Paenibacillus larvae Bacteremia in injection drug users.

Paenibacillus larvae causes American foulbrood in honey bees. We describe P. larvae bacteremia in 5 injection drug users who had self-injected honey-prepared methadone proven to contain P. larvae spores. That such preparations may be contaminated with spores of this organism is not well known among pharmacists, physicians, and addicts.

Methadone hydrochloride, which is widely used for opioid substitution, can be mixed with viscous substances such as syrup to yield a solution that is not suitable for misuse through self-injection. Methadone syrup is intended to be taken only as an oral medication. Some pharmacies use honey instead of syrup to prepare such a solution.

Underestimation of the frequency of true P. larvae bacteremia therefore cannot be excluded. Thus, infectious disease physicians, microbiologists, and pharmacists need to be aware that injection of material contaminated with P. larvae, such as honey-prepared methadone, may cause bacteremic infection.

Rieg, S., Bauer, T. M., Peyerl-Hoffmann, G., Held, J., Ritter, W., Wagner, D., ... & Serr, A. (2010). Paenibacillus larvae bacteremia in injection drug users. Emerging infectious diseases, 16(3), 487.

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