Generalized (system, disseminated) candidiasis
- Symptoms Generalized (system, disseminated) candidiasis
- The reasons Generalized (system, disseminated) candidiasis
- Treatment Generalized (system, disseminated) candidiasis
Cases of the widespread combined candidiases with damage of internals, with development of barmy sepsis began to register in all countries in connection with broad use of antibiotics for treatment of various diseases. Express opinion that in a pathogeny of visceral candidiases the phenomenon of dysbacteriosis of which oppression under the influence of antibiotics of life activity of gram-negative sticks and cocci is characteristic matters, being in an organism of the healthy person antagonists of drozhzheiodobny mushrooms of the sort Candida and constraining their development. The greatest significance in development of dysbacteriosis is attached to antibiotics of a broad spectrum of activity (penicillin, streptomycin, synthomycin, etc.) and especially to their combinations. Use of antibiotics breaks vitamin balance in the patient's organism (for example, suppresses life activity of the colibacillus taking active part in synthesis and completion of various vitamins), there is a vitamin deficiency that promotes development of candidiasis. Consider that antibiotics directly stimulate development of drozhzheiodobny mushrooms. A certain part is assigned to corticosteroids and cytostatics though the mechanism of their action leading to candidiasis is studied insufficiently. Apparently, in a pathogeny of visceral candidiases the sorted reasons with dominance in one cases of a factor of dysbacteriosis, in others - a vitamin deficiency, etc. matter.
Symptoms Generalized (system, disseminated) candidiasis:
At visceral candidiases mucous membranes of respiratory tracts, digestive tract, urinogenital bodies are most often affected. Barmy defeats of cardiovascular and nervous systems, kidneys, a liver, a spleen, bronchial tubes and lungs (pneumonia), brain tissue, a muscle of heart, blood vessels and other bodies are described. Visceral candidiasis can lead to a septic state which sometimes arises also without the previous damage of internals. These defeats, as a rule, arise at the weakened and exhausted patients suffering from heavy persistent infections or a serious general illness and also at treatment of such patients with antibiotics, corticosteroids or cytostatics. There are no specific clinical symptoms for visceral candidiases or very little. It is necessary to think of barmy defeat of internal body when the disease accepts a long, sluggish current (pneumonia, enteritis, colitis, myocarditis, etc.), subfebrialny temperature is noted, there is no effect at usual methods of treatment, process at use of antibiotics worsens. Barmy damage of visible mucous membranes (especially visceral candidiasis of an oral cavity), nail rollers and nail plates which is often accompanied by damages of internals helps to suspect quite often. Less often in these cases various sites of an integument are surprised. Finally the issue is resolved on the basis of these laboratory researches.
The reasons Generalized (system, disseminated) candidiasis:
Sort Candida mushrooms.
Treatment Generalized (system, disseminated) candidiasis:
* removal of intravascular catheters
* Amphotericinum In intravenously
* флуконазол intravenously or orally
* liposomal Amphotericinum In intravenously
Inspection for early detection of the centers of dissimination is shown to all patients with a kandidemiya (a retinitis, an entophthalmia, damage of kidneys, lungs, skin and so forth).
Before purpose of medicamentous therapy by the patient with a kandidemiya and the acute disseminated candidiasis removal of all central venous catheters is shown.
The choice of antimycotic depends on a clinical condition of the patient, a type of the activator and its sensitivity to antifungal means. As initial treatment it is recommended to clinically stable patients who were earlier not receiving derivatives of an azol флуконазол in a dose of 6 mg/kg/days. At clinically unstable patients (shock, multiorgan insufficiency), and also at not specified a type of the activator use of Amphotericinum In in a dose of 0,6 mg/kg/days as its action spectrum is wider in comparison with flukonazoly is shown.
At newborns with the acute disseminated candidiasis as drug of the first line Amphotericinum In in a dose of 0,6 mg/kg/days usually is applied. Use of a flukonazol is recommended at clinically stable patients with the activator, sensitive to drug.
Definition of sensitivity of activators of a kandidemiya and the acute disseminated candidiasis to antimycotics is recommended to carry out with use of the standard methods, for example, of NCCLS M27-A. As sensitivity of Candida spp. substantially depends on a look, identification of species of the activator of a kandidemiya and the acute disseminated candidiasis has important clinical value.
At a kandidemiya and the acute disseminated candidiasis caused by S. albicans, S. tropicalis of m of S. parapsilosis use of a flukonazol in a dose of 6 mg/kg/days or Amphotericinum In in a dose of 0,6 mg/kg/days is shown.