October 2010 (posted 10/20/10)
During the last year, we have sent out several health alerts regarding contaminated cocaine. The contaminant is Levamisole. The CDC in a surveillance study has noted that the Levamisole is now showing up as an isomer mix. As previously reported, it has caused significant agranulocytosis in some of those exposed. However, a new adverse consequence to use has been reported - ANCA vasculitis.
Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is the most common primary systemic small-vessel vasculitis to occur in adults. Although the etiology is not always known, the incidence of vasculitis is increasing. Vasculitis may affect the large, medium, or small blood vessels. Small-vessel vasculitis may be further classified as ANCA-associated or non-ANCA-associated vasculitis. ANCA-associated small-vessel vasculitis includes microscopic polyangiitis (can affect many of the body's organ systems including (but not limited to) the kidneys, nervous system, skin, and lungs), Wegener's granulomatosis (affects the lungs, kidneys and other organs), Churg-Strauss syndrome,Â (involves mainly the lungs, gastrointestinal system, and peripheral nerves, but also affects the heart, skin and kidneys) and drug-induced vasculitis.
Features that may aid in defining the specific type of vasculitic disorder include the type of organ involvement, presence and type of ANCA (myeloperoxidase-ANCA or proteinase 3-ANCA), presence of serum cryoglobulins, and the presence of evidence for granulomatous inflammation.
Treatment usually includes corticosteroid and immunosuppressive therapy.
May 2010 (posted 5/5/10)
An initial advisory (see below) was provided in October 2009 regarding contaminated cocaine. Over the last four years, contamination has increased from seven percent to most recently 82 percent in Chicago.
A new initial symptom of contamination has also been described in addition to the agranulocytosis, that being redness and dark discoloration of the skin, starting in the ears. This appears to be a sign of skin cell death.
It has been reported by the Departments of Health in New Mexico, Canada and Delaware that there have been several cases of agranulocytosis (uh-gran-yuh-loh-sahy-toh-sis) following the use of cocaine. This condition leaves patients unable to fight off infections.
The unusual condition can be fatal because it compromises the immune system. It appears that the condition could be related to using cocaine that is contaminated with levamisole. The U.S. Department of Justice reported that between January and April 2008, levamisole found in tested cocaine had increased from nine percent to 19 percent.
Levamisole is a cancer (antineoplastic) medication used in cancer treatment. It is also widely used in veterinary medicine in the de-worming of many animals. Serious side effects have been reported with the use of levamisole including: allergic reactions (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); decreased bone marrow function or blood problems (fever or chills; or signs of infection); nervous system problems (confusion or loss of consciousness, extreme fatigue, memory loss, muscle weakness, numbness or tingling; seizure, speech disturbances); and others.
People who use cocaine and experience one or more of the following symptoms listed below should see a doctor and inform them of their cocaine use.
- persistent or recurrent fever and chills
- worsening swollen glands
- painful sores in the mouth or around the anus
- frequent, persistent or worsening skin infections
- worsening or persistent sore throat
- thrush - a white coating of the mouth, tongue, or throat
- other unusual infection