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Patho-anatomic changes in a narcotic addict.Lijec
Vjesn. 1991 Nov-Dec;113(11-12):415-7.
The
pathoanatomical analyses made on biopsy specimens of organs of a
woman with a several year history of drug abuse who died suddenly
because of drug intoxication is presented. Characteristic
pathological findings such as scars on the forearm arranged in a
series along the vein as well as fresh needle marks in the cubital
region suggesting intravenous drug use are described. Birefringent
talc crystals as a positive sign of drug addiction were found in
macrophages of the lungs, liver, spleen and kidneys. In the lungs,
they were present perivasculary within the foreign-body granulomas,
in the liver, within the Kupffer's cells and macrophages of the
porta hepatis, in the spleen, in macrophages around the folliculi
and in the kidneys within the endothelial cells of glomerular loops.
The liver showed chronic viral hepatitis as well. As a sign of an
acute drug intoxication, the so-called "drug addict's lung" was
observed and the brain showed a pronounced edema and perivascular
bleeding. The mentioned acute pathological changes demonstrate that
the sudden death was most probably caused by drug intoxication and
this has been confirmed by toxicological analysis. In summary, the
value of the necroscopy and histological analysis of organs,
particularly by using a polarizing microscope, in detecting
pathological changes caused by drug addiction and, thus, the need
for pathoanatomical analysis of all drug addicts who expired and
young persons who died by a sudden death of unknown origin is
emphasized.
Clinical
manifestations and outcome in Staphylococcus aureus endocarditis
among injection drug users and nonaddicts: a prospective study of 74
patients.BMC
Infect Dis. 2006 Sep 11;6:137.
BACKGROUND:
Endocarditis is a common complication in Staphylococcus aureus
bacteremia (SAB). We compared risk factors, clinical manifestations,
and outcome in a large, prospective cohort of patients with S.
aureus endocarditis in injection drug users (IDUs) and in nonaddicts.
METHODS: Four hundred and thirty consecutive adult patients with SAB
were prospectively followed up for 3 months. Definite or possible
endocarditis by modified Duke criteria was found in 74 patients: 20
patients were IDUs and 54 nonaddicts. RESULTS: Endocarditis was more
common in SAB among drug abusers (46%) than in nonaddicts (14%)
(odds ratio [OR], 5.12; 95% confidence interval [CI], 2.65-9.91; P <
0.001). IDUs were significantly younger (27 +/- 15 vs 65 +/- 15
years, P < 0.001), had less ultimately or rapidly fatal underlying
diseases (0% vs 37%, P < 0.001) or predisposing heart diseases (20%
vs 50%, P = 0.03), and their SAB was more often community-acquired
(95% vs 39%, P < 0.001). Right-sided endocarditis was observed in
60% of IDUs whereas 93% of nonaddicts had left-sided involvement (P
< 0.001). An extracardiac deep infection was found in 85% of IDUs
and in 89% of nonaddicts (P = 0.70). Arterial thromboembolic events
and severe sepsis were also equally common in both groups. There was
no difference in mortality between the groups at 7 days, but at 3
months it was lower among IDUs (10%) compared with nonaddicts (39%)
(OR, 5.73; 95% CI, 1.20-27.25; P = 0.02). CONCLUSION: S. aureus
endocarditis in IDUs was associated with as high complication rates
including extracardiac deep infections, thromboembolic events, or
severe sepsis as in nonaddicts. Injection drug abuse in accordance
with younger age and lack of underlying diseases were associated
with lower mortality, but after adjusting by age and underlying
diseases injection drug abuse was not significantly associated with
mortality.
Morphological changes in the lungs in chronic drug addiction.Sud
Med Ekspert. 2006 Jul-Aug;49(4):6-10.
Morphological studies of the lungs and immune system organs were
made in drug addicts with narcotic intoxication. Depletion of the
central and peripheral lymphoid organs was found in most cases. It
is shown that morphological changes in the lungs in acute and (or)
chronic narcotic drug intoxication, the rate of acute and chronic
inflammatory lung diseases reflect development of lung inflammation
in the presence of aquired immunological deficiency in terminal
chronic drug abuse. The documented features of different
pathological processes in the lungs can improve diagnosis of acute
and chronic drug intoxication by results of section and histological
examinations.
Infectious
endocarditis in drug addicts.Sud
Med Ekspert. 2006 Sep-Oct;49(5):11-5.
Clinicomorphological features of infectious endocarditis (IE) were
studied on autopsy material from chronic drug addicts. Of special
interest were morphological changes in the lymphoid organs. The
experience of the author and literature data suggest that IE in drug
addicts is a manifestation of secondary immunodeficiency syndrome on
the background of chronic narcotic intoxication.
Histopathological findings in 851 autopsies of drug addicts, with
toxicologic and virologic correlations.Am
J Forensic Med Pathol. 2005
Jun;26(2):106-16.
This
investigation was carried out on 851 consecutive judicial autopsies
of drug addicts who died mostly of heroin overdose from 1977 to
1996. Research of anti-HIV/HBV/HCV antibodies was performed, and
histologic sections were retrospectively reviewed. More than 65%
were HBV/HCV-positive and about 17% HIV-positive; females were
HIV-positive more often than males. Intracranial microhemorrhages
were frequently found; cerebral infectious diseases were rare.
Inflammatory heart lesions, myocardial fibrosis, and acute ischemia
were common. Interstitial nephritis (found in about 8%) was more
frequent in females, in older patients, and in those carrying HIV
infection; glomerular sclerosis was detected in about 12%. Acute
bronchitis and/or pneumonia was demonstrated in 12%, without
significant association with HIV infection; pulmonary hemorrhages,
foreign body granulomas, and food aspiration were also commonly
seen; hyperplasia of pulmonary perivascular lymphatic tissue was
rather characteristic. Liver was carrying steatosis in 66.3% and/or
hepatitis in 64.5%; acute hepatitis was more frequent in females,
chronic hepatitis in older subjects and in those proven positive for
hepatotropic viruses; cirrhosis occurred more often in older
patients, in those carrying virus infection, and in consumers of
nonnarcotics drugs such as ethanol. No pathologic finding was
clearly related to drug abuse; therefore, during autopsy, drug
addiction can be suspected, but anamnestic and circumstantial data
are needed to lead pathologists to request toxicologic analysis to
ascertain the cause of death. The present investigation emphasizes
that, in addition to the risk of death by overdose, the high
incidence of acute and chronic diseases could seriously undermine
the health status of heroin and/or other drug consumers.
Spleen and
portal lymphnode pathology in fatal drug addiction.Forensic
Sci Int. 1984 Aug;25(4):233-44.
Spleen
and portal lymphnode sections from 86 drug addicts submitted for
medico-legal autopsy at the Institute of Forensic Medicine in
Copenhagen in the year 1979 were studied together with tissue
sections from 24 "normal" persons. In 70% of the drug addicts the
spleen weight was more than 200 g, and in 71% portal lymphnode
hyperplasia was found. Birefringent foreign material was found in
spleen tissue of drug addicts in 72% and in portal lymphnode tissue
in 44%. Signs of antigen stimulation in both spleen and portal
lymphnode tissue evaluated by the number of germinal centre and
plasma cells were found in more than 80% of the drug addicts
compared with about 20% of the "normal" persons. The results were
related to anamnestic information of duration of drug abuse, to the
spleen weight, to the occurrence of birefringent material and to the
liver changes. Examination of lysozyme and immunoglobulin containing
cells using the indirect preoxidase technique was performed in a
total of 72 cases of spleen tissue, 59 cases of portal lymphnode
tissue from drug addicts, 24 cases of spleen tissue and 18 of portal
lymphnode tissue from "normal" persons. Lysozyme, IgM and IgG
containing cells were found significantly more often among drug
addicts than "normal" persons. The results indicate that the
splenomegalia and the portal lymphnode hyperplasia often found in
drug addicts are caused by continuous antigen stimulation due to
repeated injections of various antigens.
Postmortem findings of
pulmonary lesions of older datum in intravenous drug addicts. A
forensic-pathologic study.Virchows
Arch A Pathol Anat Histopathol.
1984;402(4):405-14.
At
post-mortem examination the lungs of 30 intravenous narcotic addicts
were compared to two groups of 30 age- and sex-matched controls with
no history of narcotic abuse. A distinctly uneven distribution of
pulmonary pathology among the two groups was found, with various
non-acute, non-granulomatous lesions dominating in the addict group.
