Digestive tract mycoses

Description:

Fungal infections are one of the most important problems of health care now. From potential "diseases of the future" they turned into urgent "diseases of the present". It is promoted by immunosuppressive impact of a modern civilization on a human body. There is no doubt that the list of the mushrooms able to cause a disease in the person, will be constantly replenished, and some of them, according to Dupont, already became "stars". It is Candida tropicalis – at patients is leukemia, C.albicans-at addicts, Cryptococcus neoformans – at patients is AIDS, Rhizopus spp. – at treatment by the drugs connecting iron, Malassezia sp. – at perfusion of the solutions rich with lipids, and also Penicillium marneffei which causes in 40% of cases an opportunistic infection in patients with AIDS in Thailand. The German mycologists studying an intestines mikobiota came to a conclusion that mushrooms of the sort Candida occur almost at 50% of residents of Germany, and they represent endogenous danger.

Symptoms of Mycoses of digestive tract:

Oral (orofaringealny) candidiasis – eurysynusic mycosis at the persons suffering from various forms of immunodeficiencies, first of all AIDS and hemoblastoses, and gastrointestinal localization of candidiasis at patients with AIDS can be a source of a kandidemiya which at other localizations of candidiasis occurs at such patients in only 1% of cases.

Quite frequent mycosis of a digestive tract is candidiasis of a gullet which is registered as at immunocompetent, and (is much more often) at immunokomprometirovanny persons. Candidiasis of a gullet can be complicated by plentiful bleeding that at untimely diagnosis and inadequate therapy can lead to a lethal outcome. By comparative assessment of various diagnostic methods of candidiasis of a gullet it is shown that in 95% of cases candidiasis was revealed in the analysis of scrapings and only in 39% - in the analysis of material of biopsies.

Stomach mycoses including candidiasis, in the absence of any other pathology of a somatic or bacterial etiology note seldom. According to M. A. Shevyakov, his share from all cases of candidiasis of an upper part of a digestive tract makes only 5,2%. Much more often (to 17-30%) Candida spp. find in bioptata of gastroduodenal ulcers, and also at chronic gastritises, however, only finds of psevdomitselialny structures of a mushroom, but not the separate not budding cells, at a morphological research painted according to Romanovsky-Gimz or by PAS method of cytologic and/or tissue specimens, authentically confirms the diagnosis of candidiasis of a stomach. In recent years Candida spp. often allocate in association with Helicobacter pilori, and standard protivokhelikobakterny therapy promotes increase in frequency of candidiasis of a stomach. Vast majority of Candida spp., allocated from patients (65,6%), had high or moderate virulence. At allocation from a gastric juice of patients with gastroduodenal diseases of Candida spp association. and Helicobacter pilori it is possible to assume more severe disease, and the planned antibacterial therapy needs to be carried out together with antifungalny.

Intestines candidiasis as the isolated form of a disease happens not often. Usually it is "continuation of candidiasis of a stomach and upper part of a digestive tract". Intestines candidiasis quite often is followed by diarrhea. Distinguish diarrheas of various etiology with the accompanying allocation of Candida and the candidosis diarrheas (CD) at which Candida is the only allocated activator. The main contributing risk factor of CD, especially at the hospitalized patients, an antibioticotherapia is. Other risk factors: endocrine disturbances, immune dysfunctions, neoplasms, steroid therapy; plays a role and advanced age of patients. From sick CD allocate S. to albicans, further more often - C. krusei, with C. tropicalis, C. kefyr, C. stellatoidea, C. guillermondii, C. parapsilosis, C. lusitaniae. By data Bernhard when Candida is a component of a normal biota of intestines, its growth and reproduction is suppressed with intestines microorganisms where the mushroom is present at stable quantity and does not breed. At suppression of a bakteriobiota antibiotics note reproduction of yeast with education at them growth tubes and emergence of mitselialny structures. In recent years the hypothesis that chronic intestinal candidiasis is perhaps, is made by an etiological factor of a syndrome of chronic fatigue.

Diarrhea is frequent display of candidiasis of intestines at patients with AIDS, however note geographical variations in an etiology of diarrheas at this category of patients. Intestines candidiasis is often registered at oncological patients. According to T. V. Tolkacheva et al., the frequency of allocation of barmy mushrooms from intestines of immunokomprometirovanny patients remains high, reaching 63-65% in the last 2 years. The ratio of frequency of identification of strains of C. albicans and non-albicans makes 52,5%. Among the last dominate C. krusei - 40%, C. glabrata - 28% and C. kefyr - 15,6%. Increase in frequency of occurrence of association from 2 types of Candida non-albicans and expansion of a specific range of the barmy mushrooms colonizing intestines of patients with hemoblastoses is noted. Candidiasis of a large intestine – a rare disease, more often it is registered in association with other intestinal pathogens of the bacterial nature.

