title: [Endogenous Candida endophthalmitis in drug misusers injecting intravenous buprenorphine].
abstract: OBJECTIVE
  To analyze patients presenting ocular candidiasis caused by intravenous drug addiction to buprenorphine.
  
  
  METHODS
  We have listed all the cases of endogenous fungal endophthalmitis hospitalized between 1996 and 2005 in the ophthalmology department of the university-affiliated hospital of Rouen, France. Posterior vitrectomy was performed for each patient, with direct examination and bacterial and fungal cultures. The treatment was begun both with an intravitreal injection of amphotericin B and oral fluconazole, modified in the event of resistance.
  
  
  RESULTS
  Seven men, drug addicts, all using intravenous buprenorphine users, were included in the study. The vitreal culture revealed four cases of Candida albicans candidiasis and one case of Candida tropicalis candidiasis. In two cases, oral fluconazole had to be replaced with oral voriconazole. Of the seven patients, three evolved unfavorably despite treatment.
  
  
  CONCLUSIONS
  Intravenous drug use is known to be a risk factor for ocular candidiasis. However, buprenorphine does not seem to be related to endogenous endophthalmitis, since this was also observed among patients using methadone or heroine. Salivary contact during the preparation of the syringe being used for the injection of the substitute appears to be the source of the candidemia in our series and in the literature.
  
  
  CONCLUSIONS
  Inappropriate intravenous use of oral buprenorphine in drug users is a significant risk factor of endogenous fungal endophthalmitis. Visual monitoring by pharmacists of the oral intake of buprenorphine seems essential. We underline the advantages of removing the vitreous in ocular candidiasis.
authors.affiliation: Service d'Ophtalmologie, CHU Charles Nicolle, Rouen. dhirsbein@hotmail.fr
authors.forename: D
authors.initials: D
authors.lastname: Hirsbein
authors.forename: P
authors.initials: P
authors.lastname: Attal
authors.forename: J
authors.initials: J
authors.lastname: Gueudry
authors.forename: I
authors.initials: I
authors.lastname: Guet
authors.forename: G
authors.initials: G
authors.lastname: Brasseur
authors.forename: C
authors.initials: C
authors.lastname: Vasseneix
mesh_terms: D000284:Administration, Oral; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002047:Buprenorphine / Q000008:administration & dosage*; D002177:Candidiasis / Q000209:etiology*; D015821:Eye Infections, Fungal / Q000209:etiology*; D006801:Humans; D008297:Male; D015819:Substance Abuse, Intravenous / Q000382:microbiology*; D013594:Syringes; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine