Fever may be the result of apparent or occult bacterial, viral, or fungal infection, febrile reactions to injected materials, or even fever of unknown origin.
- Sharing of needles and spoons
- Contaminated drugs or solvents
- Unpredictable immune status, poor psychosocial conditions
- Often less than optimal hygiene and nutritional status.
- At risk of blood borne and local spread infections from injections
Sources and Clinical
- DVT/PE: femoral vein is commonn. May have aneurysms. Pleural rub, Dyspnoea
- Compartment syndrome from local injections
- Psoas abscess from local injections
- Septic arthritis from local injections
- Endocarditis: often right sided. New murmurs. V waves in tricuspid endocarditis. Chills, pleuritic chest pain, back pain, heart murmur, splenomegaly, and peripheral embolic phenomena
- Clostridium infection with IM Heroin
- Viral: HIV-1, hepatitis B or C
- Skin and soft tissue infections: due to frequent injection, nonsterile technique, sharing equipment, and skin-popping. Cellulitis, skin abscesses, thrombophlebitis, necrotizing fasciitis, gas gangrene, and pyomyositis
- Tetanus caused by exotoxin produced by Clostridium tetani.
- Skeletal infections including septic arthritis and osteomyelitis. These are third most common complication of IV drug use
- Pulmonary infections
- Ocular infections including fungal and bacterial endophthalmitis
- CNS: meningitis, epidural abscess, and brain abscess
- Malaria (uncommon)
- FBC, U&E, CRP, ESR. Blood Cultures, Lactate
- Viral serology - Hepatitis and HIV
- CXR, Echocardiogram
- Admit all febrile IV drug users because serious infection, especially endocarditis, cannot be excluded in the initial ED evaluation.
- Flucloxacillin is useful against Staphylococcus aureus
- Vancomycin may be needed if MRSA is present
- ED physician must always ask about past and present drug use in all patients presenting to emergency department.