Anthrax death from heroin reported in Germany

Following the deaths of seven heroin users and infections of 14 by anthrax in Scotland, fears have begin to rise in Germany following a fatal case of anthrax in a 24-year-old male injecting drug user.

The man, who has not been identified, was hospitalized on December 6, complaining of swelling in his leg following a drug injection. Details are unknown, but it is believed that the man was attempting to inject heroin into a vein.

The man was treated with meropenem and received surgical debridement following the subsequent necrotising fasciitis, eventually dying of multiorgan failure on December 13. At the time, anthrax was not suspected.

A wound swab specimen revealed spore-forming bacteria which, on December 18, was diagnosed as anthrax. The last case of anthrax in Germany prior to this was reported in 1994, when a 66-year-old man suffered from an anthrax infection.

There is currently no known link between this death and the Scotland deaths and the man is not believed to have travelled to Scotland. It is assumed, however, that other drug users in the same area of Germany and even elsewhere in the country have been exposed.

If a link to the Scottish cases is shown, the hypothesis is that other countries have also been supplied with injectable drugs contaminated with anthrax.

To determine if there is a link, an epidemiological investigation was launched by the Robert Koch Institute in collaboration with the Friedrich Loeffler Institute in Jena, the Federal Research Institute for Animal Health, and local and regional health authorities in the Aachen District, North-Rhine-Wesphalia, Germany. Information was also exchanged with investigators in Scotland.