Despite its innocuous name, the extreme dangers of the new street drug known as “bath salts” are just beginning to emerge, and doctors from the Louisiana State University Health Sciences Center in New Orleans have found a new menace.
People who take “bath salts” by injecting them into their muscles are not only putting themselves at risk for deep paranoia and recurrent delusions—known and common effects of bath salt abuse identified since the drug hit American streets in 2009. [see Bath Salts Side Effects]
In addition, they are also exposing themselves to infection with a deadly flesh-eating bacterial infection that can lead to amputation or even death, say Dr. Russell R. Russo and his colleagues from the LSU.
Because the deadly necrotizing fasciitis—or flesh-eating bacterial infection—is hard to diagnose, people who get it are bound to lose limbs or even die, the doctors warn.
Necrotizing fasciitis is a rapidly spreading infection that attacks connective tissues, damaging and killing the tissue. While rare, this flesh-eating disease can occur in almost any area of the body.
Usually caused by infection with streptococci bacteria, health experts now agree that the infection is frequently polymicrobial—with many different bacterial genera and species working together to cause this disease. Occasionally, fungi can also cause necrotizing fasciitis.
Writing in the journal Orthopedics, Dr. Russo and his colleagues say necrotizing fasciitis is particularly lethal for many reasons: One, because the majority of the damage rages below the surface of the skin, it’s hard to diagnose. Two, causes and vectors continue to change. And three, the bacteria destroys tissue very rapidly so doctors trying to cure it are literally working against the clock.
“As ‘bath salts’ gain popularity, medical centers of all disciplines must be prepared to identify not only the signs of intoxication, but the potential side effects including deadly necrotizing fasciitis,” writes Dr. Russo in the paper, published in January 2012.
First case from bath salt abuse
The paper sprung from a case report of a 34-year old woman who came to LSU’s emergency room complaining of pain from an extensive cellulitis or skin infection extending to the middle of her upper arm. Unknown to the doctors, the woman had made an intramuscular injection of ‘bath salts’ two days before.
Doctors did not realize the infection was due to a ‘bath salt’ injection until it progressed rapidly.
Initially, the cellulitis responded to broad-spectrum antibiotics given intravenously. But 48 hours later, it began to deteriorate rapidly, the doctors write in their paper. The infection moved so fast, healthy tissue was dying before their eyes, the doctors say. They had to remove tissue continuously until they reached a clear margin that indicated the arm had to amputated. Along with her arm, the woman’s shoulder and collarbone were also surgically removed.
The woman even had to undergo a radical mastectomy and further chest wall debridement to obtain healthy tissue margins and control the disease, the doctors say.
Doctors’ warning vs. bath salts
Worldwide, bath salts or synthetic cathinones have become increasing popular in the past few years. Despite the innocent name, bath salts have no legitimate use for bathing; they are intended only for substance abuse.
Unlike that for common illicit drugs like cocaine, heroin, lysergic acid diethylamide (LSD), phencyclidine and ecstasy, the dangers of bath salts are unknown and have only begun to emerge. Only 16 American states so far have placed emergency bans on the products.
“Despite the drug’s legal status, it must be treated as illicit, says Dr. Russo.
As the drug’s use has evolved from an oral, smokable and snortable form to an injectable version, communities need to become aware of the implications of this increase in injectable illicit substances, the LSU doctors earn. This includes the possibility that cases necrotizing fasciitis may rise.
“The emerging popularity of this highly obtainable, injectable substance may lead to an increase in cases of necrotizing fasciitis,” Dr. Russo and colleagues say.
Many previous studies have outlined the dangers of injecting illegal drugs ranging from anabolic steroids to heroin with dirty needles. Injection risks range from local pain and swelling to peripheral nerve palsies, and the most severe consequence is a necrotizing fasciitis infection, the doctors warn.
A large retrospective study performed in California between 1984 and 1999 showed a sharp increase in necrotizing fasciitis between 1994 and 1999 that corresponded to the rise in popularity of the injectable drug black tar heroin.
Dr. Russo’s paper advises orthopedic surgeons to be vigilant in diagnosing this process early and should perform an extensive debridement.
“One must be suspicious when examining a patient with this clinical history (of injectable drug use) because the diagnosis of flesh-eating bacteria can masquerade as abscesses and cellulitis,” Dr. Russo says.
The keys to treatment are early recognition, swift diagnosis and immediate extensive surgical debridement, coupled with penicillin G and clindamycin IV antibiotics. Because of the bacteria’s rapid timeline, treatment will also include extensive surgery, the doctors recommend in their paper.