Friday, 10 January 2014

Candida and CSF - may be important

Clin Infect Dis. 1999 May;28(5):1139-47.

Clinical significance of Candida species isolated from cerebrospinal fluid following neurosurgery.


Twenty-one patients for whom adequate clinical data were available were identified in a retrospective review of cases of Candida species isolated from cerebrospinal fluid (CSF) following neurosurgery; 86% had indwelling cerebrospinal devices (shunts). Candida species were isolated from multiple CSF samples from 10 patients; CSF samples from seven of 10 were initially drawn through indwelling devices and those from nine of 10 were obtained by subsequent lumbar punctures. All of these patients were treated with antifungals, although therapy was delayed in 50% of cases until the second positive culture was reported. In 11 cases, Candida was the only isolate recovered from CSF samples drawn through indwelling devices; cultures of subsequent CSF samples obtained by lumbar puncture were negative in 10 of 11 cases. Only two patients for whom a single culture was positive for Candida species were treated with antifungals (both of whom were symptomatic), and none of the untreated patients died of infection. The clinical significance of a single positive CSF sample drawn through an indwelling device is difficult to assess, and a definitive diagnosis may require repeated cultures of CSF samples obtained by lumbar puncture.
[PubMed - indexed for MEDLINE]

Meningitis caused by Candida species- I think that this maybe important even though 1995

Clin Infect Dis. 1995 Aug;21(2):323-7.

Meningitis caused by Candida species: an emerging problem in neurosurgical patients.


Three cases of candida meningitis were encountered in a 3-year period in our hospital; all occurred in neurosurgical patients. We describe these three cases and review the 15 cases of neurosurgery-related candida meningitis previously reported in the English-language literature. Data regarding these 18 patients formed the basis for our review. Most patients with candida meningitis had recently received antibacterial agents, and it is notable that 50% of patients suffered from antecedent bacterial meningitis. The CSF analysis revealed neutrophilic pleocytosis that was indistinguishable from that of bacterial meningitis. The overall mortality was 11%. Administration of amphotericin B combined with flucytosine appeared to be the best therapeutic approach for candida meningitis.
[PubMed - indexed for MEDLIN

Fungal Meningitis - is it Candida related??????????????

Fungal Meningitis

Meningitis is the inflammation of the meninges (the membrane lining of the brain and spinal cord). It usually refers to infections caused by viruses, bacteria, fungi or other microorganisms.
Fungal meningitis is a very rare, life threatening disease and may be caused by a variety of fungi, including most commonly Cryptococcus neoformans and Candida albicans .  Fungal meningitis usually occurs in people whose immune system has been severely depressed by disease (e.g. leukaemia or AIDS or by immunosuppressant drug therapy).
Cryptococcus neoformans is the most common cause of fungal meningitis. The organism is found in soil, is common in the environment and can be spread through the air.  The organism usually gains entry into the body when people inhale air-borne spores.  The vast majority of  healthy people will not develop an infection from these inhaled fungi, however people with severely depressed immune systems may be unable to prevent the fungi from surviving and causing infection.1
Cryptococcus neoformans can cause localised skin lesions, pulmonary disease (infection in the lung and airways) and disease of the central nervous system.  In some people the organism can spread to the meninges and cause meningitis.2
Fungal meningitis may develop slowly and the disease may be difficult to diagnose and treat.  However sometimes the onset of the infection can be acute and symptoms may develop quickly.
The symptoms of fungal meningitis are similar to other forms of meningitis and hospital tests are required to tell which organism is responsible for causing the disease.  The symptoms may include:
  • Headache
  • Neck Stiffness
  • Nausea and vomiting
  • Muscle or joint pain
  • Drowsiness / Confusion
  • Dislike of bright lights
  • Convulsions
  • Altered mental state
  • Feber
  • Dizziness
  • Problems with coordination
  • Memory Loss
  • Behavioural changes (such as irritability)
  • Problems with vision
The symptoms do not need to occur in any order and may not all be present. If you think you may have meningitis seek medical attention and advice quickly.
Diagnosis is usually based on the analysis of blood and cerebrospinal fluid (CSF) samples. Repeated lumbar punctures may be required to culture the organism.
Treatment typically involves the administration of antifungal medication, often two drugs in combination intravenously for some weeks initially . The overall duration of antifungal treatment (both intravenous and oral) will depend on a number of factors including whether a person has problems with their immune system and the type of fungus causing the infection.  The treatment often  take several weeks to months in people who do not have problems with their immune system.  However people with lowered immunity may require prolonged therapy and many also require long-term maintenance on antifungal therapy.5
Unlike some other meningitis infections (eg meningococcal), there is no risk of someone with fungal meningitis spreading the infection to other people.  There is no vaccine for fungal meningitis.


