June 9, 2000
BY MARLENE CIMONS LOS ANGELES TIMES
WASHINGTON--In a scenario eerily reminiscent of the beginnings of the AIDS epidemic, nearly five dozen intravenous drug users in Scotland, Ireland and England have become ill or died since April of a mysterious illness whose origins health officials have not yet identified.
The baffling ailment is characterized by excessive swelling and redness at the injection site, low blood pressure and a high white blood cell count, often followed by heart failure.
More than half of the victims have died--most of them about two days after being admitted to a hospital--despite treatment with broad spectrum antibiotics and other measures.
And although cultures of their blood and tissue have shown multiple organisms, none has yet been identified as the likely culprit.
The federal Centers for Disease Control and Prevention, called two weeks ago by health authorities in the United Kingdom to help in the investigation, said in its first public report on the mystery illness Thursday that "the emergence of a new illness is possible," but emphasized that it appears to be confined to intravenous drug users.
"This is a serious illness among members of this particular community," said Dr. Marc Fischer, coordinator of CDC's surveillance project for unexplained deaths and critical illnesses. "Something is going on--but we're not sure at this point what it is."
But he emphasized that, because the early part of the illness involves a local reaction at the injection site, "this suggests that it is somehow related to that practice."
No cases have shown up as yet in the United States, but the experience of AIDS--believed to have begun in Africa--has taught the public health community a sobering lesson that it has not forgotten: that deadly infectious agents are just an airplane ride away.
Surveillance has been heightened in the United Kingdom and Ireland, as well as in the United States. The CDC sent letters last week to state health authorities alerting them to the cases and asking them to be on the lookout for them in their jurisdictions. So far, none has been reported.
Health officials here and abroad are disseminating information about the illness to health care practitioners and trying to identify possible risk factors for the disease so prevention strategies can be developed.
They are questioning surviving patients to see what they might have in common--specifically sources of their drugs and the timing of their injections.
Thus far, there have been 59 cases--30 in Glasgow, Scotland; 15 in Dublin, Ireland; and 14 in scattered sites in England, with 30 deaths among them, CDC said.
Health officials at first feared that the cause might be anthrax because the bacterium had been isolated from the spinal fluid of an intravenous drug user in Oslo, Norway, who became ill and died. But health investigators have found no evidence of anthrax among any of the U.K. cases.
Cultures, however, have found several bacteria among some of the patients, including group A streptococcus, Staphylococcus aureus and bacteria from the families of Clostridium and Bacillus, which cause several potentially serious diseases.
Because antibiotics have failed to help any of these patients, health authorities speculated that the agent could be a toxin-producing one. Also, these patients typically have a high white blood cell count, which is often the body's response to an infection or to a toxin-producing agent, Fischer said.
Once a toxin is produced, the illness is difficult to treat unless specific anti-toxins are available.
A few toxin-related illnesses--such as botulism and tetanus--can be treated with anti-toxins.
"But we can't treat a toxin when we don't know what it is," Fischer said.