BAFFLING ILLNESS HITS DRUG 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.