well.

What is it?

Osteomyelitis is usually a secondary infection that follows an infection borne elsewhere in the body – perhaps caused by a wound, (such as an infected abscess), surgery, bone fracture, or a foreign body such as a surgical plate. IV line, urinary catheter or bullet. Once started, the infection can then spread to the bone via the blood and when the bone is infected, pus is produced within the bone. This can result in an abscess, depriving the bone of its blood supply. Early treatment can save the bone from destruction but as bone is hard tissue it is often resistant to antibodies and this can be difficult to treat.

Similar to infective endocarditis (BP issue 7 and BP’s A-Z of Health), osteomyelitis is usually caused by the same bacteria: Staphylococcus aureus (Staph. a). This bacterium can be introduced into the body in a variety of ways. Staph a. live intermittently on the skin in more than 70% of the population at any one time and the other 14 are colonized persistently. Those who use injecting equipment on a regular basis and inject in sites that are potentially Staph A colonized such as the feet, hands, groin etc can be at greater risk of attracting infection (see prevention). Again, this is why a hygienic injecting regime is essential for all IV users to help reduce as many factors as possible that could encourage an infection, (see overleaf & BP no. 7).

To read the rest of this important article on osteomyelitis and catch up on the symptoms, treatment, its relation to intravenous drug use and more, click here (from BP issue 8)

Staph Infection – a very interesting run down on an injectors worst enemy

bug for today: staphylococcus aureus

Staphylococcus aureus (Image by estherase via Flickr)

I found a very interesting article on Staphylococcus infection. There is floating bits of discussion about it in the harm reduction scene and many people (especially injectors) have heard of it. It is interesting for drug injectors as its an infection that turns up when we get abscesses, or endocarditis (infection in heart valve), or osteomyelitis (infection in bone) cellulitis (in skin) and blood poisoning. Here is an article that, in layman’s language, talks about staph, its life on the body and how it gets to play a role in so many infections. Definitely useful information to have if you either inject drugs or you work with injectors and/or harm reduction. Here’s an excerpt of the article and a link to the page…

“….Anyone can develop a Staph infection, although certain groups of people are at greater risk, including newborn infants, breast feeding women, and people with chronic conditions such as diabetes, cancer, vascular disease, and lung disease. Injecting drug users, those with skin injuries or disorders, intravenous catheters, surgical incisions, and those with a weakened immune system all have an increased risk of developing Staph infections.

Symptoms and Signs

Staphylococcal disease of the skin usually results in a localized collection of pus, known as an abscess, boil, or furuncle. The affected area may be red, swollen, and painful. Drainage or pus is common.

Skin infections are the most common type of disease produced by Staphylococcus. Staph infections of the skin can progress to impetigo (a crusting of the skin) or cellulitis (inflammation of the connective tissue under the skin, leading to swelling and redness of the area). In rare cases, a serious complication known as scalded skin syndrome can develop. In breastfeeding women, Staph can result in mastitis (inflammation of the breast) or in abscess of the breast.

Staphylococcal pneumonia predominantly affects people with underlying lung disease and can lead to abscess formation within the lungs.

Infection of the heart valves (endocarditis) can lead to heart failure. Spread of Staphylococci to the bones can result in severe inflammation of the bones known as osteomyelitis.

When Staph bacteria are present in the blood, a condition known as Staphylococcal sepsis (widespread infection of the bloodstream) or Staphylococcal bacteremia exists. Spread of the organisms to the bloodstream is known as bacteremia or sepsis. When Staph is in the blood (bacteremia or sepsis) it can cause high fevers, chills, and low blood pressure.Staphylococcal sepsis is a leading cause of shock and circulatory collapse, leading to death, in people with severe burns over large areas of the body. When untreated, Staph aureus sepsis carries a mortality (death) rate of over 80 percent.

Toxic shock syndrome is an illness caused by toxins secreted by Staph aureus bacteria growing under conditions in which there is little or no oxygen.

