Download nfective endocarditis (IE), although relatively uncommon, can be a

nfective endocarditis (IE), although relatively uncommon, can be a real issue
for injecting drug users. It is caused by bacteria entering the blood stream
through poor injecting, and can be fatal if left untreated. IE can be avoided by
using a more hygienic and safer injecting regime.
B
reaking down the word endocarditis helps explain its meaning:
‘endo’ means inside; ‘card’ refers to the heart; ‘itis’ signifies the
process of inflammation. Put it all together and you have an inflammation of the inside of the heart, usually caused by a bacterial infection and
occasionally by a fungus entering the bloodstream.
Infection-causing microbes enter the bloodstream during the injection
process and build up on the valves of the heart, weakening them as well
as other parts of the heart muscle (see diagram).
Endocarditis can eventually cause a heart murmur, as well as fever,
chest pains, fainting spells, shortness of breath and heart palpations. IE
can be treated with antibiotics if detected early.
Unfortunately, injecting drug users can be at high risk for infective
endocarditis, as unhygienic injecting practices and equipment allow
aggressive bacteria many opportunities to enter the blood.
Acute infective endocarditis can come on very quickly (acute) with a
rapid onset of symptoms over 1-2 days; these include high fever, chest
pains, shortness of breath, cough, small haemorrhages (eg bruising) on
the palms and soles of the feet and delirium.
If the attack is very severe, damage to the heart can cause shock; the
patient may suddenly collapse, and will have a rapid pulse and pale,
cool, clammy skin.
Acute endocarditis can appear extremely fast, and most often occurs
when an aggressive type of skin bacteria (such as staphylococcus which
normally live normally on the surface of the skin) enters the bloodstream.
Acute infective endocarditis can result in death very
quickly if left untreated.
swabbing your injecting site in one
direction prior to injecting; and,
definitely, not touching the needle.
Chronic infective endocarditis can build up (chronic) over weeks,
sometimes months. Symptoms are more vague and include a lowgrade fever (less than 38.4 degrees C), chills, night sweats, pain in
the muscles and joints, a persistent tired feeling, headaches, shortness of breath, poor appetite, weight loss, small tender nodules on
the fingers and toes, and tiny haemorrhages on the whites of the
eyes, the palate, inside the cheeks, on the chest, on the fingers and
toes, and odd chest pains.
The slower, chronic form of infective endocarditis is most often
caused by one of the group of streptococci that normally live in the
mouth and throat. This form has a slow and insidious progression
that can occur over weeks or months if left untreated. It can progress for as long as a year before it also is fatal.
The chances of getting endocarditis are determined by how easily
bacteria can get into the body. The main bacteria affecting drug
users (Staphylococcus aureus) is the same bug that can cause
things like septicaemia, cellulitis and abscesses. If you have an
infected sore on your skin you must take care to avoid spreading
the bacteria to your injecting site, potentially allowing entry into
your bloodstream or deeper skin tissue.
The risk to injecting drug users is increased further if you; drink
heavily; have had endocarditis in the past; have HIV/AIDS or any
other disease which compromises the immune system; have , a malformation of the heart or an implanted device in the heart (such as
an artificial heart valve); have , cancer with chemotherapy; or have
a history of chronic illness.
Any injecting drug user who has any of these risks or a compromised immune system should talk with their doctor or dentist before
any dental or medical procedure is done which might introduce
infection.
Prevention for injecting drug users comes with hygienic injecting
practices and the use of antibiotics (if required) before undergoing
any medical or dental procedure in which bacteria have a chance of
entering the blood.
Hygienic injecting practices include such things as: washing your
hands before and after injecting yourself and/or others;
Since the bacteria that cause
infective endocarditis are found on
the skin or in soft tissue infections,
such as abscesses or cellulitis,
you need to pay particular attention that your injection site and
injecting equipment are as hygienic
and/or sterile as possible. Licking
the needle tip and/or injection site,
blowing on the needle tip and/or
injecting site, and coughing or
sneezing on or around your gear are all ways of transferring streptococci bacteria that could be living inside your mouth or throat.
Endocarditis can be suspected based on your medical history, risk
factors and symptoms. Testing involves a thorough physical examination, blood tests and an echocardiogram (ECG) which uses sound
waves determine the structure of the inside of the heart.
The first line of defensive treatment is a combination of antibiotics
given intravenously, over a course of weeks, and this may include
hospital admission. Despite the seriousness of the condition, endocarditis is treatable as long as it is recognised early.
1. Never EVER lick, touch or blow on
your spike or works before a hit.
2. Never inject near any skin infection
or wound, no matter how small.
3. If you have a heart condition, HIV/AIDS
(or a compromised immune system) or
have had Endocarditis in the past - tell
your GP and dentist before surgery to
receive preventative antibiotics.
4. Never cough, sneeze on/near your gear.
5. Never pick or squeeze pimples or sores in
between hits (as you might do on the coke).
If you can’t help yourself then ensure
you seriously wash your hands