Role of the lemon in disseminated candidiasis of heroin abusers

The occurrence of several small outbreaks of disseminated candidiasis among heroin abusers in Australia suggests that a common source for infection was present in each incident. Because in all outbreaks so far described lemon juice has been used to dissolve heroin powder before injection, we decided to examine the ability of lemon juice to support the growth of Candida albicans. Lemons which were experimentally inoculated with small numbers of C. albicans promoted the rapid growth of the organism at room temperature. We propose that clinical infection results from the intravenous injection of a large inoculum of C. albicans from contaminated lemon juice. This is supported by the simultaneous occurrence of the disease in three drug abusers. We also propose that the lemon was contaminated by the heroin abusers, as disseminated candidiasis occurred only after the lemon was used a second time after being left at room temperature for one week.