HUNTINGTON — It used to be rare that doctors treated strokes caused by bacteria in the bloodstream, but now they are seeing at least one patient every week in Cabell County, said Dr. Carl McComas, a neurologist at St. Mary’s Medical Center.
The rise in infections is fueled by the opioid epidemic and IV drug use, typically from dirty or shared needles. The infections, known as bacterial endocarditis, are injected into the bloodstream, entering the brain and leading to a massive stroke.
McComas, director of St. Mary’s Stroke Center, spoke about the rise in infection-related strokes before the release of a 22-year study to be presented next month at the 2019 American Stroke Association’s International Stroke Conference in Honolulu, Hawaii.
Using a national hospital inpatient database, researchers identified U.S. residents hospitalized from 1993 to 2015 with the combination of opioid abuse, bacterial endocarditis and any type of stroke.
The study found 5,283 patients were hospitalized with strokes from opioid-related bacterial endocarditis during that time period across the country. There was no significant increase in the rate of stroke hospitalization between 1993 and 2008, but between 2008 and 2015 the rate of stroke hospitalizations increased by 20 percent per year, coinciding with the worsening of the opioid epidemic.
The rates of stroke hospitalizations increased most dramatically in non-Hispanic white patients in the northeastern and southern United States, across all ages and genders. Significant increases occurred in women and people younger than 45 years old.
McComas said those numbers are “almost certainly” to be higher in Cabell County, which was once labeled the epicenter of the heroin and opioid crisis.
“The drug abuse is devastating in all aspects. This is perhaps the worst part because you may not die, but you will be left devastated,” he said. “These are not minor, little strokes. They are major, devastating strokes that quite often send people to a nursing home if they survive all of this.”
People experiencing bacterial endocarditis usually undergo six weeks of IV antibiotics, drug withdrawal and typically some type of treatment for their drug addiction. While hospitalized, they may undergo heart valve replacement surgery.
“Then if they survive all that, the relapse rate in the drug abuse is extraordinarily high,” he said. “It’s not uncommon to see people in on their second or third go-around.”
McComas said 40 or 50 years ago, bacterial endocarditis was common in patients who had childhood rheumatic fever, but that disease virtually doesn’t exist anymore.
“It used to be rare that we saw anybody with bacterial endocarditis-related stroke,” he said. “Now we see one at least every week. I think there are two in the hospital currently.”
There’s an ongoing debate in the medical community about when to decline someone’s second or third heart valve replacement surgery, he said.
“You reach a point and you ask yourself, ‘We know the drug addiction is not solved in this person. At what point do you finally say no?’” he said. “I don’t have an answer to that, but people do raise that question.”
There are some medical centers across the country that refuse to do second heart valve replacements, he said.
The bacterial endocarditis-related stroke presents like a typical stroke, with numbness or weakness in the face, arm or leg on one side of the body. It may also lead to difficulty speaking, confusion, vision loss and a loss of balance. If left untreated, bacterial endocarditis may lead to death.
McComas urged anyone at risk of contracting bacterial endocarditis to seek help for their addiction immediately. He also applauded the Cabell-Huntington Health Department’s needle exchange program, which he said has helped lessen the number of infections.
