Contaminated lemons as possible source of infection in heroin abusers with disseminated candidiasis

Podzamczer, Daniel; Ventin, Manuel; Sauca, Goretti; Fernández-Viladrich, P; Martín, R. Jorba; Gudiol, Francesc

doi:10.1007/bf02075717

Cited by 16 publications

(8 citation statements)

References 3 publications

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“…The final stage of the syndrome is osteoarticular involvement, which occurs weeks to months after the initial symptoms and involves primarily costochondral regions, although the spine is also frequently involved [14,60]. Epidemiological and laboratory studies traced the potential source of Candida contamination to lemon juice used to dissolve the injected heroin [61][62][63][64]. Curiously, our patient used lemon juice to dissolve her crack cocaine before injection and even commented that the lemons frequently appeared moldy.…”

Section: Discussionmentioning

confidence: 93%

Vertebral Osteomyelitis due toCandidaSpecies: Case Report and Literature Review

2001

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Candida species uncommonly cause vertebral osteomyelitis. We present a case of lumbar vertebral osteomyelitis caused by Candida albicans and review 59 cases of candidal vertebral osteomyelitis reported in the literature. The mean age was 50 years, and the lower thoracic or lumbar spine was involved in 95% of patients. Eighty-three percent of patients had back pain for >1 month, 32% presented with fever, and 19% had neurological deficits. The erythrocyte sedimentation rate was elevated in 87% of patients, and blood culture yielded Candida species for 51%. C. albicans was responsible for 62% of cases, Candida tropicalis for 19%, and Candida glabrata for 14%. Risk factors for candidal vertebral osteomyelitis were the presence of a central venous catheter, antibiotic use, immunosuppression, and injection drug use. Medical and surgical therapies were both used, and amphotericin B was the primary antifungal agent. Prognosis was good, with an overall clinical cure rate of 85%.

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Section: Discussionmentioning

confidence: 93%

Vertebral Osteomyelitis due toCandidaSpecies: Case Report and Literature Review

2001

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“…Other sources of C. novyi or C. botulinum, such as injection paraphernalia or the acidulates used during drug injection, were not investigated. Lemon juice (also used as an acidulant in heroin abuse) has been implicated as a source of Candida albicans in outbreaks of systemic candidosis among IDUs [38,39].…”

Section: Discussionmentioning

confidence: 99%

An investigation into the microflora of heroin

McLauchlin¹,

Mithani²,

Bolton³

et al. 2002

Journal of Medical Microbiology

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In 2000, an unusual increase of morbidity and mortality among illegal injecting drug users in the UK and Ireland was reported and Clostridium novyi was identified as the likely source of the serious infection, although infections due to C. botulinum and Bacillus cereus were also reported. Because heroin was a possibile source of infection, this study investigated the microflora of heroin samples seized in England during 2000 and 2002. Two methods were developed for the examination of the microflora of heroin. The first consisted of suspension of the drug in maximum recovery diluent (MRD) which was inoculated directly into Clostridium Botulinum Isolation Cooked Meat Broth (CBI). The second method rendered the heroin soluble in citric acid, concentrated particulate material (and bacterial cells) by filtration and removed heroin residues by washing with citric acid and phosphate-buffered saline before placing the filter in CBI broth. Duplicate CBI broths from both methods were incubated without heating and after heating at 608C for 30 min. Subcultures were made after incubation for 7 and 14 days on to eight different solid media. The methods were evaluated with heroin samples spiked with either C. botulinum or C. novyi spore suspensions; recovery of 10 spores in the original sample was demonstrated. Fifty-eight heroin samples were tested by citric acid solubilisation and 34 by the MRD suspension technique. Fifteen different grampositive species of four genera were recognised. No fungi were isolated. Aerobic endospore-forming bacteria (Bacillus spp. and Paenibacillus macerans) were the predominant microflora isolated and at least one species was isolated from each sample. B. cereus was the most common species and was isolated from 95% of all samples, with B. licheniformis isolated from 40%. Between one and five samples yielded cultures of B. coagulans, B. laterosporus, B. pumilus, B. subtilis and P. macerans. Staphylococcus spp. were isolated from 23 (40%) samples; S. warneri and S. epidermidis were the most common and were cultured from 13 (22%) and 6 (10%) samples respectively. One or two samples yielded cultures of S. aureus, S. capitis and S. haemolyticus. The remainder of the flora detected comprised two samples contaminated with C. perfringens and two samples with either C. sordellii or C. tertium. Multiple bacterial species were isolated from 43 (74%) samples, a single species from the remaining 15. In 13 samples B. cereus alone was isolated, in one B. subtilis alone and in one sample B. pumilus alone. C. botulinum and C. novyi were not isolated from any of the heroin samples. Recommendations for the optimal examination of the microflora of heroin are given.

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“…Lemon juice proved to be a source of C albicans. [9][10][11][12] Recently, a few cases have been reported in patients with ocular candidiasis who injected buprenorphine, an oral substitute for heroin. These cases seem to confirm that the fungi probably come from lemon juice or from the patient.…”

Section: Discussionmentioning

confidence: 99%

Phacoemulsification in isolated endogenous Candida albicans anterior uveitis with lens abscess in an intravenous methadone user

Trpin¹,

Gračner²,

Pahor³

et al. 2006

Journal of Cataract and Refractive Surgery

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We report the clinical course of a 31-year-old former intravenous drug user on methadone substitution therapy who injected methadone mixed with orange juice. She developed isolated metastatic Candida albicans anterior uveitis, which was treated with adequate systemic and local antifungal therapy. The uveitis regressed, but despite adequate local and systemic treatment, a lens abscess developed. Phacoemulsification and endocapsular intraocular lens implantation were performed, and the patient recovered 20/20 visual acuity in the affected eye. In patients with a history of injection drug use, persisting intravenous drug or substitution therapy abuse must be considered. Quick diagnosis and adequate treatment can prevent the development of widespread C albicans endophthalmitis, which has a poor visual prognosis. Early administration of antifungal and surgical therapy is crucial for achieving good functional results.

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Contaminated lemons as possible source of infection in heroin abusers with disseminated candidiasis

Cited by 16 publications

References 3 publications

Vertebral Osteomyelitis due toCandidaSpecies: Case Report and Literature Review

Vertebral Osteomyelitis due toCandidaSpecies: Case Report and Literature Review

An investigation into the microflora of heroin

Phacoemulsification in isolated endogenous Candida albicans anterior uveitis with lens abscess in an intravenous methadone user

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