The intestines mycoses caused by mitselialny opportunistic mushrooms register seldom and, first of all, at patients with AIDS and other immunodeficiencies. Aspergilla, Zygomycetes can be the cause of a gastrointestinal disease. According to foreign authors, Zygomycetes are an etiological factor of a gastrointestinal form of mycosis at 2% of patients, and they though rare, but high-invasive infections at recipients of transplants of parenchymatous bodies.

Quite often the two-phase mushroom of Histoplasma capsulatum relating to microorganisms of the II group of pathogenicity is the reason of mycosis of a digestive tract.

Histoplasmosis of an upper part of a digestive tract can be manifestation disseminated, and also local process. So, Klati was described et al. by defeat of language and almonds at the immunocompetent patient who was a consequence of dissimination of a mushroom from lungs, and Bins  diagnosed histoplasmosis with damage of an oral cavity and upper jaw. Cases of the localized damage of a gullet are frequent, and such localization of defeat often is followed by a dysphagy, a stenosis of the lower third of a gullet that demands operational treatment.

The peroral way of infection with histoplasmosis is not characteristic of this mycosis therefore histoplasmosis of a digestive tract, apparently, is a consequence of dissimination of the activator from primary center. In literature cases of local histoplasmosis of a stomach which had clinical symptomatology of malignant stomach ulcer are described. Local histoplasmosis of a stomach can be caused both by Histoplasma capsulatum option, and H. var. duboisii, and at both activators there is a suspicion on a carcinoma, and only the histologic research allows to establish true nature of a disease, at the same time in the cuts painted by hematoxylin-eosine with the subsequent silvering find diffusion limfogistiotsitarny infiltrates (29%), an ulceration (45%), limfogistiotsitarny nodes (25%) or small inflammatory reaction (15%) and is rare – eumorphic granulomas (8,5%). The progressing gastrointestinal histoplasmosis often is followed by complications in the form of obstruction of a gleam of intestines or intestinal bleedings. Note that gastrointestinal histoplasmosis is usually preceded by immunodeficiencies of various etiology, in particular AIDS. These predecessors are characteristic also of histoplasmosis of a large intestine.

Reasons of Mycoses of digestive tract:

Among the mushrooms colonizing mucous membranes of a digestive tract Candida spp are the most widespread. So, according to Petrova et al., the frequency of colonization of a pharynx barmy mushrooms makes 33%, and clinical forms of candidiasis of a mucous membrane of a mouth are various; also asymptomatic forms meet. The latest modern data on candidiasis of an oral cavity and mucous membranes of a digestive mouth it is summed up in V. S. Lesovy and M. A. Shevyakov's review articles. Now candidiasis of intestines is carried to its usual pathology. Except candidiasis as clinically expressed disease, the kandidonositelstvo, and also a new form of candidiasis of intestines which Khmelnytsky O. K. who described it called "kandidopatiya" quite often takes place. The last circumstance does necessary differential diagnosis between a kandidonositelstvo and candidiasis of intestines.

Treatment of Mycoses of digestive tract:

For treatment of mycoses including a digestive tract, use, as a rule, system antifungalny drugs which list, and also the mechanism of action and efficiency at various mycoses and various forms of the same mycosis is given in the review article of V. S. Mitrofanov. The most widespread mycosis – candidiasis. Apply the most various antimycotics to its treatment of both system, and local action. Now in literature widely discuss the draft of recommendations about treatment of candidiasis submitted by big group of authors which incorporated long-term observations on effective treatment of the most various forms of candidiasis. In domestic literature most fully questions of diagnosis and treatment of candidiasis of a digestive tract are lit by M. A. Shevyakov. The same author described a special case of successful treatment of candidiasis of a stomach flukonazoly which was effective in the conditions of an achlorhydria whereas other drugs (кетоконазол, итраконазол) in these conditions rezorbirutsya badly and their antifungalny effect significantly decreases. At treatment of candidiasis of a digestive tract the right choice of a dosage form of drug is important. So, according to G. A. Klyasova et al., at treatment of an oropharyngeal form of candidiasis orungaly immunokomprometirovanny patients had effective suspension of an itrakonazol. Now attempts of development of new approaches to diagnosis and treatment of candidiasis of a stomach are made. So, according to E. V. Fayzulina et al., risk factors of developing of candidiasis of a stomach the alcoholism, including reception of substitutes of alcohol, prescription of gipoatsidny gastritis more than 5 years, a diabetes mellitus 1 and 2 types, дисбиоз intestines, an autoimmune thyroiditis, the accompanying symptoms is from cardiovascular system – a hypertensive varicose symptom complex, a Raynaud's disease. Authors consider that at an endoscopic research there has to be a suspicion of stomach candidiasis when reveal an ulcer, insensitive to standard therapy, or erosive gastritis.