Chest
Volume 94, Issue 2, August 1988, Pages 251-253
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Pulmonary Complications of Intravenous Drug Abuse: Experience at an Inner-City Hospital

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Fifty-one intravenous drug abusers were evaluated by a pulmonary consultative team over a 22-month period at a large inner city hospital. The most common pulmonary complication was septic pulmonary embolism, seen in 12 patients (23.5 percent). Community-acquired pneumonia was diagnosed in ten patients (19.6 percent). Mycobacterium tuberculosis occurred in five patients (9.8 percent). Although 25 of 40 patients (63 percent) tested for human immunodeficiency virus antibody were positive, acquired immunodeficiency syndrome (AIDS) was present in only five patients (9.8 percent). Bronchoscopy was used to evaluate pulmonary infiltrates in 15 of 51 cases (29 percent). Common bacterial infections and tuberculosis remain the most frequently encountered pulmonary problems in drug abusers, despite the onset of the AIDS epidemic.

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METHODS

During the 22 months from July 1985 through April 1987, the Georgetown Pulmonary Service performed 423 inpatient consultations at the District of Columbia General Hospital, an inner-city facility providing care to mainly indigent patients. We reviewed these charts and identified 53 patients with history of IV drug abuse. The records of 51 of these 53 patients were available for final analysis. Sex, age, race, human immunodeficiency virus (HIV) antibody status, and pulmonary diagnosis were

Demographics

The patients in this series were predominantly black males in the fourth decade of life (Table 2). All were heroin abusers, and several injected cocaine and amphetamines as well. None had sickle cell anemia. Because of the retrospective nature of this study, data on smoking history, tuberculin status, and other past problems were not consistently available from all charts.

Of the IV drug abusers seen in pulmonary consultation, 40 of 51 (78 percent) were tested for HIV antibody, and 25 of 40

DISCUSSION

The 51 patients in this series demonstrate that intravenous drug abusers continue to develop traditional infectious complications in large numbers. Many of our cases are remarkably similar to early reports of septic pulmonary infarction6 and pneumonia7 in heroin users. Contaminated needles and drug supplies continue to result in hematogenous seeding of the lung parenchyma.

IV drug abusers are at higher risk for tuberculosis, both because of drug use alone8 and because of HIV-related

REFERENCES (11)

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Manuscript received September 17; revision accepted January 25.

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