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A Molecular Epidemiology Investigation

David R. Bangsberg, MD, MPH; Judith I. Rosen, RN, MSN, MPH; Tomás Aragón, MD, PhD; Andre Campbell, MD; Lucy Weir, BS; Francoise Perdreau-Remington, PhD

Arch Intern Med. 2002;162:517-522.

A molecular epidemiologic investigation was performed on a cluster of severe necrotizing Clostridium infections in 5 injection drug users admitted to an urban community hospital. Interviews with survivors suggested a point source of infection. Pulsed-field gel electrophoresis of SmaI restriction digests was performed to determine the molecular relatedness of clinically obtained isolates and isolates obtained from heroin samples and the home environment. A common clonal strain was found in Clostridium sordellii isolates from 2 socially unrelated patients and from drug paraphernalia. Clonality of a Clostridium perfringens strain from another patient isolate was identical to an isolate from a syringe found in her home. Other C perfringens isolates from patients, heroin, and the environment were determined to be polyclonal. We postulate that rapid recognition and public health notification led to rapid resolution of the outbreak.

From the Epidemiology and Prevention Interventions Center, Division of Infectious Diseases (Drs Bangsberg and Perdreau-Remington and Ms Rosen), the Positive Health Program (Dr Bangsberg), and the Departments of Surgery (Dr Campbell) and Microbiology (Ms Weir), San Francisco General Hospital, University of California San Francisco; and Community Health Epidemiology, Epidemiology Research Unit, San Francisco Department of Public Health (Dr Aragón), San Francisco.

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