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Special Article
March 11, 2002

Clostridial Myonecrosis Cluster Among Injection Drug Users: A Molecular Epidemiology Investigation

Author Affiliations

From the Epidemiology and Prevention Interventions Center, Division of Infectious Diseases (Drs Bangsberg and Perdreau-Remington and Ms Rosen), the Positive Health Program (Dr Bangsberg), and the Departments of Surgery (Dr Campbell) and Microbiology (Ms Weir), San Francisco General Hospital, University of California San Francisco; and Community Health Epidemiology, Epidemiology Research Unit, San Francisco Department of Public Health (Dr Aragón), San Francisco.

Arch Intern Med. 2002;162(5):517-522. doi:10.1001/archinte.162.5.517

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 Sma I 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.

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