Makindo Medical Notes.com

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.

About

• Sharing of needles and spoons
• Contaminated drugs or solvents
• Unpredictable immune status, poor psychosocial conditions
• Often less than optimal hygiene and nutritional status.

Aetiology

• At risk of blood borne and local spread infections from injections

Sources and Clinical

• DVT/PE: femoral vein is common. 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)

Investigations

• FBC, U&E, CRP, ESR. Blood Cultures, Lactate
• Viral serology - Hepatitis and HIV
• CXR, Echocardiogram

Management

• 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.

References

• Fever in IV Drug User (PUO)