• Cocaine Laced With Dewormer
• Crack Cocaine Cut With Levamisole
• Cocaine Cut With Dewormer
• Levamisole Cocaine Symptoms
• Levamisole Induced Vasculitis
• Cocaine Cut With Levamisole

Disease summary is provided courtesy of VisualDx, the visual diagnostic decision support system for health care professionals. To view more images of Cocaine Levamisole Toxicity and other visually presenting diseases and adverse drug reactions, log in to VisualDx or try it now.

Diagnosis Synopsis

Cocaine Levamisole Toxicity : Cocaine contaminated with levamisole has been detected in the United States since 2003, and the incidence of toxicity caused by this contamination has been increasing rapidly since 2008. Use of cocaine that has been adulterated with levamisole can lead to a constellation of symptoms including agranulocytosis, neutropenia, and a vasculitis-like purpuric tender skin eruption. The most common sites of purpura are the external ears and cheeks. The purpura is generally followed by skin necrosis, but resolves several weeks after cessation of cocaine use. Recurrent use of contaminated cocaine generally results in recurrent skin eruptions.

Concomitant symptoms of arthralgias, fever, and mouth pain have been reported.
The CDC estimates that approximately 70% of cocaine in the United States may be contaminated with levamisole. Toxicity induced by levamisole seems to affect all ages and both genders equally depending on cocaine use. The cocaine can be either smoked as crack cocaine or snorted. Some analyses have revealed up to 10% contamination of individual cocaine products.
Because levamisole is difficult to test for and because other treatable causes of vasculitis may be present, levamisole-induced toxicity is a diagnosis of exclusion. Several published cases have had concurrent or preceding medical histories that involve both chronic and acute infections as well as signs of chronic autoimmune disease. Other cases have had absolutely no preceding medical history.
Since neutropenia is a common presenting sign of this toxicity, bacterial or fungal infections may be presenting features of levamisole toxicity.

Look For

Jul 02, 2019  This woman, who had been taking cocaine laced with de-wormer levamisole, noticed the skin on her face was starting to rot Credit: BMJ CASE REPORTS. Cocaine cut with the veterinary drug levamisole could be the culprit in a flurry of flesh-eating disease in New York and Los Angeles. The drug, used to deworm cattle, pigs and sheep, can rot the skin off noses, ears and cheeks. And 82 percent of the country's coke supply contains it.

Oct 16, 2018  A patient in New York was diagnosed with ANCA-associated vasculitis and compromised kidney function caused by levamisole-adulterated cocaine, which scientists consider to be a rare occurrence. The study, “ Unusual case of levamisole-induced dual-positive ANCA vasculitis and crescentic glomerulonephritis, ” was published in BMJ Case Reports. Samples of cocaine that were analyzed in July found that nearly 80 percent contained the veterinary drug, according to SAMHSA. 31 Associated Press article reported that levamisole began showing up frequently in cocaine from Columbia beginning in January 2008, and that, by late 2008, the DEA found the laced cocaine being widely circulated.

Somewhat tender purpuric macules and papules on the helix of the ear or the cheeks. Retiform or stellate purpura on the trunk and extremities that can progress to bullae. Very early, the purpura may be preceded by erythematous macules. Progression of the purpura to necrosis and crusting eschars is common before resolution.
Dark Skin Patient Considerations
In dark-skinned individuals, the rash may present with deep red to brown or purple macules and papules. Purpura is difficult to detect in extremely dark skin.

Download now the serial number for Adobe Acrobat 7 Professional. All serial numbers are genuine and you can find more results in our database for Adobe software. Updates are issued periodically and new results might be added for this applications from our community. Acrobat pro 7 serial number.

Diagnostic Pearls

Neutropenia is a common laboratory finding. The combination of neutropenia in a patient with purpura of the ears and a urine toxicology screen positive for cocaine should suggest levamisole-induced vasculitis. Levamisole testing of serum or urine is difficult and unreliable.
Multiple autoimmune serological markers can be positive including anti-dsDNA, ANCAs, platelet factor IV antibody, lupus anticoagulant, Russell viper venom time, elevated PTT, and anticardiolipin IgM. Careful consultation with rheumatology to consider autoimmune diseases is recommended.

Differential Diagnosis & Pitfalls

The differential diagnosis for cocaine levamisole toxicity includes many of the same diagnoses as for leukocytoclastic vasculitis (LCV) or drug toxicities. Secondary causes of LCV such as infection, medication reactions, neoplasms, and autoimmune connective tissue disorders should be sought out.

