Eurosurveillance banner




Announcements
Read our articles on the ongoing Ebola outbreak in West Africa

Follow Eurosurveillance on Twitter: @Eurosurveillanc


In this issue


Home Eurosurveillance Edition  2010: Volume 15/ Issue 2 Article 2 Printer friendly version
Back to Table of Contents
Previous Next

Eurosurveillance, Volume 15, Issue 2, 14 January 2010
Rapid communications
Preliminary case report of fatal anthrax in an injecting drug user in North-Rhine-Westphalia, Germany, December 2009
  1. Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
  2. Postgraduate Training for Applied Epidemiology („PAE”, German Field Epidemiology Training Programme) at the Robert Koch Institute, Berlin, Germany
  3. European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
  4. Local Health Department, Aachen, Germany
  5. Federal State Health Department, North-Rhine-Westphalia, Duesseldorf, Germany
  6. Federal Ministry of Labour, Health and Social Affairs North-Rhine-Westphalia, Duesseldorf, Germany
  7. Center for Biological Security, Div. Highly Pathogenic Microorganisms , Robert Koch Institute, Berlin, Germany
  8. Friedrich-Loeffler-Institut, Jena, Germany
  9. Federal Information Centre for Biological Safety, Robert Koch Institute, Berlin, Germany

Citation style for this article: Radun D, Bernard H, Altmann M, Schöneberg I, Bochat V, van Treeck U, Rippe R , Grunow R, Elschner M, Biederbick W, Krause G. Preliminary case report of fatal anthrax in an injecting drug user in North-Rhine-Westphalia, Germany, December 2009. Euro Surveill. 2010;15(2):pii=19464. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19464
Date of submission: 14 January 2010

A fatal case of anthrax occurred in an injecting drug user in Germany, in December 2009. A potential link to similar cases in Scotland in the same time period is currently under investigation.


 

The Robert Koch Institute, in collaboration with the Friedrich Loeffler Institute in Jena, the Federal Research Institute for Animal Health, and the respective local and regional health authorities in the Aachen district, North-Rhine-Westphalia, Germany, are currently investigating a fatal case of anthrax in a 42 year-old male injecting drug user.

The individual was hospitalised on 6 December 2009, complaining of a swelling of his leg following drug injection into the popliteal fossa – reportedly attempting to inject into a vein. He probably injected heroin, however, details are unknown. Following treatment with meropenem and surgical debridement of a subsequent necrotising fasciitis, the patient died with multiorgan failure on 13 December 2009. Anthrax had not been suspected clinically.

Spore-forming bacteria from a wound swab specimen were identified, and on 18 December, the diagnosis of anthrax was confirmed by PCR. The last case of human anthrax in Germany had been reported in 1994, at that time affecting a 66 year-old man [1].

At this point in time, it is not clear whether there is a link between this case and the anthrax outbreak among injecting drug users in Scotland. As far as we know, the deceased had no travel history to Scotland. However, it can be assumed that other drug users in the same area in Germany, or perhaps elsewhere in the country, have been exposed. In case the hypothesis of a potential link to the Scottish cases proves true, it might well be that also other countries have been supplied with contaminated injectable drugs.

We launched an epidemiological investigation and exchanged information with the colleagues in the United Kingdom and, in particular, Scotland to coordinate the approach.

So far, the following measures have been taken: 

  • We have distributed information to public health colleagues, medical care facilities and low-threshold facilities in Germany to raise awareness of the event.
  • We are collecting information on the case and his contacts, and on the substances consumed.
  • We attempt further case finding.
  • We aim at a microbiological comparison of isolates to establish a potential epidemiological link with the Scottish cases.

The success of the epidemiological investigation will rely on public health authorities' efforts, alertness amongst clinicians and medical microbiologists, but also on the degree to which drug users themselves can be reached. Therefore, it is of utmost importance to utilise existing communication channels to inform those who might be at risk.   


References

1. Robert Koch Institute: Ein Fall von Milzbrand im Land Niedersachsen. [A case of anthrax in Lower Saxony]. Epid Bull. 1994;1:10. German.



Back to Table of Contents
Previous Next

Disclaimer:The opinions expressed by authors contributing to Eurosurveillance do not necessarily reflect the opinions of the European Centre for Disease Prevention and Control (ECDC) or the editorial team or the institutions with which the authors are affiliated. Neither ECDC nor any person acting on behalf of ECDC is responsible for the use that might be made of the information in this journal.
The information provided on the Eurosurveillance site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. Our website does not host any form of commercial advertisement.

Eurosurveillance [ISSN] - ©2007-2013. All rights reserved
 

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.