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Clostridial myonecrosis cluster among injection drug users: a molecular epidemiology investigation
David R Bangsberg1, Judith I Rosen, Tomás Aragón
1Epidemiology and Prevention Interventions Center, Box 1372, Room 301, Bldg 100, San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110, USA. db@epi-center.ucsf.edu
Abstract:
A molecular epidemiologic investigation was performed on a cluster of severe necrotizing Clostridium infections in 5 injection drug users admitted to an urban community hospital. Interviews with survivors suggested a point source of infection. Pulsed-field gel electrophoresis of SmaI restriction digests was performed to determine the molecular relatedness of clinically obtained isolates and isolates obtained from heroin samples and the home environment. A common clonal strain was found in Clostridium sordellii isolates from 2 socially unrelated patients and from drug paraphernalia. Clonality of a Clostridium perfringens strain from another patient isolate was identical to an isolate from a syringe found in her home. Other C perfringens isolates from patients, heroin, and the environment were determined to be polyclonal. We postulate that rapid recognition and public health notification led to rapid resolution of the outbreak.
Insights
Molecular epidemiologic investigation identified a common Clostridium strain linked to severe infections in injection drug users, suggesting a shared source. Rapid public health response aided in resolving the outbreak.
Area of Science:
- Molecular epidemiology
- Infectious disease transmission
- Public health surveillance
Background:
- Severe necrotizing Clostridium infections pose a significant health risk, particularly in vulnerable populations.
- Injection drug use is associated with increased risk of various infections, including those caused by Clostridium species.
Observation:
- A cluster of severe necrotizing Clostridium infections occurred in five injection drug users at an urban hospital.
- Interviews with survivors suggested a potential point source for the infections.
Findings:
- Pulsed-field gel electrophoresis revealed a common clonal strain of Clostridium sordellii in two patients and drug paraphernalia.
- A Clostridium perfringens strain from one patient matched an isolate from a syringe in her home.
- Other Clostridium perfringens isolates were polyclonal, indicating diverse sources.
Implications:
- Identifying a common clonal strain suggests specific contaminated sources, like drug paraphernalia, can drive outbreaks.
- Rapid recognition and public health notification are crucial for controlling Clostridium infection outbreaks in at-risk populations.
- This study highlights the importance of molecular typing in tracing infection sources and guiding public health interventions.