• Cryoglobulinemia – check for serum IgM and IgG cryoglobulins, HCV infection.
• Cryofibrinogenemia
• Bacterial sepsis
• Coumadin necrosis
• Heparin necrosis
• Purpura fulminans
• Acute meningococcemia – the patient is usually systemically ill, but since cocaine use may complicate the neurologic exam, this diagnosis should be considered carefully.
• Calciphylaxis
• Vasculitis secondary to viral infections such as hepatitis A, B, C, VZV, parvovirus B19, and CMV, or to medications.
• Arthropod bites
• Erythema multiforme minor (EM) – characteristic findings on histology will assist in differentiating EM from LCV. Systemic involvement is rare.
• Toxic epidermal necrolysis (TEN) – usually larger areas of skin are involved with more skin pain and resulting bullae.
• Frostbite or chilblains (perniosis) – history of recent cold exposure.
• Microscopic polyangiitis is ANCA positive and has palpable purpura and constitutional symptoms; look for evidence of pulmonary and renal involvement.
• Wegener's granulomatosis is ANCA positive and has necrotizing granulomatous inflammation of the upper and lower respiratory tracts, glomerulonephritis.
• Churg-Strauss syndrome is ANCA positive and is associated with eosinophilia and asthma.
• Polyarteritis nodosa – medium vessel vasculitis with subcutaneous nodules, livedo reticularis, ulcers, and gangrene as cutaneous manifestations.
• Immune thrombocytopenic purpura – look for isolated thrombocytopenia.

Sometimes non-vasculitic purpura on the lower extremities may be palpable such as those seen in the following:

• Over-anticoagulation with Coumadin (warfarin) or heparin
• Early disseminated intravascular coagulation

Best Tests

Cocaine levamisole toxicity is a diagnosis of exclusion and depends heavily on the history. Although very suggestive, the use of cocaine before a characteristic purpuric eruption does not necessarily implicate this drug or contamination with levamisole. It is critical to identify other treatable causes of vasculitis such as infection or autoimmune disease. It is also important to evaluate and identify any internal organ involvement.
A skin biopsy will be helpful to rule out other diseases but will not implicate cocaine or levamisole directly. Fibrin thrombi are commonly seen in the vessels, but all features of leukocytoclastic vasculitis may not be present.
Laboratory studies:

• Urine toxicology to detect cocaine use
• Liver function tests
• CBC with differential (neutropenia is a common associated finding; also look for the presence of leukocytosis, eosinophilia, and atypical lymphocytes to indicate ongoing infection or leukemia)
• Urinalysis and renal function tests

Lumbar puncture or imaging studies can be ordered to rule out other causes of vasculitis or altered mental status if localizing symptoms are present.
A skin biopsy will likely be helpful, but this diagnosis depends on ruling out other causes of vasculitis.

Management Pearls

Consultations may be needed with dermatology, critical care, infectious disease, and rheumatology. Depending on the level of cocaine abuse or the use of other addictive drugs, psychiatry may need to be consulted during withdrawal.
Elevated serological markers tend to resolve after 2-10 months.
When patients are severely neutropenic, care should be taken to monitor for concurrent bacterial and fungal infections.

Therapy

Use of contaminated cocaine must be stopped immediately. Management is generally supportive. Many patients will recover spontaneously, although sometimes slowly. Optimize supportive care for any specific complications or wound care.
Authors
Art Papier MD, Noah Craft MD

COCAINE users are being warned their skin and genitals could ROT away because the drug is being laced with dangerous cattle de-wormer.

Around two thirds of the Class A drug smuggled into Britain is cut with levamisole, which is fed to cows and horses.

The news comes as The Sun launches its End Of The Line campaign to raise awareness of the devastating effect the drug can have on users' mental and physical health.

Cocaine use has doubled in the UK over the last five years, and use among young people is surging, with 20 per cent of 16 – 24-year-olds taking it in the last year.

Cocaine used to arrive in the UK from South America in pure form, but drug gangs now cut the product before it is shipped.

Levamisole is cheap in countries such as Colombia and Venezuela and acts as a stimulant so it's easy to disguise to users.

Have you or your family been affected by cocaine? Tell us your story by emailing endoftheline@thesun.co.uk

It was used to treat arthritis and bowel cancer in the past, but it was banned for use by humans in 2000.

This was due to the severe side effects, including damaging white blood cells so badly that it causes skin rotting.

Now, it's only supposed to be used in veterinary medicine to kill parasitic worms.

But there have been a number of reported cases where people have been left with rotting skin after taking cocaine that's been mixed with the chemical.

Rotting away

Doctors in Colombia published a report in BMJ Case Reports of 11 patients who had all taken cocaine-levamisole that had caused parts of their face, limbs, buttocks and stomach to rot away.

For three of them, the blood supply to the genitals had been cut off - causing the skin to turn black and die.

The group were aged between 31 and 39, nine of them were men and all of them had been using cocaine for more than two years.

Experts said that cases had risen due to the use of cocaine mixed with the chemical, and as well as the skin concerns, they also noted joint and lung conditions.

They were treated with steroids and after quitting drugs, all of the patients were able to recover.

Hair-raising

In another case, a 42-year-old woman went to see her doctor in the Netherlands complaining of ulcerating sores on her legs and face.

She persistently denied substance abuse but after testing her hair for toxins, medics discovered she had been taking cocaine cut with levamisole.

In another instance, in Texas, USA, a 68-year-old woman went to doctors with a blood-filled blister on the end of her nose while her forearms and face were covered in fleshy sores.

Tests revealed she had been taking cocaine laced with levamisole and doctors diagnosed her with vasculitis - an inflammation of the blood vessels.

