ADDICTED INMATES
    References and Abstracts

    1. Unique Identifier 91143734
    Author Klimas NG; Blaney NT; Morgan RO; Chitwood D; Milles K; Lee H; Fletcher MA
    Institution Center for the Biopsychosocial Study of AIDS, Miami, Florida.
    Title Immune function and anti-HTLV-I/II status in anti-HIV-1-negative intravenous drug users receiving methadone [see comments]
    Source Am J Med 1991 Feb;90(2): p163-70
    ISSN 0002-9343
    Abstract

    PURPOSE: The study objective was to evaluate the effects of long-term methadone use and human T-cell leukemia virus (HTLV) types I and II seropositivity on the distribution of lymphocyte subsets and on lymphocyte function as measured in vitro in intravenous drug users seronegative for human immunodeficiency virus type 1 (HIV-1).

    PATIENTS AND METHODS: Anti-HIV-1-negative intravenous drug users receiving methadone maintenance therapy (n = 24) were studied in a Veterans Administration drug abuse treatment center. These subjects were compared to 38 age- and sex-matched control subjects who did not abuse drugs. HIV-1 and HTLV serostatus was determined by repetitive enzyme-linked immunosorbent assay and confirmed by immunoblot. Lymphocyte subsets were determined by two-color flow cytometry. Lymphocyte function was measured by proliferative response to plant mitogens and by natural killer (NK) cell-mediated cytotoxicity to a tumor cell target.

    RESULTS: Significant differences were seen in lymphocyte phenotype in the methadone-treated group, with elevations in the T-cell helper subset CD4+CD26+; in CD8 and CD8+I2+ cells, suppressor/cytotoxic T lymphocytes, and activated suppressor/cytotoxic T cells; and in CD2+CD26+ cells and activated total T lymphocytes. Lymphocyte function was suppressed in the methadone group, with poor responses to pokeweed mitogen and phytohemagglutinin in culture. Moreover, NK-cell cytotoxicity was significantly reduced in the methadone group. None of these immunologic differences were attributable to HTLV serostatus.

    CONCLUSION: The immune abnormalities seen suggest that a clinically significant degree of immune impairment exists in methadone-treated intravenous drug users. However, these abnormalities could not be explained by the presence of other retroviruses in this HIV-1-negative study group, as there was no significant difference in immune function when HTLV-seropositive patients were compared to HTLV-seronegative subjects treated with methadone.

    2. Medical Litigation News Volume 2 Issue 7 Bacterial Endocarditis

    3. Unique Identifier 95344297
    Author Mathew J; Addai T; Anand A; Morrobel A; Maheshwari P; Freels S
    Institution Department of Medicine, Cook County Hospital, Chicago, IL, USA.
    Title Clinical features, site of involvement, bacteriologic findings, and outcome of infective endocarditis in intravenous drug users.
    Source Arch Intern Med 1995 Aug 7-21;155(15): p1641-8
    ISSN 0003-9926
    Abstract

    BACKGROUND: Intravenous drug use is an increasingly common condition predisposing to infective endocarditis. Data on infective endocarditis in intravenous drug users are limited.

    OBJECTIVE: To determine the clinical features, bacteriologic findings, site of involvement, complications, and mortality associated with infective endocarditis in intravenous drug users.

    METHODS    : Cohort study of intravenous drug users with native valve infective endocarditis.

    RESULTS    : A total of 125 cases of infective endocarditis occurred in 114 patients (84 cases [67%] in men and 41 cases [32%] in women) with a mean (+/- SD) age of 37 +/- 7 years. The tricuspid valve was involved in 58 cases (46%), the mitral valve in 40 cases (32%), and the aortic valve in 24 cases (19%). The microorganisms identified included Staphylococcus in 82 cases (65.6%) and Streptococcus in 32 cases (25.6%). Twenty-three patients (18%) underwent surgery, and two (9%) of them died. One hundred two patients (82%) were treated medically, and nine (9%) of them died. Fifteen patients (63%) with aortic valve involvement vs 17 patients (17%) without aortic valve involvement underwent surgery or died without surgery (odds ratio, 8.24; 95% confidence interval, 3.1 to 21.8). Among the survivors, at least one major cardiovascular complication occurred in 79 cases (69.3%).

    CONCLUSIONS    : Infective endocarditis in intravenous drug users affects the right and left sides of the heart with approximately equal frequency. At present, more than 90% of cases of infective endocarditis in intravenous drug users in Chicago are caused by staphylococci or streptococci. Involvement of the aortic valve is predictive of increased morbidity and mortality in intravenous drug users with infective endocarditis. With medical treatment, and surgery when medical treatment fails, intravenous drug users with infective endocarditis have an in-hospital survival rate of 91%.

    4. Author Sande MA, Lee BL, Mills J, et al.
    Title Endocarditis in intravenous drug users.
    Source In Kaye D (ed): Infective Endocarditis, ed 2. New York, Raven Press, 1992, pp 245-259

    5. Unique Identifier 91137880
    Author Stone MH; Stone DH; MacGregor HA
    Institution Department of Orthopaedic Surgery, Glasgow Royal Infirmary, UK.
    Title Anatomical distribution of soft tissue sepsis sites in intravenous drug misusers attending an accident and emergency department.
    Source Br J Addict 1990 Nov;85(11): p1495-6
    ISSN 0952-0481
    Abstract

    Of 77,686 case records of attendance at an accident and emergency department during 1986, 488 (0.6%) contained documented evidence of intravenous drug misuse (IDM). Clinical examination had revealed signs of soft tissue sepsis in 150 (31%) of these, the commonest sites being the wrist and forearm (31% of lesions), the antecubital fossa (19%), fingers and hand (14%) and thigh and groin (11%). These data highlight the anatomical areas to which medical and nursing staff should pay particular attention when examining patients with a background of IDM. Conversely, the presentation of soft tissue sepsis in these sites should alert clinicians to the possibility of underlying IDM.

    6. Author Hyman SE.
    Title Approach to the Substance-Abusing Patient
    Source In Goroll: Primary Care Medicine, 3rd ed., 1995 Lippincott-Raven Publishers

    7. Author Ross SM, Chappel JN.
    Title Substance use disorders difficulties in diagnoses
    Source Psychiatric Clinics of North America 21(4), December 1998, W. B. Saunders Company

    8. Author Mendelson M.
    Title Fever in the immunocompromised host
    Source Emergency Medicine Clinics of North America 16(4) November 1998, W. B. Saunders Company

    9. Unique Identifier 84147037
    Author Novick DM; Ness GL
    Title Abuse of antibiotics by abusers of parenteral heroin or cocaine.
    Source South Med J 1984 Mar;77(3): p302-3
    ISSN 0038-4348
    Abstract

    We studied antibiotic intake in 197 abusers of alcohol, sedatives, or parenteral heroin or cocaine. Thirteen patients, all abusers of parenteral heroin or cocaine, had taken antibiotics without prescription, obtained from friends, from old prescriptions, or by purchase on the street. Past or present street purchase of antibiotics was noted in 27 patients and was more common (P less than .02) in parenteral substance abusers. Four parenteral substance abusers had infection or colonization with methicillin-resistant Staphylococcus aureus, and three of them had purchased antibiotics on the street before the present or a recent past hospitalization. Physicians treating abusers of parenteral heroin or cocaine should be aware that such patients may be taking antibiotics without medical supervision. This practice may be an important factor in the development and spread of methicillin-resistant S aureus.

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