The Meningitis Centre is a 'not for profit' support organisation based in Australia, not a professional medical authority. Consequently text contained on this website   provides general information about meningitis and septicaemia, not medical advice and is not intended for use in the diagnosis or treatment of the disease. Please consult your doctor to discuss the information or if you are concerned someone may be ill. Medical information and knowledge changes quickly and you should contact your doctor for further information or if you are concerned about your health.


1. Meningitis  Research Foundation. (2003). About the diseases - Fungal Last accessed, Meningitis Research Foundation. 20/3/03.  
2. Cryptococcosis, Mycology Online. Cryptococcosis, Uinversity of Adelaide Australia. 18/3//2003,.,. New site    
3. Cryptococcosis, Mycology Online. Cryptococcosis, Uinversity of Adelaide Australia. 18/3//2003,. New site   
4. Meningitis  Research Foundation. (2003). About the diseases - Fungal Last accessed, Meningitis Research Foundation. 20/3/03.   5. Saag. M. et. al. (2000). " Practice Guidelines for the Management of Cryptococcal Disease." Clinical Infectious Diseases 30: 710 - 718.  

Wednesday, 8 January 2014

Candida endophthalmitis in crack-cocaine misuse

Logo of brjopthalBritish Journal of OphthalmologyCurrent TOCInstructions for authors
Br J Ophthalmol. 2007 May; 91(5): 702–703.
PMCID: PMC1954783

Lemon juice and Candida endophthalmitis in crack‐cocaine misuse

The Centers for Disease Control and Prevention recently reported that a substantial number of drug misusers in the US are injecting crack‐cocaine instead of smoking it,1 owing to the decreased availability and increased cost of powdered cocaine. The use of lemon juice to dissolve crack‐cocaine has been shown to cause abscesses, permanent vein damage and infections.2 Furthermore, heroin dissolved in preserved lemon juice was documented to be a source of Candidaalbicans in multiple, small epidemics of fungal endophthalmitis in the 1980s in the UK and Australia.3,4 We report here two recent cases of fungal endophthalmitis in crack users who similarly disclose dissolving crack‐cocaine in lemon juice injection.

Case 1

A 34‐year‐old male intravenous drug user presented to his primary care physician with high fever and bilateral blurry vision for the past 20 days. Blood cultures and ECG were negative. The patient reported dissolving crack in preserved lemon juice.
His visual acuity was 20/40 OD and 20/70 OS. Dilated fundus examination revealed multiple condensations in the vitreous with choroidal and retinal foci in both eyes. A pars plana vitrectomy was performed OD with intravitreal injections of vancomycin (1 mg/0.1 ml), ceftazidime (2 mg/0.1 ml) and amphotericin B (7.5 μg/0.1 ml). Vitreous cultures grew Candida albicans, and the patient was treated with oral diflucan (200 mg daily). The patient received five intravitreal injections of amphotericin B (5 μg/0.1 ml) in the vitrectomised right eye and three in the non‐vitrectomised left eye over 3 weeks for persistent active lesions. At the most recent examination, 12 weeks after presentation, the patient's vision was 20/20 OD and 20/50 OS.

Case 2

A 37‐year‐old homeless male intravenous drug user reported a 3‐month history of decreased vision, eye pain and floaters in his right eye. His medical history was significant for HIV (recent CD4 count of 799 cells/mm3) and hepatitis C. The patient reported the use of preserved lemon juice to dissolve crack‐cocaine for injection.
His visual acuity was hand motions OD and 20/20 OS. Dilated fundus examination of the right eye was obscured by 3+ vitritis, but there appeared to be a large infiltrate in the macula. A vitreous aspiration was performed, with intravitreal injections of ceftazidime (2 mg/0.1 ml) and vancomycin (1 mg/0.1 ml) in the right eye. The vitreous aspire grew C albicans. Amphotericin B (5 mg/0.1 ml) was injected, and the patient was admitted for intervenous flucanozole (400 mg four times a day). Blood cultures and ECG were negative. A therapeutic vitrectomy with a lensectomy was performed. Ten days postoperatively, the patient's vision improved to 20/400 OD, with a decrease in inflammation and resolution of the infiltrate, whereas the left eye was unchanged. The patient was unfortunately lost to follow‐up.


