Maine health officials are investigating a cluster of serious bacterial illnesses among users of synthetic bath salts.
Four patients with a history of injecting the drug were sickened by the Group A streptococcal bacterium over the last several weeks, according to a health alert issued by the Maine Center for Disease Control and Prevention. The common germ is responsible for strep throat and skin problems in its milder form but can also lead to life-threatening infections including the much-feared flesh-eating bacteria.
The first three cases arose in Aroostook County, followed by one in Penobscot County, said state epidemiologist Dr. Stephen Sears. The patients were between the ages of 23 and 37.
“Fortunately, they all survived,” he said. “It’s a pretty nasty infection.”
Two of the cases resulted in streptococcal toxic shock syndrome, which causes a rapid drop in blood pressure and can lead to organ failure. All of the patients were hospitalized, one required treatment in intensive care, and one developed necrotizing fasciitis, a condition that’s known as flesh-eating bacteria in its rare and most dangerous form.
The widely publicized infection — most recently grabbing headlines after forcing Georgia woman Aimee Copeland to undergo multiple amputations — destroys muscles, fat and skin tissue. The Maine patient, however, did not suffer the rapid, uncontrolled damage associated with flesh-eating bacteria, Sears said.
“This person, although having some tissue destruction, did not have the continuous, progressive problems we’ve seen described in other cases,” he said.
About a quarter of patients with necrotizing fasciitis die, while streptococcal toxic shock syndrome kills more than 35 percent of patients.
The Group A streptococcal bacterium is commonly found in the throat and on the skin, and people can carry it without experiencing symptoms or illness. It also causes cellulitis and impetigo, a highly contagious minor skin infection often caught by preschool-aged children.
Severe infections result when the otherwise tolerable bacterium infects blood and tissue. Healthy people can contract invasive forms of the disease, but those at higher risk include people with chronic illness, skin lesions, a history of alcohol abuse or injection drug use, as well as the elderly and those with suppressed immune systems.
The bacteria likely cropped up among bath salts users not through the sharing of needles but because injecting drugs gives it a way to enter the body, Sears said. For that reason, health officials are also concerned that the infection could strike users who inject drugs of any kind, he said.
“When you penetrate your skin you put yourself at much greater risk,” Sears said. “We don’t think that it’s necessarily in the bath salts themselves, that’s been one theory.”
Invasive Group A streptococcal disease strikes between 9,000 and 11,500 Americans every year, according to the U.S. CDC. Streptococcal toxic shock syndrome and necrotizing fasciitis each make up about 6 percent of those cases.
Severe Group A streptococcal infections are seasonal, and arise more often from December through April, Sears said. Thorough hand washing, especially after coughing and sneezing and before preparing food or eating, can limit the spread.
Maine CDC has advised physicians and other health providers to be on the lookout for the infections among intravenous drug users, but the public should also be aware, Sears said.
“What people need to know is that strep is around,” he said. “Even without an injection, if they happen to get really painful, red swollen skin, they need to take that seriously.”
Synthetic bath salts, which can be snorted, injected or smoked, first appeared in Maine last year and took hold in the Bangor area. Users often suffer from extreme paranoia, hallucinations and a dangerously high heart rate and body temperature.
Bath salts have been tied to at least one death in Maine.