Volume 24, Number 4—April 2018
CME ACTIVITY - Synopsis
Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA
Nongnooch Poowanawittayakom, Anamika Dutta, Shannon Stock, Sunkaru Touray, Richard T. Ellison, and Stuart M. Levitz
Table 2
Summary of characteristics of patients with candidemia and a history of IVDU admitted to a tertiary care hospital, Massachusetts, USA, 2010–2017*
| Pt no. | Age, y/ sex | Date admitted | IVDU, by history | Toxicology screen | Last use, by history | Candida species | Vegetations on echo | Antifungal therapy (duration) | Outcome |
|---|---|---|---|---|---|---|---|---|---|
| 1 |
32/M |
2010 Jan |
Heroin |
Heroin,
morphine, cocaine |
5 d |
C. parapsilosis |
No |
Fluc (14 d) |
Cured |
| 2 |
28/M |
2010 Oct |
Heroin |
ND |
6 mo |
C. parapsilosis |
No |
Fluc (14 d) |
Cured |
| 3 |
52/F |
2012 Jul |
Heroin,
cocaine |
Opiates |
NA |
C. glabrata |
No |
MF (8 d) then fluc (20 d) |
Cured |
| 4 |
43/F |
2012 Oct |
Heroin |
Cocaine,
opiates† |
1.5 d |
C. parapsilosis |
Yes (aortic, mitral) |
None |
Died |
| 5 |
59/M |
2012 Nov |
Not documented |
ND |
30 y |
C. glabrata |
No |
Fluc (14 d) |
Died |
| 6 |
54/M |
2013 Mar |
Heroin,
cocaine |
Methadone,
opiates |
2 y |
C. parapsilosis |
No |
MF (3 d) then fluc (25 d) |
Cured |
| 7 |
43/F |
2013 Apr |
Heroin |
ND |
NA |
C. albicans |
No |
MF (3 d) then
fluc (25 d) |
Cured |
| 8 |
31/M |
2013 Aug |
Heroin |
Opiates |
2 y |
C. albicans |
No |
MF (2 d) then fluc (12 d) |
Cured |
| 9 |
36/M |
2013 Dec |
Heroin |
Oxycodone,
hydromorphone |
6 d |
C. glabrata,
C. parapsilosis |
No |
None |
Lost to follow up |
| 10 |
49 /F |
2014 Jan |
Unspecified narcotic |
Opiates |
NA |
C. glabrata |
No |
MF (3 d) |
Died |
| 11 |
38/F |
2014 Feb |
Heroin |
Oxycodone,
oxymorphone |
2 y |
C. albicans |
Possible
(tricuspid on TTE, TEE negative) |
Fluc (2 d) then MF (40 d) |
Remission
(had epidural abscess) |
| 12 |
50/M |
2014 Aug |
Heroin |
Morphine |
6 mo |
C. tropicalis |
No |
Fluc (14 d) |
Cured |
| 13 |
49/M |
2015 Mar |
Cocaine |
ND |
Unknown |
C. lipolytica |
No |
Fluc (14 d) |
Cured |
| 14 |
22/M |
2015 Jun |
Heroin |
Marijuana |
Day admitted |
C. glabrata |
No |
MF (3 d) then fluc
(25 d) |
Cured |
| 15 |
53/M |
2015 Sep |
Cocaine |
Cocaine |
Remote |
C. tropicalis |
No |
Fluc (2 d) |
Died |
| 16 |
31/F |
2016 Jan |
Cocaine |
Morphine |
NA |
C. tropicalis |
No |
Fluc (14d) |
Cured |
| 17 |
37/M |
2016 Feb |
Heroin |
ND |
3 wk |
C. glabrata |
No |
Fluc (14d) |
Cured |
| 18 |
35/M |
2016 Mar |
Heroin,
Cocaine |
Cocaine, opiates† |
NA |
C. albicans |
No |
MF (4 d) then
fluc (24 d) |
Cured |
| 19 |
44/M |
2016 Apr |
Cocaine,
heroin |
Buprenorphine,
norbuprenorphine |
7 mo |
C. parapsilosis |
Yes (aortic) |
Fluc (indefinite) |
Remission follow up TTE after 3 mo: no vegetation |
| 20 |
47/M |
2016 Apr |
Cocaine |
ND |
1 y |
C. albicans |
No |
MF (6 d) then fluc (8d) |
Cured |
| 21 |
32/F |
2016 May |
Heroin |
Methadone,
oxycodone |
2 wk |
C. albicans |
Yes (mitral) |
AmpB (1 d) then fluc and vori (indefinite)‡ |
Remission follow up TTE after 3 mo: no vegetation |
| 22 |
46/M |
2016 May |
Cocaine,
heroin |
ND |
Day admitted |
C. glabrata |
No |
Fluc (21 d) |
Cured |
| 23 |
40/M |
2016 Jun |
Heroin |
Opiates |
Day admitted |
C. albicans,
C. glabrata |
No |
MF (13 d) then fluc (1 d) |
Cured |
| 24 | 54/M | 2016 Sep | Heroin | ND | 1 mo | C. parapsilosis | Yes (aortic) | MF (5 d) then ampB and 5FC (5 d) | Died |
*ampB, amphotericin B; 5FC, 5-flucytosine; echo, echocardiogram; fluc, fluconazole; IVDU, intravenous drug use; MF, micafungin; NA, not available; ND, not done; Pt, patient; TEE, transesophageal echocardiogram; TTE, transthoracic echocardiogram; vori, voriconazole.
†Positive toxicology screen was obtained during a previous admission.
‡Patient developed hypercalcemia after courses of fluconazole and treatment was changed to voriconazole.
Page created: March 16, 2018
Page updated: March 16, 2018
Page reviewed: March 16, 2018
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