The modification of illicit drugs is not an uncommon phenomenon. Awareness of the differential diagnosis will assist clinicians with case timely detection and appropriate management. Some patients may be genetically predisposed to develop levamisole-related neutropenia. Our findings support a link between neutropenia and levamisole tainted cocaine particularly from smoking the crack form of cocaine. A further 18 cases were identified through the retrospective review of laboratory and medical examiner data in Alberta Interpretation Analysis of two crack pipes and one drug sample obtained from NATC cases confirmed the presence of both cocaine and levamisole. One Alberta NATC case produced anti-neutrophil antibodies, and four were positive for anti-neutrophil cytoplasmic antibody (ANCA). Cases typically presented with bacterial/fungal infections and fever. Fifty percent of the NATC cases had multiple episodes of neutropenia associated with cocaine use. Of the 42 NATC cases: 23(55%) were from Alberta 19(45%) were from British Columbia 57% of these cases reported crack cocaine use (93% of those who identified type of cocaine used) 7% reported using cocaine powder and the main route of cocaine administration was from smoking (72%). We compare cases of severe neutropenia associated with tainted cocaine (NATC) identified in Alberta and BC between Januto March 31, 2009. Only the confirmed and probable cases are included in this paper. Cases were categorized as confirmed, probable or suspect. MethodsĬases were identified prospectively through reporting by clinicians and a retrospective review of laboratory and medical examiners data from Januto March 31, 2009. This paper presents the findings of the public health investigations. Alberta and British Columbia (BC) public health officials issued an advisory and urged health care professionals to report cases to public health. Five cases of severe neutropenia (neutrophil counts < 0.5 per 10 9 cells/L) associated with exposure to cocaine and levamisole, an antihelimithic agent no longer available in Canada, were identified in Alberta in 2008.
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