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Fungal infections re-emerge with surge in opioid crisis, study shows

Stuart Levitz documents increase in Emerging Infectious Diseases journal

  Stuart Levitz, MD

Stuart Levitz, MD

UMass Medical School infectious disease researchers have identified a re-emergence of fungal infections associated with illicit intravenous drug use as the United States grapples with the opioid crisis, according to an article published in the April 2018 online issue of Emerging Infectious Diseases and distributed by the Centers for Disease Control and Prevention (CDC).

During the 1970s through the 1990s, fungal infections due to Candida albicans were associated with injections of contaminated impure brown heroin among illicit intravenous drug users, according to Stuart Levitz, MD, professor of medicine and microbiology & physiological systems. Dr. Levitz explained that as opioid overdoses have emerged as a major problem in the United States, documented by the CDC, the trend has resurfaced.

“During that time period, the heroin supply was relatively impure and people would use lemon juice to dissolve it,” said Levitz, whose research and clinical interest is in fungal infections. “It was believed the lemon juice got contaminated with Candida, and drug users were injecting Candida into their blood stream and getting Candida infections. But, the problem went away when the heroin supply became much purer.”

Levitz worked with colleagues, including infectious disease physician Nongnooch Poowanawittayakom, MD, who is pursuing a master’s of public health at UMass, to review cases of Candida in patients at UMass Memorial Medical Center. They analyzed 198 cases of Candida infections occurring from January 2010 through January 2017 in patients 14 or older. A surprisingly large number, 24, had a history of illicit intravenous drug use.

“The take home point from the study is not necessarily that we compared 24 patients with intravenous drug use to 174 without. It’s the fact that we had 24 patients who were using IV drugs and suffered from Candida infections,” Levitz added. “In addition, nine of the 24 cases were in the last year of the study in correspondence with the surging opioid crisis.”

These cases emphasize that in addition to overdoses, infections remain a serious cause of illness and death for intravenous drug users.

The full article can be found in the April 2018 online issue of Emerging Infectious Diseases .

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