Public Health in British Columbia continues to receive reports of agranulocytosis related to levamisole tainted cocaine. The BC investigation is coordinated by the BC Centre for Disease Control which is once again reminding MHOs and physicians about the importance to be attached to this issue. A public health alert was originally issued in December 2008, providing background and context.
A standard case report form has been developed to collect case details; urine testing for levamisole (when urine sample obtained within 48 hours of last cocaine use) can be arranged; please contact your local Medical Health Officer for more details.
Background
Levamisole was previously used as an antihelmithic and colon cancer treatment, but has not been available in Canada since 2005. Previously levamisole was found to cause neutropenia associated with an autoimmune response and HLA-B27 antigen.
A cluster of cases were identified in Alberta in November 2008 and cases subsequently confirmed in BC. An alert was sent out in BC on December 11th 2008; 21 individuals with levamisole associated agranulocytosis have been reported in BC occurring between January 1st 2008 and March 31st 2009. Many individuals have had repeat episodes of severe neutropenia - defined as neutrophil count < 0.5 per 109/L.
For more information, please refer to Agranulocytosis (neutropenia) associated with levamisole in cocaine British Columbia UPDATE: April 9, 2009 [PDF, 85KB]
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