BAFFLING ILLNESS HITS DRUGS USERS ABROAD

Health: Scotland, Ireland and England report 59 cases that began with
swelling, redness at injection site. Thirty deaths have occurred despite
antibiotic treatment.

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 while 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 Britain to help in the
investigation, said in its first public report on the mysterious
illness Thursday that "the emergence of a new illness is possible" but
stressed 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.

"Right now, though, the greatest likelihood is that it is an organism
previously known and described and showing itself in a new way," he
said.

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 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 but an airplane ride away.

"Those of us who have lived through the AIDS epidemic know to take
quite seriously reports of unexplained and deadly illnesses," said
Jeffrey Levi, co-director of George Washington University's Center for
Health Services Research and Policy.

"We need to be careful not to assume that the HIV experience will
always be replicated," he added. "But we also know that dismissing
carefully documented reports relating to high-risk behavior can come
at a very high price."

With AIDS, which turned out to be caused by a virus, sicknesses and
deaths resulting from the collapse of the immune system first appeared
in June 1981 among five gay men in Los Angeles, followed a month later
by 26 gay men in New York City. In December, the first cases among
intravenous drug users were identified. Today, the United Nations
estimates that 30 million people worldwide may be living with AIDS or
HIV.

"We have ongoing surveillance in the United States for cases of
unexplained deaths and severe illnesses for this very purpose--to
identify cases that are new," Fischer said in an interview. "This
investigation highlights the importance of maintaining that type of
surveillance."

Surveillance has been heightened in the United Kingdom and Ireland, as
well as in the United States. 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. Thus 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.

The illnesses begin with the local inflammation--swelling, redness and
warmth and fluid retention at the injection site--and patients become
progressively sicker during the next few days. Usually, they are
admitted to hospitals about three days after the onset of illness.
Among fatalities, patients usually died about two days after being
admitted.

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 health
investigators have found no evidence of anthrax among any of the
British cases.

Cultures, however, have found several different 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.

While antibiotics can be effective against many bacteria, they do not
kill them all. Antibiotic resistance has become a growing problem in
recent years.

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 antitoxins are available for the disease. A few toxin-related
illnesses--such as botulism and tetanus--can be treated with antitoxins.

"But we can't treat a toxin when we don't know what it is," Fischer
said. He stressed that health officials are still far from knowing all
the answers.