Gullet candidiasis

Description:

The gullet candidiasis which is display of visceral candidiasis ranks high among infectious damages of a gullet. In recent years the tendency of increase of frequency of KP, especially at patients with immunity disturbance is traced. Growth of a candidosis infection is substantially caused by increase in number of patients with HIV infection, achievements in transplantology and immunosuppressive therapy, uncontrolled use of antibiotics.

Candidiasis of a gullet occurs at 0,7-1,5% of patients of a gastroenterological profile.

The problem of the heavy fungal infections caused by opportunistic pathogens consists that they will difficult respond to treatment and can lead to a lethal outcome. It was revealed that mortality at invasive candidosis infections makes 34%.

Gullet Candidiasis symptoms:

Disease symptoms are practically absent at 25-30% of the patients having gullet candidiasis, especially at immunocompetent persons.

Nevertheless most of patients show the complaints connected with a gastrointestinal tract disease.

The most typical clinical displays of candidiasis of a gullet — a dysphagy and are slightly more rare an odinofagiya.

Degree of manifestation of esophageal symptoms fluctuates from moderate difficulty when swallowing to sharply expressed pain what are result of inability to eat food and development of secondary dehydration.

At a heavy odinofagiya existence of other reasons or coinfection, especially at patients with AIDS is possible.

Much less often patients can complain of the retrosternal pains which are not connected with swallowing, heartburn, nausea, sometimes vomiting with allocation of films (pseudomembranes), a loss of appetite and weight, emergence of a liquid chair with slime.

At KP the physical research can be useful. About two thirds of patients with AIDS and esophageal candidiasis have candidosis stomatitis. KP is observed at patients with chronic mucous and skin candidiasis which belongs to severe forms of a candidosis infection and to a thicket is observed at dysfunction of adrenal glands and parathyroids.

Gullet Candidiasis reasons:

Different types of Candida represent the most often found esophageal pathogen, first of all it concerns Candida albicans, S. of tropicalis, S. of parapsilosis, S. of glabrata, S. of lusitania and S. of krusei sometimes meet.

These microorganisms are normal components of oral flora, and their growth is contained by bacterial commensals.

Infection with mushrooms like Candida which are eurysynusic in the environment occurs in the endogenous or exogenous way. Endogenous infection is connected with activation of mushrooms saprophytes; exogenous infection can happen in direct contact to carriers of an infection or from the environment.

If the organism of the owner is not weakened, many mushrooms do not show the pathogenic properties.

Researches of the last years showed that intestines are a source of dissimination of mushrooms, and candidiasis of an oral cavity, genitalias, a gullet is display of system candidiasis. The probability of development of systemic lesion depends as on properties of the microorganism (their quantity, virulence, genetic and specific heterogeneity of population), and on a condition of a macroorganism, especially its immune system, the alimentary status and an abdominal blood-groove.

Favorable conditions for development of infectious process are created by various disturbances of physiological, anatomic and immunologic mechanisms of protection of an organism.

Treatment of Candidiasis of a gullet:

There is a set of peroral and intravenous medicines which are used for treatment of a candidosis esophagitis. Despite rather wide choice of drugs, treatment of candidiasis of a gullet is an urgent problem as some medicines are insufficiently effective, others have serious side effects; besides, growth of resistance to anti-fungal drugs is noted now.

At treatment of candidiasis of a gullet peroral therapy has to be originally appointed, intravenous administration is used only in case of the refractory course of a disease or if there are contraindications to peroral use of medicines. The reduced therapy course with use of the system absorbed medicines like an oral azol is necessary for patients with moderate severity of a disease and the minimum disturbance of immunity.

The arsenal of modern antifungal means is rather wide. For treatment of esophageal candidiasis use anti-fungal drugs of several groups. Drugs from group of an azol are most effective. Orally use not soaking up azoles (Clotrimazolum, Miconazolum); however drugs of systemic action from this group are more effective (кетоконазол, флуконазол and итраконазол). These drugs, it is similar to other of group of an azol, change permeability of a cellular membrane of mushrooms by means of P450 cytochrome (RMS) - dependent intervention in ergosterol biosynthesis that leads to damage of a mushroom cell and its death.

Ketokonazol (nizorat, ороназол) is derivative an imidazole and at daily reception in a dose from 200 to 400 mg gives good effect in treatment of esophageal candidiasis. At patients with AIDS for whom higher doses of a ketokonazol usually are required the day dose can be increased if there is no nausea, to maximum (800 mg). Ketokonazol well gets into various bodies and fabrics, but it is bad — through a blood-brain barrier. Drug is well soaked up in digestive tract, but optimum absorption requires acid medium.

Flukonazol (Diflucan, дифлазон, форкан, flucostat — domestic флуконазол) represents water-soluble triazole and is appointed in a dose of 100 mg a day. Flukonazol is a drug which absorption does not depend from рН a gastric juice and which is much more effective at treatment of esophageal candidiasis at AIDS, than кетоконазол (200 mg daily).
The newest class of antifungal drugs are the kandina interfering with synthesis of a fungal wall. They are effective concerning the majority of types of Candida, including S. krusei. Early studies showed that капсофунгин, representing this group of drugs, it was so effective at KP, as well as Amphotericinum of Century.

At treatment of sick KP it is necessary to consider existence of resistance which because of broad use of azoles considerably increased now.

The good effect of endoscopic introduction is gained by sick KP of a concentrate of granulocytes and high-intensity pulse laser radiation that improves immune functions.

Thus, for achievement of success at patients with heavy fungal infections, including with candidiasis, an integrated approach to diagnosis and treatment is reasonable. Increase in survival will be promoted by operational diagnosis with the subsequent selection of effective specific antifungal therapy and holding the medical actions directed to increase in number of granulocytes and stimulation of phagocytosis.