Cryptococcus meningitis mimicking cerebral septic emboli, a case report series demonstrating injection drug use as a risk factor for development of disseminated disease

In a sentinel hepatitis surveillance study conducted by sentinel health units, 1469 patients were enrolled, and 959 (65.3%) were positive for antibody to hepatitis C virus (HCV). Samples from 387 patients (40.4%) were tested for HCV RNA, and 289 (74.7%) were positive for RNA. The major risk factor for HCV infection was injection drug use, reported in 71% of cases. The genotyping of HCV isolates showed that subtype 1a (48%) was predominant in Canada. The other subtypes detected were 1b (19%), 2a (6%), 2b (3%), 3a (22%) and 4a (1%). In Winnipeg, Manitoba, subtype 3a (47%) was more prevalent than subtype 1a (37%), and, in Guelph, Ontario, both subtypes 1a and 3a had equal (40%) distribution. The prevalence of subtype 3a was significantly higher in injection drug users (27%) than in nonusers (10%) (P<0.005). In Canada, injection drug use is the major risk factor for HCV infections, and subtype 1a is more prevalent.

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Childhood abuse as a risk factor for injection drug use: A systematic review of observational studies

Drug and Alcohol Review ◽

10.1111/dar.13001 ◽

2019 ◽

Vol 39 (1) ◽

pp. 71-82 ◽

Cited By ~ 2

Author(s):

Amy Prangnell ◽

Sameer Imtiaz ◽

Mohammad Karamouzian ◽

Kanna Hayashi

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Drug Use ◽

Childhood Abuse ◽

Injection Drug Use ◽

Observational Studies ◽

Injection Drug

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Enhanced Surveillance of Acute Hepatitis B and C in Four Health Regions in Canada, 1998 TO 1999

Canadian Journal of Infectious Diseases ◽

10.1155/2001/719650 ◽

2001 ◽

Vol 12 (6) ◽

pp. 357-363 ◽

Cited By ~ 11

Author(s):

Shimian Zou ◽

Jun Zhang ◽

Martin Tepper ◽

Antonio Giulivi ◽

Beverley Baptiste ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Hepatitis C ◽

Drug Use ◽

Hepatitis B ◽

Acute Hepatitis ◽

Injection Drug Use ◽

Injection Drug ◽

Acute Hepatitis C ◽

Acute Hepatitis B

OBJECTIVE:To assess the incidence and risk factors for acute hepatitis B and acute hepatitis C in a defined Canadian population.PATIENTS AND METHODS:An enhanced surveillance system was established in October 1998 to identify cases of acute hepatitis B and C infections in four regions in Canada, with a total population of approximately 3.2 million people. Information on demographic and clinical characteristics, laboratory results and potential risk factors was collected using predefined questionnaires.RESULTS:A total of 79 cases of acute hepatitis B and 102 cases of acute hepatitis C were identified from October 1998 to December 1999, resulting in an incidence rate of 2.3 and 2.9/100,000 person-years, respectively. Males had higher incidence rates than females. The incidence of acute hepatitis B peaked at age 30 to 39 years for both males and females, whereas acute hepatitis C peaked at 30 to 39 years for males and 15 to 29 years for females. At least 34% of acute hepatitis B and 63% of acute hepatitis C were associated with injection drug use. Persons who were 15 to 39 years of age were more likely to report injection drug use as a risk factor. Heterosexual contact was reported to be a risk factor for 36.6% of acute hepatitis B cases and 3.5% of acute hepatitis C cases.CONCLUSIONS:The surveillance provides national incidence estimates of clinically recognized acute hepatitis B and C. Both hepatitis B and C are important public health threats to Canadians. Prevention efforts for both diseases should focus on injection drug use, especially for people aged 15 to 39 years. Risky sexual behaviour is also a major concern in prevention of hepatitis B in Canada.

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Injection Drug Use-Associated Candidemia: Incidence, Clinical Features, and Outcomes, East Tennessee, 2014–2018

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa024 ◽

2020 ◽

Vol 222 (Supplement_5) ◽

pp. S442-S450

Author(s):

John A Rossow ◽

Radhika Gharpure ◽

Julia Brennan ◽

Pryanka Relan ◽

Sabrina R Williams ◽

...

