Injection Anthrax—a New Outbreak in Heroin Users

Skin infectionssuch as abscesses, erysipelas, and phlegmonare the commonest complications of intravenous drug abuse. The sources of these infections are usually the body’s own flora (1). Injection anthrax, however, is probably causedby contaminated heroin and, together with Clostridium botulinumand Bacillus cereus(B. cereus) infections, is one of the rarer causes of severe sepsis following percutaneous application or injection (2, 3). In 2012 so far there have been four cases of injection anthrax in Germany, one of which was fatal. Isolated cases have also been recorded in various other European countries, such as Denmark, France, and the UK. Further cases should be expected. There had already been three cases of injection anthrax associated with drug use in Germany in 2009/2010. That outbreak had centered on Scotland, where there were 119 cases (3). Events have led us to compile this article in order to raise awareness of injection anthrax, among German physicians in particular. To illustrate the procedure to be followed in the event of injection anthrax, the first three cases of anthrax that occurred in 2012 are described.