LETHAL INJECTION

The Deaths Of Heroin Addicts Have Sparked An Anthrax Scare

ANTHRAX is now a prime suspect in a spate of deaths among heroin
addicts in Europe. Tests at Britain's lab for dangerous pathogens at
Porton Down have found signs of anthrax infection in two Scottish
victims. Nine more Scots are ill, and doctors fear the disease-which
is hard to monitor among drug users-may be far more widespread.

"Heroin can contain almost anything in small amounts," says Les King
of the Forensic Science Service, which analyses seized heroin in
Britain. But no one checks it for infectious agents, he notes. "There
could be a long history of this, and we just haven't observed it till
now."

Ten addicts in Glasgow and Aberdeen have died over the past few weeks
after injecting the drug into muscle, rather than their veins. They
developed a painless, pusfree lesion at the injection site, then died
hours after the appearance of more general symptoms including severe
oedema, leakage of fluids around the heart and lungs, and soaring
white blood cell counts.

No one knew of a possible contaminant in heroin that could be to
blame. But now the spotlight is on anthrax, following the appearance
of an anthrax case history on ProMED, the Internet forum for emerging
diseases. Per Lausund of the Norwegian Army Medical School posted
details of an Oslo addict who died in April after injecting heroin
into muscle. He developed an abscess, then fell into a coma 10 days
later. After antibiotics failed to save him, tests showed anthrax
bacilli in his spinal fluid, which was confirmed by DNA analysis.

Now scientists at Porton Down have tested blood samples from five
Scottish victims. Two tested positive for "protective antigen", the
main anthrax toxin. "Nothing else would give that result," says Phil
Hanna, an anthrax expert at the University of Michigan at Ann Arbor,
who says the symptoms are also typical of anthrax.

Anthrax bacilli have not shown up in any of the blood samples, but
that does not rule out infection. "Antibiotics can wipe out
circulating anthrax bacilli, making diagnosis very difficult," says
Martin Hugh-Jones of Louisiana State University, who investigated a
1979 anthrax outbreak in Russia. The circulating toxins can still kill
patients, even though the bacteria have gone.

Chris McGuigan of the Greater Glasgow Health Board adds that at least
one sufferer in Scotland, who is still alive, has the black scab
typical of localised anthrax infection.

The link with injecting into muscles, rather than veins, is also
consistent with an anthrax diagnosis, says Hanna. Infection spreads
only when anthrax spores are consumed by macrophages, the roving white
blood cells that eat bacteria. They do this much more effectively in
muscle than in blood. Hanna adds that intravenous users may succumb
later if spores encounter macrophages in the spleen.

As New Scientist went to press, the Glasgow Health Board was still
undecided. "We do not discount anthrax, but we have so far failed to
find the bacilli," says Syed Ahmed of the Health Board. It is also
considering necrotising fasciitis, or "flesh-eating disease", as some
of its symptoms are similar. While investigations continue, addicts
have been advised to smoke heroin rather than inject it. No one else
is at risk, as neither disease passes from person to person.

Anthrax is endemic in Pakistan, Afghanistan and Iran, where most of
Europe's heroin originates. Hugh-Jones says animalderived material
from the region, such as gelatin or bone meal, may well be
contaminated with spores. Such material could have found its way into
heroin.

The National Institute of Public Health in Oslo warns that further
cases may occur elsewhere. But addicts might not come forward for
treatment, says Hugh-Jones. Many cases may not even be noticed, he
adds, because deaths among heroin users are relatively commonplace.