Potential sources of infection in injecting drug users are the impure drug itself, poorly disinfected skin at the site of injection, unsterile preparation of the drug, and/or contaminated needles or syringes. This report raises the possibility that the lemon juice used to dissolve crack‐cocaine might be another risk factor for fungal infection. In treating injecting drug users, ophthalmologists should inquire about the use of preserved juices. If used, this should raise the concern of fungal endophthalmitis. Furthermore, when an injecting drug user is infected with fungal endophthalmitis, it might be recommended to advise other users, who share the lemon juice, of the risk for endophthalmitis. Finally, public health efforts to decrease the morbidity of intervenous crack‐cocaine use should discourage users from dissolving crack‐cocaine in lemon juice. In fact, outreach programmes in certain inner cities are distributing packets of ascorbic acid to injecting drug users.


Funding: Unrestricted grant from Research to Prevent Blindness, New York, NewYork, USA RNK is a Heed Fellow and supported by the Heed Ophthalmic Foundation
Competing interests: None.
Informed consent was obtained for publication of the persons details in this report.


1. Santibanez S S, Garfein R S, Swartzendruber A. et al Prevalence and correlates of crack‐cocaine injection among young injection drug users in the United States, 1997‐1999. Drug Alcohol Depend 2005. 77227–233.233. [PubMed]
2. Buchanan D , Tooze JA , Shaw S , et al Demographic, HIV risk behavior, and health status characteristics of “crack” cocaine injectors compared to other injection drug users in three New England cities. Drug Alcohol Depend 2006. 81221–229.229. [PubMed]
3. Servant J B, Dutton G N, Ong‐Tone L. et al Candidal endophthalmitis in Glaswegian heroin addicts: report of an epidemic. Trans Ophthalmol Soc UK 1985. 104(Pt 3)297–308.308. [PubMed]
4. Newton‐John H F, Wise K, Looke D F. Role of the lemon in disseminated candidiasis of heroin abusers. Med J Aust 1984. 140780–781.781. [PubMed]

Articles from The British Journal of Ophthalmology are provided here

Heroin Addicts and Candida folliculitis

ABSTRACT: Three heroin addicts had Candida folliculitis of the scalp, beard, and pubis associated with fever, chills, headache, and fatigue. In each case, pseudohyphae were found within a hair and yeasts around it and Candida was recovered from urine. These facts support a systemic dissemination. Since serious ocular and osteoarticular lesions have been described with this type of skin lesion, prompt diagnosis may be important to initiate treatment and prevent sequelae.

My Candida trail led me back to here-a sober recovery center in Georgia

Why has Candidiasis become nearly epedemic in America?

Why has Candidiasis become nearly epidemic in America?

The extensive use of broad spectrum antibiotics destroys much of the “good” bacteria in our gut that would otherwise keep candida in its place. Many women are aware that taking antibiotics for a bladder infection virtually guarantees an onset of a vaginal yeast infection. Birth control pills and estrogen replacement therapy are also thought to put women at a greater risk for Candidiasis. Yeast, a natural inhabitant of the vagina, proliferates in the presence of the estrogen in these drugs. According to Candida expert Leon Chaitow, N.D., fully 35% of women using birth control pills have associated cases of acute vaginal candidiasis.

There is no doubt that the main culprit responsible for opening the door to candida overgrowth is a poor diet, high in sugar and white flour. According to Newsweek Magazine, In Sugar We Trust (July 13, 1998), the average American now consumes 150 lbs. of sugar per year, up 28 lbs. since 1970. And we’re paying the price. Our bodies’ digestive and eliminative systems have become sluggish under the strain of our inadequate, sugar laden diet. When sugary foods remain in our intestines for two to three days (the average transit time for Americans) we become a veritable smorgasbord for all sorts of opportunistic organisms, including Candida Albicans.