Aspergillosis in drug addicts

Infections might seriously harm individuals who are addicted to illicit drugs, with systemic fungal infections being occasionally implicated. Drug users can acquire different forms of aspergillosis by inhalation of fungal spores during marijuana smoking or by direct inoculation from a contaminated drug supply or injection material. Marijuana may sometimes be contaminated with Aspergillus, and that is a potential hazard for individuals predisposed to aspergillosis. Marijuana smoking may subject immunosuppressed patients such as transplant recipients or those receiving chemotherapy for haematological malignancies to develop invasive pulmonary or disseminated aspergillosis (7 cases have been described so far). On the other hand, when the fungal infection is acquired by intravenous drug consumption, direct inoculation with fungi can cause haematogenous spread and local clinical manifestations, including endocarditis (5 cases), endophthalmitis (17 cases) and central nervous system (5 cases) or osteoarticular (7 cases) involvement. Disseminated aspergillosis has not been described in intravenous drug users. This chapter reviews different forms of aspergillosis occurring in patients using illicit drugs.