Mainly caused by bacteria entering the skin through injecting, infective Endocarditis (infective Endocarditis) can be extremely unpleasant and has a nasty habit of ironing you out completely if left untreated. Know the signs and symptoms!
AIthough relatively uncommon in comparison to most health problems intravenous
drug users encounter, it is extremely important for us to be aware of infective
Endocarditis for several reasons:
First of all, it has a high mortality rate, and almost always kills the
patient if left untreated.
Secondly, it is often preventable. Knowledge of the symptoms of infective
Endocarditis, early diagnosis and correct management are what makes
all the difference to your recovery.
Thirdly, a hygeinic injecting regime is crucial when avoiding the types
of bacteria that cause Endocarditis.
In most cases, these organisms are streptococci (“strep”), staphylococci (“staph”) or members of other species of bacteria that normally live on body surfaces, entering the bloodstream through a break in the skin, as happens through injecting,
Infective Endocarditis in a nutshell
In a nutshell, what happens is that the bacteria or fungus involved can collect on one of the four valves inside the heart which normally keep the blood flowing in the right direction. The bacteria grow to form ‘vegetations’ which then damage the valve and interfere with the normal flow of blood.
The infected vegetation will send intermittent showers of bacteria into the circulation, which results in fever in many people. Occasionally a piece of the vegetation may break off and enter the circulation causing systemic emboli (clots). The growth eventually destroys the heart valve. The bacteria are able to maintain their presence in the bloodstream because the heart valves are an especially difficult place for the body’s immune system to reach when fighting off the infection.
Acute Endocarditis
Endocarditis can escalate to an acute case rapidly, especially when an
aggressive species of skin bacteria enters the bloodstream and attacks a
normal, undamaged heart valve. Once staph bacteria begin to multiply inside
the heart, they may send small clumps of bacteria called septic emboli into
the bloodstream to spread the infection to other organs, especially
to the kidneys, Iungs and brain.
Unfortunately injecting drug users are at high risk for acute Endocarditis,
as aggressive staph bacteria have many opportunities to enter the blood
through broken skin and unhygienic drug paraphernalia. If untreated, this
form of Endocarditis can be fatal in less than two months.
Chronic Infective Endocarditis
Never EVER lick touch or blow on your spike or works before a hit.
Never inject near any skin infection or wound, no matter how small.
If you have a heart condition, HIV/AIDs, a compromised Immune system, or
have had Endocarditis in the past - tell your GP or dentist before surgery
to receive preventative antibiotics.
Never cough or sneeze on or near your gear.
Never pick or squeeze pimples or sores in between hits (as you might
do if using coke). If you can’t help it, then ensure you wash your
hands and fingers really well afterwards.
Always wash your hands well before and after a hit. can also occur more
slowly. This chronic form of Infective Endocarditis (IE), is most often
caused by a group of streptococci that normally live in the mouth and throat.
These form a slow progression over weeks to months. If left untreated it
is usually fatal.
Symptoms of Endocarditis
‘’Acute’ IE can come on extremely quickly, with rapid
onset of symptoms over one to two days. These symptoms can include:
• High fever and possibly delirium
• Chest pain, coughing, shortness of breath
• Small haemorrhages on the palms of the hands and soles of the
feet.
If very severe, heart damage can cause shock – the patient may suddenly
collapse, have a rapid pulse and pale, cool, clammy skin. The more ‘chronic’
variety can build up over weeks or sometimes months, and symptoms can be
more vague:
• Low-grade fever (less than 39.4 degrees C)
• Chills and night sweats
• Pain in muscles and joints
• Persistent tired feeling
• Headache
• Shortness of breath
• Poor appetite and weight loss
• Small, tender nodules on the fingers or toes
• Tiny broken blood vessels on the whites of the eyes, the palate,
inside the cheeks, and on the chest, fingers and toes
• Odd chest pains.
Risks for injecting drug users
The chances of getting Endocarditis are mainly determined by how easily the bacteria can gain entry to the body and how easy it is for them to grow on the heart valves. Obviously, consistent care must be taken to avoid bacteria entering your body from poor injecting technique.
