Research identifies ‘bath salts’ as new source of flesh-eating infection

A case report published in the January issue of Orthopedics found that an intramuscular injection of the street drug known as ‘bath salts’ is a potential source of necrotizing fasciitis.

According to a news release from the Louisiana State University Health Sciences Center, the study covers the first known case of necrotizing fasciitis from this particular cause.

“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,” lead researcher Russell R. Russo, MD, stated in the release.

Russo and colleagues treated a 34-year-old who woman presented with forearm pain and redness that began after she attended a party. While the patient did not report any other symptoms, the physicians noted a small red puncture wound on her arm. Cellulitis treatment with broad-spectrum intravenous antibiotics reduced the symptoms, but lingering pain at the injection site led the researchers to perform an ultrasound.

The patient then noted she had injected ‘bath salts’ 2 days prior to the development of symptoms. Upon re-examination, the study authors found rapidly progressing redness, skin sloughing and drainage. Necrotizing fasciitis was suspected, and the patient underwent immediate emergent surgical debridement and exploration. Further antibiotic treatments were also added.

According to the news release, the study authors had to amputate the patients arm, shoulder and collarbone to stop the infection. The patient also needed a radical mastectomy. The patient survived and underwent skin grafting and rehabilitation.

Bacterial isolates revealed through analysis included alphahemolytic Steptococcus, Steptococcus viridians, Peptostreptococcus micros, Gemella morbillorum and Actinomyces odontolyticus.

The researchers noted that while these infections are typically associated with crush trauma and farm injuries, physicians should now be prepared and vigilant when presented with a cellulitic patient who reports a history of needle use.

“The recent emerging popularity of this highly obtainable, injectable substance may lead to an increase in cases of necrotizing fasciitis,” Russo stated in the release. “Surgeons must be ready to diagnose and perform extensive debridements in association with general surgeons in some instances to save limbs, preserve function and prevent death.”

Reference:

Russo R, Marks N, Morris K, et al. Life-threatening necrotizing fasciitis due to ‘bath salts’ injection. Orthopedics. 2011. doi: 10.3928/01477447-20111122-36

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