HEALTH EXPERTS PUZZLED BY A BRITISH ISLES ILLNESS

59 Cases Among Drug Users Are Stirring Fear

WASHINGTON - In a scenario eerily reminiscent of the beginnings of
the, AIDS epidemic, nearly five dozen intravenous drug users in
Scotland, Ireland and England since April have become ill or died of
an unidentified illness.

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.

While cultures of their blood and tissue have shown multiple
organisms, none has yet been identified as the likely culprit.

In Glasgow, which has long had the reputation of being Britain's
heroin capital, the cases have been largely treated as a drug problem.

But the U.S. Centers for Disease Control and Prevention, contacted
last month by the British health authorities to help in the
investigation, said Thursday in its first public report that "the
emergence of a new illness is possible," stressing that it appears to
be confined to intravenous drug users.

"This is a serious illness among members of this particular
community," said Marc Fischer, coordinator of the U.S. agency's
surveillance project for unexplained deaths and critical illnesses.
"Something is going on, but we're not sure at this point what it is."

"The greatest likelihood," Dr. Fischer added, "is that it is an
organism previously known and described and showing itself in a new
way."

He emphasized, however, 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. "

The experience of AIDS, which is believed to have begun in Africa, has
taught the public health community a sobering lesson that it has not
forgotten: Deadly infectious agents are but an airplane ride away.

Surveillance has been heightened in Britain and Ireland. In the United
States, the Centers for Disease Control sent letters last week to
state health authorities alerting them to the cases. Thus far, no U.S.
cases have been reported.

Health officials are disseminating information about the illness to
healthcare practitioners and trying to identify possible risk factors
so that 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.

So far 59 cases have been reported 30 in Glasgow, 15 in Dublin and 14
in scattered sites in England, with 30 deaths among them, the Centers
for Disease Control 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 who became ill and died. But
investigators have found no evidence of anthrax in any of the British
cases.

Cultures have revealed several different bacteria, however, some of
which can cause potentially serious diseases.

Because antibiotics failed to help any of the patients, the health
authorities speculated that the agent could be a toxin-producing one.
Also, the patients typically have a high count of white blood cells,
which is often the body's response to an infection or to a
toxinproducing agent, Dr. Fischer said.

Once a toxin is produced, the illness is difficult to treat unless
specific antitoxins are available for the disease.

A few toxin-related illnesses, such as botulism and tetanus, can be
treated with antitoxins. But, Dr. Fischer said, "We can't treat a
toxin when we don't know what it is."