One type of brown heroin associated with systemic candidiasis was from Iran and used lemon juice as the acidifying agent that was contaminated with Candida albicans. In this situation large numbers of Candida organisms were injected with the heroin.
Clinical features of systemic candidiasis in intravenous drug abusers:
(1) disseminated folliculitis with papules, nodules and pustules
(2) eye infection (chorioretinitis, endophthalmitis, other)
(3) osteoarticular lesions (vertebrae, costal cartilage, knees, sacroiliac joints)
(4) infection of the central nervous system (meningitis, ventriculitis, other)
Many of the patients are HIV positive with immunodeficiency.
Presentation may include:
(1) headache
(2) loss of vision
(3) joint or bone pain
(4) disseminated skin lesions
The diagnosis is supported by identification of Candida albicans from the patient. A sample of the heroin should also be cultures.