She was told to stop using the drugs and her condition cleared up in six months.

Cocaine use is reaching epidemic levels in Britain, with the UK branded the ‘Coke capital’ of Europe.

Use has doubled in the last five years, and with young people the numbers are even worse.

A staggering one in five 16-to-24-year-olds have taken cocaine in the last year.

That’s why The Sun has launched its End Of The Line campaign, calling for more awareness around the drug.

Cocaine use can cause mental health problems such as anxiety and paranoia, while doctors have linked the rise in cheap, potent coke to an increase in suicide rates.

People from all walks of life, from builders and labourers to celebrities like Jeremy McConnell – who is backing our campaign – have fallen foul of its lure.

It’s an issue that is sweeping the UK and, unless its tackled now, means a mental health crisis is imminent.

Dr Sarah Jarvis, GP and clinical director of Patient.info, says people need to know about the risks they are taking when using coke.

She said: 'When you buy recreational drugs, you’re not just putting yourself at risk from the drug itself.

'Unscrupulous drug dealers often ‘cut’ their drug with other, cheaper products to increase their profits even further. And they don’t care how dangerous those other products are.

'Levamisole is one such product – it’s used to deworm cattle but used to be used to treat cancer in humans before it was taken off the market because of safety concerns.
'It can cause complete collapse of your immune system and even cause your skin to rot.

'There is no cure for either of these side effects – people just have to be admitted to hospital and given therapy to try and prevent life-threatening complications.”

Politicians have previously warned over the dangers of levamisole-laced cocaine making its way to the UK.

Lib Dem MP and former Crime Prevention Minister, Norman Baker, told The Sun in 2014: 'Those who choose to use cocaine and think they know what they’re doing are playing Russian Roulette with their lives.

Helpline open 24/7: 0300 123 6600

For help finding a service or to Instant chat

Help for anyone with drug and alcohol issues.

Dedicated help for people under 25.

Check out the green mp3 converter button, it actually adds meta data to the mp3, such as artist name, song title, genre, and of course video thumbnail as album art, oralbum art as album art, which ever is present at the right time. Also note, if your software is showing same thumbnail for all mp3s, -it's a known android thing, just get a different software, like VLC. It's easy to locate new mp3s this way. There are services that provide youtube to mp3 conversion, if you put their button on your site. So here's how our website works.

Mental health support line: 0300 304 7000

Rehab and community addiction treatment

0300 330 0659

Cocaine Laced With Dewormer

Helpline open 9am-9pm, 7 days a week

0300 888 3853

Help for families affected by drugs and alcohol

“They have no idea what is in them. Who wants cattle dewormer up their nose?”

Almost all cocaine and crack sold on the street is diluted by at least one of other chemical, studies have shown.

They are often local anaesthetics such as benzocaine, lidocaine and phenacetin, but can also include paracetamol or lactose.

From the moment cocaine is snorted, smoked or injected, it starts wreaking havoc on the body.

It creates a euphoric high, but this is short-lived, lasting between 20 to 30 minutes - leaving users desperately chasing the same high.

The more you use it, the more your brain will adapt to it, meaning you need a stronger dose to feel the same euphoria the next time around.

Aside from rotting flesh, using cocaine can have other long-term impacts on your health.

Dr Jarvis added: 'It can cause heart attacks even in young, otherwise healthy people; seizures and brain damage; and severe mental health problems, including paranoid ideas.'

Yet worryingly, more than one in ten British adults have tried cocaine, double the EU average and use among young people is surging, with 20 percent of 16-to-24-year-olds taking it in the past year.

As well as the physical side-effects, the drug can have a profound impact on users’ mental health, as the devastating deaths of Love Island’s Mike Thalassitis and Sophie Gradon have shown.

Both had traces of cocaine in their systems when they killed themselves.

Crack Cocaine Cut With Levamisole

This is why The Sun is calling for the End Of The Line.

Cocaine is highly addictive and what can start out as a one-off can quickly turn into a habit.

Cocaine Cut With Dewormer

Regular use of the drug changes the way the brain releases dopamine - a chemical in the brain that makes you feel happy.

But the high is short-lived so often users will take more to feel the desired effects again.

Levamisole Cocaine Symptoms

Over time, the body and brain can become too used to cocaine that it builds up a tolerance, which means you have to take more to feel the same high.

Levamisole Induced Vasculitis

If you recognise any of the following behaviours in yourself, it might mean you've developed an addiction to cocaine:

Cocaine Cut With Levamisole

• You're taking more of the drug to feel the effects
• When you stop or reduce your dosage, you feel agitated, restless and depressed
• You're struggling to cut down or control how much you take, even if you try to
• You spend a lot of time thinking about and trying to get cocaine
• You're disregarding family, friends and work in favour of taking cocaine
• You know the damage it's doing to you, but you can't stop taking it

We pay for your stories! Do you have a story for The Sun Online news team? Email us at tips@the-sun.co.uk or call 0207 782 4368 . You can WhatsApp us on 07810 791 502. We pay for videos too. Click here to upload yours.