Staphylococcal infections should be contagious and can be transmitted from person to person. Pus from infected wounds may contain the bacteria, proper hygiene and handwashing is required when caring for Staph-infected wounds.

Are Staph infections contagious?

Staph skin infections are contagious. They can spread by:

* Skin to skin contact with infected person

* Sharing razors, towels, clothes, bed linens, sport equipment (athletes!), toys

* Walking barefoot or sitting around swimming pools

* Contact with infected pets

* Auto-infection by nose picking and skin scratching

* Sneezing – when droplets from the nose of infected person (or staph carrier) fall on an injured skin of another person

To read the rest of what is a useful article – and of which an excerpt, click here.

Endocarditis

Heart diagram with labels in English. Blue com...

Image via Wikipedia

BP takes a long hard look at INFECTIVE ENDOCARDITIS, a potentially life-threatening infection of the heart valve. Mainly caused by bacteria entering the skin through injecting, IE can be extremely unpleasant and has a nasty habit of ironing you out completely if left untreated. Know the signs & symptoms.

Although relatively uncommon in comparison to most health problems intravenous drug users encounter, it is extremely important for us to be aware of infective endocarditis (IE) for several reasons:

First of all, Infective Endocarditis has a high mortality rate, and almost always kills the patient if left untreated;

Secondly, it is often preventable. Knowledge of the symptoms of IE, early diagnosis and correct manage­ment are what makes all the difference to your recovery.

And thirdly, a hygienic injecting regime is crucial when avoiding the types of bacteria that cause endocarditis.

In most cases, these organisms are streptococci (“strep”), staphylococci (“staph”) or members of other species of bacteria that normally live on body surfaces, entering the bloodstream through a break in the skin, as happens through injecting,

What is it?

Explaining what endocarditis is requires a little translation of the name; endo- means inside, -card- refers to the heart (like ‘cardiac’) and the -itis bit signifies a process of inflammation. Combining all three gives you an inflammation of the inside of the heart, usually caused by an infection, but occasionally by a fungus.

To read the rest of the article (which appeared in Black Poppy Issue 8) click here

Abscesses; Sterile or Infected?

An abscess on the skin, showing the redness an...

An abscess on the skin, showing the redness, swelling & characteristic blackish ring surrounding the head.

Identification, Treatment and Prevention

Abscesses are something most of us have encountered before and they can be excruciatingly painful. Sympathetic medical care can be hard to come by for many of us who use drugs and so some people resort to treating themselves. This can lead to some serious complications as the toxicity of an abscess can vary considerably. Here are a few things to remember when it comes to getting to grips with an abscess….

Abscesses present themselves as raised lumps on the skin and can either be sterile or infected.

Many drug injectors will have an abcess at some stage in their inecting careers but it is by no means a certainty – they can be prevented.

A sterile abscess is caused by injecting either an irritating or insoluble substance into a vein – particularly so if you miss the vein and your drugs leak into the muscle / skin area. It may develop slowly and not usually show signs of heat although there may be a touch of redness and it can feel like a solid nodule under the skin but generally will not be sore to the touch. Don’t try to squeeze or poke it as it will usually go away in its own time ( although this can take quite a while and it may look pretty ugly.) See ‘What’s in an Abscess’ for what happens if you decide to squeeze…

An infected abscess, on the other hand, is a different story. Caused by either using non-sterile injecting equipment or by bacteria from your skin entering under the skin via the injecting process, an infected abscess will soon come up as a swollen lump on or near the injection site. Appearing inflamed and red, it feels hot to the touch and soon becomes very painful. The abscess may come to a ‘head’ or ‘point’ and be filled with pus. It can be tempting to squeeze or burst it now – but DON’T! This will only spread the infection, driving it deeper and wider, and it could head for the bloodstream giving you blood poisoning.

If you want to know what inside your abscess – here’s a little insight – For the remaining article, which appeared in Black Poppy issue 2, click here.

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