Exposure

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Adverse Manifestations

Cardiovascular Manifestations

Endocarditis (see Endocarditis, [[Endocarditis]])

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Infectious Manifestations

Human Immunodeficiency Virus (HIV) Infection (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])

• Epidemiology: IVDA is a strong risk factor for the acquisition of HIV

Septic Embolism (see Septic Embolism, [[Septic Embolism]])

• Epidedmiology
• Physiology
  • Embolization from Endocarditis (see Endocarditis, [[Endocarditis]])
    • Right-Sided (Tricuspid Valve) Endocarditis is More Common Than Left-Sided Endocarditis in the Setting of IVDA
  • Embolization from Septic Thrombophlebitis (see Septic Thrombophlebitis, [[Septic Thrombophlebitis]])

Ophthalmologic Manifestations

Talc Retinopathy

• Epidemiology: occurs in >50% of foreign body granulomatosis cases
• Clinical: talc emboli near macula within small vessels

Pulmonary Manifestations

Amyloidosis (see Amyloidosis, [[Amyloidosis]])

• Epidemiology: reported in intravenous drug abusers with HIV infection
• Clinical
  • Bilateral Pulmonary Nodules (see Lung Nodule or Mass, [[Lung Nodule or Mass]])

Chest Pain + Wheezing + Hemoptysis (see Chest Pain, [[Chest Pain]], Obstructive Lung Disease, [[Obstructive Lung Disease]], and Hemoptysis, [[Hemoptysis]])

• Epidemiology: associated with acute intravenous methylphenidate abuse (see Methylphenidate, [[Methylphenidate]])
• Physiology
  • Adrenergic Activity
  • Vasospasm

Foreign Body Granulomatosis (see Foreign Body Granulomatosis, [[Foreign Body Granulomatosis]])

• Epidemiology
  • Associated with the Pulverization of Tablets (Which May Contain Fillers Such as Talc, Starch, Cotton, Cellulose), Dissolution in Water, and Subsequent Intravenous Injection
• Physiology
  • Embolization of Filler Substances to the Pulmonary Capillaries with Formation of Foreign Body Granulomas
• Clinical
  • Advanced Emphysema-Like Picture (see Obstructive Lung Disease, [[Obstructive Lung Disease]])
  • Granulomatous Interstitial Lung Disease/Fibrosis (see Interstitial Lung Disease, [[Interstitial Lung Disease]])
  • Granulomatous Pulmonary Arterial Occlusion with Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]])
  • Hilar Lymphadenopathy (see Mediastinal Mass, [[Mediastinal Mass]])
  • Progressive Massive Fibrosis-Like Conglomerate Lung Masses (see Lung Nodule or Mass, [[Lung Nodule or Mass]])

Increased Risk of Candida Pneumonia (see Candida, [[Candida]]) (Thorax, 1990) [MEDLINE]

• Physiology
  • Candida Contamination of Drug

Increased Risk of Community-Acquired Pneumonia (CAP) (see Community-Acquired Pneumonia, [[Community-Acquired Pneumonia]])

• Epidemiology
  • Intravenous Drug Abuse Carries a 10x-Increased Risk of Community-Acquired Pneumonia (CAP) (Thorax, 1990) [MEDLINE]
• Physiology
  • Altered Mental Status with Increased Risk of Aspiration
  • Bacteremia with Hematogenous Seeding of the Lung
  • Coexisting HIV Infection (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])
  • Impaired of Local Pulmonary Defenses, Impaired Macrophage Activity, and Impaired Mucociliary Clearance Due to Concomitant Illicit Drug/Tobacco Abuse (see Tobacco, [[Tobacco]])
• Most Commonly-Implicated Organisms
  • Escherichia Coli (see Escherichia Coli, [[Escherichia Coli]])
  • Haemophilus Influenzae (see Haemophilus Influenzae, [[Haemophilus Influenzae]])
  • Klebsiella Pneumoniae (see Klebsiella Pneumoniae, [[Klebsiella Pneumoniae]])
  • Staphylococcus Aureus (see Staphylococcus Aureus, [[Staphylococcus Aureus]])
  • Streptococcus Pneumoniae (see Streptococcus Pneumoniae, [[Streptococcus Pneumoniae]])

Increased Risk of Fatal Asthma (see Asthma, [[Asthma]])

• Epidemiology: in intravenous drug abusers with a history of asthma

Increased Risk of Tuberculosis (see Tuberculosis, [[Tuberculosis]])

• Epidemiology
  • Confounding Risk Factors in this Population
    • HIV Infection (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])
    • Homelessness
    • Malnutrition (see Malnutrition, [[Malnutrition]])
    • Poor Medical Care
    • Poverty

Non-Cardiogenic Pulmonary Edema/Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome, [[Acute Respiratory Distress Syndrome]])

• Epidemiology
  • Associated with Intravenous Cocaine Injection (see Cocaine, [[Cocaine]])
  • Associated with Opiate (Heroin, etc) Injection (see Opiates, [[Opiates]])
  • Associated with Methadone Overdose (see Methadone, [[Methadone]])
• Possible Physiologic Mechanisms
  • Central Nervous System Depression with Upper Airway Obstruction: resulting in negative-pressure pulmonary edema
  • Direct Effect of Drug with Resulting Increased Pulmonary Capillary Permeability
  • Cerebral Edema-Associated Neurogenic Pulmonary Edema (see Neurogenic Pulmonary Edema, [[Neurogenic Pulmonary Edema]])

Pneumothorax/Pneumomediastinum (see Pneumothorax, [[Pneumothorax]] and Pneumomediastinum, [[Pneumomediastinum]])

• Epidemiology
  • Associated with Attempted Injection into the Subclavian or Jugular Veins (“Pocket Shot”)

Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]])

• Epidemiology
  • Associated with Sympathomimetics
    • Cocaine (see Cocaine, [[Cocaine]])
    • Amphetamine (see Amphetamine, [[Amphetamine]])
    • Methamphetamine (see Methamphetamine, [[Methamphetamine]])
• Physiology
  • xxxx

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• xxxx

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References

• Pulmonary complications of intravenous drug misuse. 2. Infective and HIV related complications. Thorax. 1990 Dec;45(12):957-61 [MEDLINE]