Microscopically, the typical pattern consisted of focally thickened,
fibrotic and hypercellular alveolar septa, accumulation of
haemosiderin-laden macrophages in alveolar walls as well as in the
lumina of alveoli and respiratory passages, and vascular lesions
with full-thickness fibrosis of arterial walls. An attempt at
quantitative scoring of the changes indicated that the extent of
pulmonary pathology increases with the addict's age or duration of
narcotic abuse and with the degree of social deterioration. The same
changes could also be demonstrated in some control cases with a
history of salicylate or alcohol abuse, or with known heart/lung
disease. The addict group also exhibited myocardial alterations in
28 of 30 cases. Typical findings were myofibrillar degeneration and
fatty infiltration. In 15 of 30 addicts morphological and
toxicological examination did not yield a definitive cause of death.
However, the present demonstration of cardiopulmonary pathology
suggests that narcotic addicts may be prone to acute circulatory
and/or respiratory derangement even if no overdose of drugs is
taken.
Lung and
heart pathology in fatal drug addiction. A consecutive autopsy
study.Forensic
Sci Int. 1987 May-Jun;34(1-2):39-51.
Lung and
heart sections from 33 drug addicts submitted for medico-legal
autopsy at the Institute of Forensic Medicine in Copenhagen were
studied together with tissue sections from 20 'normal' persons. In
the drug addict cases focal bleedings in lung tissue were found in
94%, signs of earlier bleedings, haemosiderin containing histiocytes,
were seen in 91%, and focal fibrosis in 46%. The bleeding episodes
may be due to hypoxia in connection with heroin intake. In 94% of
the drug addicts birefringent material in lung tissue was
demonstrated, in 58% in granulomas and giant cells, in 27% in giant
cells only and in 9% in isolated histiocytes. The material was
localized in the wall of pulmonar arteries and/or in the
interstitial tissue, undoubtedly depending on the duration of the
abuse. In 18% angiothrombosis was seen, in all cases granulomas/giant
cells were observed in the wall of the vessel concerned. The results
indicate periodical intravenous injection of dissolved tablets in
addition to heroin. Histological signs of pulmonary hypertension
were not seen, possibly due to the fact that abuse of central
stimulants is very rare in Denmark. Regarding heart alterations no
significant differences were demonstrated between drug addicts and
controls. The only note-worthy finding was focal infiltration of
lymphocytes in the atrio-ventricular bundle in two drug addicts, the
meaning of which is uncertain.
Liver
pathology in fatal drug addiction.Forensic
Sci Int. 1982 Sep-Oct;20(2):141-51.
Liver
sections from 273 drug addicts submitted to medicolegal autopsy at
the Institute of Forensic Medicine in Copenhagen in the period
1975-1979 were studied. In 65% of the cases non-specific portal
inflammation only was found. Birefringent material--identified as
the mineral talc (magnesium silicate) was observed in 38% of the
cases; in these cases non-specific portal inflammation was always
present. Changes compatible with acute or chronic persistent
hepatitis or hepatitis sequelae were observed in 8% of the cases;
cirrhosis in 3%. HBs-antigens were detected in 4%. In 22% fatty
infiltration was present; in 4% as the only abnormal finding.
Finally no pathological changes were found in 6%. The results were
related to anamnestic information of kind and duration of drug abuse
and to the cause of death. Furthermore a comparison was performed
between the groups with and without birefringent material. The data
suggest that the birefringent material may be of importance to the
pathogenesis of the non-specific portal inflammation.
Cardiac
lesions in intravenous drug addicts.Forensic
Sci Int. 1979 May-Jun;13(3):193-209.
Postmortem
findings in 25 intravenous addicts of centrally stimulating amines
and centrally depressive narcotics (opiates) have been analysed with
special reference to the presence of pathologic findings in the
heart, and the cause of death. Most cases exhibited myocardial
lesions of varying age, consistent with various phases of
myofibrillar degeneration, such as hemorrhages, contraction bands,
focal necroses, granulation tissue, stromal condensation, and
scarring, indicating an active chronic process in the myocardium and
the subendocardium, with a bias toward the conduction system of the
heart. The lesions have been found in drug addicts who died
immediately following an injection of narcotics as well as in those
who, irrespective of their drug influence, have died following
intervening injuries or disease. Cardiac lesions in drug addicts
seem to have a variety of causative factors: infections, toxic
influence, hypersensitivity, influence of catecholamines and general
hypoxia. The authors feel that the two latter suggested causes
appear most regularly and deserve special attention. The
significance of these heart lesions seems to vary, but at times they
may be the determining factor in the fatal outcome of a case. |
