Shrestha Manish, Cox-Davenport Becky, Powell Debra, Donato Anthony
Department of Medicine, Tower Health Medical Group, Reading, USA.
Cureus. 2024 Dec 20;16(12):e76098. doi: 10.7759/cureus.76098. eCollection 2024 Dec.
The recent development of xylazine adulteration of the illicit opiate supply has been associated with necrotic extremity wounds of unclear pathogenesis. This study sought to understand the prevalence and characteristics of delusional infestation (DI) among patients with opiate use disorders who also carried a diagnosis of cellulitis.
A retrospective cross-sectional study was performed in one health system to identify patients with opiate use disorder and cellulitis over the past three years who also described symptoms of DI. We collected demographics, comorbid substance use disorder, and psychiatric diseases and calculated the likelihood of association with drug use by applying the Naranjo Adverse Drug Reaction scale.
Fifteen patients (3.2% of all opiate-dependent individuals) were identified as also having DI. All patients had recurrent symptoms of DI, persisting over 18.3 ± 16 months with 4.6 ± 2.3 different health system contacts. The mean age was 44.4 years (range: 25 to 63 years). Twelve were female (80%, chi-square 5.4, p = 0.02). All had open wounds. Psychiatric comorbidities were common, but only two were schizophrenic, and none were actively psychotic during contact with the health system. Symptoms were either definitely (n = 1) or probably (n = 14) associated with drug exposure, according to the Naranjo Adverse Drug Reaction scale. Thirteen (87%) were also abusing other stimulants. All workups were negative for parasites and eosinophilia.
The prevalence of DI in patients with opiate use disorder was identified as significantly higher than reported in other populations. The role of DI in the formation of skin wounds deserves further study.
最近非法阿片类药物供应中掺入赛拉嗪的情况与发病机制不明的肢体坏死性伤口有关。本研究旨在了解同时患有蜂窝织炎的阿片类药物使用障碍患者中妄想性寄生虫感染（DI）的患病率和特征。
在一个卫生系统中进行了一项回顾性横断面研究，以确定过去三年中患有阿片类药物使用障碍和蜂窝织炎且描述有DI症状的患者。我们收集了人口统计学数据、合并物质使用障碍和精神疾病信息，并通过应用纳伦霍药物不良反应量表计算与药物使用相关的可能性。
15名患者（占所有阿片类药物依赖个体的3.2%）被确定同时患有DI。所有患者都有DI的复发症状，持续18.3±16个月，与卫生系统有4.6±个不同的接触。平均年龄为44.4岁（范围：25至63岁）。12名是女性（80%，卡方值5.4，p=0.02）。所有人都有开放性伤口。精神疾病合并症很常见，但只有两名是精神分裂症患者，在与卫生系统接触期间没有一人处于精神病发作期。根据纳伦霍药物不良反应量表，症状与药物暴露明确相关的有1例，可能相关的有14例。13名患者（87%）还滥用其他兴奋剂。所有检查均未发现寄生虫和嗜酸性粒细胞增多。
阿片类药物使用障碍患者中DI的患病率被确定显著高于其他人群。DI在皮肤伤口形成中的作用值得进一步研究。