The primary bacteria which affects drug users is called staphylococcus aureus (often shortened to s. aureus) This is the very same bug that can cause things like septicemia, cellulitis and abscesses. This is why, if you have an infected sore on your skin, you must take extreme care to avoid spreading the bactetria to your injecting site which allows potential entry into your bloodstream or deeper skin tissue. There is also a long list of other bugs, but they are relatively rare and tend only to cause problems in people with a compromised immune system, such as with AIDS.
As an injecting drug user, your risks increase even further if you:
• Drink heavily
• Have had Endocarditis in the past
• Have HIV/AIDS
• Have other diseases affecting your immune system
• Have a malformation of the heart or heart valves present from birth
• An implanted heart device (pacemaker wire or artificial heart valve)
• Cancer treated with chemotherapy
• History of chronic illness.
If any of these affect you, you should be offered preventative antibiotics whenever you have things like dental surgery done which might introduce infection.
Any injecting drug user with a compromised immune system should insist upon taking antibiotics both before and after any dental or medical procedure to reduce the risk of contracting Endocarditis. At the very least ensure you have a full discussion with your doctor or dentist about the risks.
Preventing Endocarditis
Prevention for injecting drug users comes with hygienic injecting practices:
Never EVER lick touch or blow on your spike or works before a hit.
Never inject near any skin infection or wound, no matter how small.
If you have a heart condition, HIV/AIDs, a compromised Immune system, or
have had Endocarditis in the past - tell your GP or dentist before surgery
to receive preventative antibiotics.
Never cough or sneeze on or near your gear.
Never pick or squeeze pimples or sores in between hits (as you might
do if using coke) - if you can’t help it, then ensure you wash your
hands and fingers really well afterwards.
Always wash your hands well before and after a hit.
To prevent Endocarditis, your doctor and dentist may prescribe antibiotics before you undergo any medical or dental procedure in which bacteria have a chance of entering your blood. Antibiotics are usually administered to patients who have had Endocarditis in the past, and patients with other high risk conditions. In general, antibiotics are given one to two hours before a high-risk procedure and up to eight hours afterward.
Before a dental procedure, an antiseptic mouth rinse can also be used, especially one containing chlorhexidine or povidone-iodine.
Endocarditis is not preventable by avoiding needle sharing as it is not transmitted directly from person to person.
Remember the bacteria that causes infective Endocarditis is found on the skin or in soft tissue infections like abscesses or cellulitis. if you have infections such as these, you need to pay particular care to ensure that your injection site and injecting paraphernalia are as hygienic and/or sterile as possible; this will help to prevent the bacteria entering your bloodstream. Licking your fit (or your injection site before or after a hit) is another way of transferring streptococci bacteria that could be living inside your mouth or throat – due to absesses or throat infections.
Whether your heart valves are normal, damaged or artificial, you can help prevent Endocarditis by not injecting your drugs. If you want to continue injecting, always be as sterile and/or hygienic as possible, when mixing up your gear and injecting.
Treatment of Endocarditis
Your doctor may suspect Endocarditis based on your medical history, risk factors and symptoms, gathering additional evidence from a physical examination (see symptoms) and drawing blood samples. Other tests include an Echocardiography (ECG), where sound waves are used to outline the structure of the heart, heart chambers and valves. The first line of defence is a combination of antibiotics given intravenously, a course which normally lasts for six weeks and it also requires a fairly long hospital admission of six weeks or more.
Drug users are usually affected on the right side of the heart — which pumps blood to the lungs — in contrast to the other forms of Endocarditis, which normally affect the valves on the left side. Left-sided valves can be relatively easily replaced surgically, but replacing a right-sided valve is a more difficult operation with lower success rates so it is usually not attempted. This means injecting drug users can be treated successfully yet be left with a permanently damaged valve and the risk of heart problems in later life.
Despite all of these serious problems with the condition, Endocarditis is still very treatable as long as it is recognised early. Read the personal story about Endocarditis on this website!
GO TGO TO THE HOME PAGE
Reproduced with permission of Black Poppy, a UK-based drug user organisation. Check out their website at www.blackpoppy.org.uk for heaps of useful information.
