UMMS Affiliation

Department of Medicine, Division of Infectious Diseases and Immunology

Publication Date


Document Type



Bacterial Infections and Mycoses | Immunology and Infectious Disease | Infectious Disease | Substance Abuse and Addiction


The epidemic of illicit intravenous drug use (IVDU) in the United States has been accompanied by a surge in drug overdose deaths and infectious sequelae. Candida albicans infections were associated with injection of contaminated impure brown heroin in the 1970s-1990s; however, candidiasis accompanying IVDU became considerably rarer as the purity of the heroin supply increased. We reviewed cases of candidemia occurring over a recent 7-year period in persons > 14 years of age at a tertiary care hospital in central Massachusetts. Of the 198 patients with candidemia, 24 cases occurred in patients with a history of IVDU. Compared with non-IVDU patients, those with a history of IVDU were more likely to have non-albicans Candida, be co-infected with hepatitis C, and have end-organ involvement, including endocarditis and osteomyelitis. Thus, IVDU appears to be reemerging as a risk factor for invasive candidiasis.


candidemia, candidiasis, Candida albicans, intravenous substance abuse, heroin, endocarditis, fungi, fungal infections, Massachusetts, United States

Rights and Permissions

Emerging Infectious Diseases is published by the Centers for Disease Control and Prevention, a U.S. Government agency. Therefore, materials published in Emerging Infectious Diseases, including text, figures, tables, and photographs are in the public domain and can be reprinted or used without permission with proper citation.

DOI of Published Version



Poowanawittayakom N, Dutta A, Stock S, Touray S, Ellison RT 3rd, Levitz SM. Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA. Emerg Infect Dis. 2018 Apr;24(4):631–7. doi: 10.3201/eid2404.171807. PMID: 29553923; PMCID: PMC5875264. Link to article on publisher's site

Journal/Book/Conference Title

Emerging infectious diseases

Related Resources

Link to Article in PubMed

PubMed ID