Keyword(s):

Risk Factor ◽

Drug Use ◽

Clinical Features ◽

Injection Drug Use ◽

Medical Records ◽

Injection Drug ◽

Persons Who Inject Drugs ◽

Opioid Crisis ◽

Additional Burden ◽

East Tennessee

Abstract Background Injection drug use (IDU) is an established but uncommon risk factor for candidemia. Surveillance for candidemia is conducted in East Tennessee, an area heavily impacted by the opioid crisis and IDU. We evaluated IDU-associated candidemia to characterize the epidemiology and estimate the burden. Methods We assessed the proportion of candidemia cases related to IDU during January 1, 2014–September 30, 2018, estimated candidemia incidence in the overall population and among persons who inject drugs (PWID), and reviewed medical records to compare clinical features and outcomes among IDU-associated and non-IDU candidemia cases. Results The proportion of IDU-associated candidemia cases in East Tennessee increased from 6.1% in 2014 to 14.5% in 2018. Overall candidemia incidence in East Tennessee was 13.5/100 000, and incidence among PWID was 402–1895/100 000. Injection drug use-associated cases were younger (median age, 34.5 vs 60 years) and more frequently had endocarditis (39% vs 3%). All-cause 30-day mortality was 8% among IDU-associated cases versus 25% among non-IDU cases. Conclusions A growing proportion of candidemia in East Tennessee is associated with IDU, posing an additional burden from the opioid crisis. The lower mortality among IDU-associated cases likely reflects in part the younger demographic; however, Candida endocarditis seen among approximately 40% underscores the seriousness of the infection and need for prevention.

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The Changing Epidemiology of Candidemia in the United States: Injection Drug Use as an Increasingly Common Risk Factor—Active Surveillance in Selected Sites, United States, 2014–2017

Clinical Infectious Diseases ◽

10.1093/cid/ciz1061 ◽

2019 ◽

Vol 71 (7) ◽

pp. 1732-1737 ◽

Cited By ~ 3

Author(s):

Alexia Y Zhang ◽

Sarah Shrum ◽

Sabrina Williams ◽

Sarah Petnic ◽

Joelle Nadle ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Risk Factor ◽

Drug Use ◽

Injection Drug Use ◽

The United States ◽

Population Based ◽

Injection Drug ◽

Active Population ◽

Initial Culture

Abstract Background Injection drug use (IDU) is a known, but infrequent risk factor on candidemia; however, the opioid epidemic and increases in IDU may be changing the epidemiology of candidemia. Methods Active population-based surveillance for candidemia was conducted in selected US counties. Cases of candidemia were categorized as IDU cases if IDU was indicated in the medical records in the 12 months prior to the date of initial culture. Results During 2017, 1191 candidemia cases were identified in patients aged >12 years (incidence: 6.9 per 100 000 population); 128 (10.7%) had IDU history, and this proportion was especially high (34.6%) in patients with candidemia aged 19–44. Patients with candidemia and IDU history were younger than those without (median age, 35 vs 63 years; P < .001). Candidemia cases involving recent IDU were less likely to have typical risk factors including malignancy (7.0% vs 29.4%; relative risk [RR], 0.2 [95% confidence interval {CI}, .1–.5]), abdominal surgery (3.9% vs 17.5%; RR, 0.2 [95% CI, .09–.5]), and total parenteral nutrition (3.9% vs 22.5%; RR, 0.2 [95% CI, .07–.4]). Candidemia cases with IDU occurred more commonly in smokers (68.8% vs 18.5%; RR, 3.7 [95% CI, 3.1–4.4]), those with hepatitis C (54.7% vs 6.4%; RR, 8.5 [95% CI, 6.5–11.3]), and in people who were homeless (13.3% vs 0.8%; RR, 15.7 [95% CI, 7.1–34.5]). Conclusions Clinicians should consider injection drug use as a risk factor in patients with candidemia who lack typical candidemia risk factors, especially in those with who are 19–44 years of age and have community-associated candidemia.

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