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Emerg Infect Dis. 2018 Apr;24(4). doi: 10.3201/eid2404.171807.

Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA.


The epidemic of illicit intravenous drug use (IVDU) in the United States has been accompanied by a surge in drug overdose deaths and infectious sequelae. Candida albicans infections were associated with injection of contaminated impure brown heroin in the 1970s-1990s; however, candidiasis accompanying IVDU became considerably rarer as the purity of the heroin supply increased. We reviewed cases of candidemia occurring over a recent 7-year period in persons >14 years of age at a tertiary care hospital in central Massachusetts. Of the 198 patients with candidemia, 24 cases occurred in patients with a history of IVDU. Compared with non-IVDU patients, those with a history of IVDU were more likely to have non-albicans Candida, be co-infected with hepatitis C, and have end-organ involvement, including endocarditis and osteomyelitis. Thus, IVDU appears to be reemerging as a risk factor for invasive candidiasis.


Candida albicans; Massachusetts; United States; candidemia; candidiasis; endocarditis; fungal infections; fungi; heroin; intravenous substance abuse

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