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Medline ® Abstract for Reference 15

of 'Candida osteoarticular infections'

Disseminated candidiasis in addicts who use brown heroin: report of 83 cases and review.
Bisbe J, Miro JM, Latorre X, Moreno A, Mallolas J, Gatell JM, de la Bellacasa JP, Soriano E
Clin Infect Dis. 1992;15(6):910.
From November 1983 to April 1990, disseminated candidiasis was diagnosed in 83 heroin addicts at our institution. All patients had consumed brown heroin diluted in fresh lemon juice. Sixty-two (75%) had skin lesions, 41 (49%) had ocular lesions, and 35 (42%) had one or several costochondral tumors. Candida albicans was grown in culture or histopathologically identified in 34 cases (41%). The patients who had only cutaneous lesions were treated with ketoconazole, and they were all cured. The patients with ocular involvement received systemic amphotericin B with or without oral flucytosine; 29 of these patients developed varying degrees of vision loss. The method of treatment of costochondral tumors was not uniform; in 14 cases the lesions were resected. The one patient who died developed endocarditis involving the aortic valve. Cases of pleuropulmonary involvement, spondylitis, and large-joint arthritis have also been described among the 300 cases reported in the reviewed literature. This is a new syndrome of candidal infection in drug addicts who use brown heroin; ocular lesions are the most harmful manifestation, and loss of vision is the major sequela.
Infectious Diseases Unit, Hospital Clinic i Provincial, Barcelona, Spain.