Study: how fungi in the intestines affect our health

Candidiasis or thrush

is a fungal, infectious disease caused by opportunistic fungi of the genus Candida. Microorganisms are present in most healthy people. A person may encounter them for the first time in the womb, during childbirth, or during breastfeeding. Candidiasis develops against the background of reduced immunity, when the body can no longer restrain the active proliferation of the fungus.

The infection affects the mucous membranes of the mouth and genitals. It can develop on smooth skin, nails, and in the intestines, as a type of dysbacteriosis. There is visceral (systemic) candidiasis that affects internal organs. Despite the fact that Candida fungi are present in many people, and the disease itself is considered a neglected disease, it must be treated even if there are no external manifestations.

Causes of candidiasis

• Frequent damage to the skin and mucous membranes, for example, due to illness, working with aggressive chemicals, dry skin, age-related changes.
• Prolonged exposure to water, humid and warm environments. This includes a climate that is not suitable for your skin type, as well as occupational hazards.
• Mechanical damage to the skin and mucous membranes: injection drug addiction, long-term surgical interventions, catheters, shunts, endotracheal tubes.

After entering the body, the fungus may not manifest itself for a long time, since its reproduction will be suppressed by the immune system. In some cases, natural defenses weaken, leading to candidiasis (thrush). Among the factors that contribute to the proliferation of Candida:

• Chronic, endocrine and immune system diseases (diabetes, HIV).
• Metabolic disorders or taking medications that disrupt the natural microflora (antibiotics, hormonal contraceptives).
• Unbalanced diet, lack of sleep, stress and depression.

The fungus can be found in raw meat, unpasteurized dairy products, and, in more rare cases, on fresh vegetables and fruits. You can become infected with candidiasis from animals: dogs, calves, poultry.

How to protect yourself from mold infection?

• Care must be taken when dismantling old, dilapidated dachas and when using stale building material. Fungi that have settled on a tree are especially dangerous.
• Although fungi on food products are less aggressive, nevertheless, a small spot of mold on bread must be carefully cut out, and if mold has appeared in several places, it is better not to eat the bread.
• Rotting places on an apple can be removed, but moldy juicy fruits and vegetables - tomatoes, pears, peaches, apricots, especially if mold has appeared around the seed - will have to be thrown away.
• Without hesitation, pour out compotes, juices and syrups with mold stains, but in confitures and jams with a high sugar content, it is enough to remove the top thick layer.
• You should not eat moldy nut kernels with a bitter, musty aftertaste. You should avoid cottage cheese and other moldy dairy products.
• Small spots of mold on the cheese can be removed, but if the mold has formed inside the head, it's not worth the risk. True, there are cheeses, for example, Roquefort, to which mold gives a special piquant flavor, but if you have a fungal infection, you will have to give up such a favorite delicacy for many gourmets for a while.

Risk factors for development

The likelihood of infection increases with casual sexual intercourse, uncontrolled use of antibiotics and drugs that disrupt the natural microflora. Foods with large amounts of sugar and carbohydrates create a favorable environment for fungal growth. Excessive sweating also leads to an exacerbation of candidiasis, so it is necessary to wear cotton underwear that allows the skin to breathe and moisture to evaporate.

At the same time, excessive cleanliness can also cause harm. We are talking about douching. It should not be used as a method of contraception, since it is not effective, and also as a means of hygiene, because it leads to the leaching of the protective flora. If you experience discomfort, you should first consult a doctor.

Diagnosis and treatment

Self-medicating in this situation is dangerous. Recognizing a fungal disease at the very beginning of the disease is possible only with timely contact with specialists involved in the treatment of affected organs or systems (gynecologists, gastroenterologists, etc.) or mycologists - specialists in fungal infections. Mycological studies make it possible to clarify the nature of the disease and distinguish a fungal disease from a bacterial one.

The doctor will select special antifungal drugs of a new generation, prescribe general strengthening procedures and multivitamin complexes. Enzymes that improve the functions of the digestive system, regulators of intestinal microflora, choleretic agents and medications that protect the liver are often prescribed.

Photo: fahroni / freepik.com

Along with antifungal treatment, much attention is paid to a special “antifungal” diet. This diet involves avoiding foods rich in carbohydrates, since impaired carbohydrate metabolism leads to increased blood sugar levels, and sugar is an excellent environment for mushrooms. Pasta, cereal dishes, as well as anything prepared with yeast are not recommended: beer, kvass, champagne, buns, pastries, cakes. Even bread can only be eaten today, since mold may begin to grow in it on the second or third day.

In order to relieve the liver while taking potent drugs, doctors recommend abstaining from fatty meat (pork, lamb, smoked meats, rich broths, fried foods, as well as duck and goose meat). You can leave veal, beef, chicken, boiled or stewed fish in your diet. It is recommended to consume vegetables, low-fat cottage cheese and sour cream, as well as fermented milk products - kefir and acidophilus.

Classification of the disease

Based on the depth of damage, candidiasis is divided into superficial and systemic forms. The first appear on visible parts of the body: mucous membranes, skin and its appendages. The second, systemic, are combined forms of the disease affecting internal organs. Without proper treatment, systemic (visceral) candidiasis can lead to the development of candidal sepsis. Most often, the fungus affects:

• gastrointestinal tract (esophagus, stomach, intestines);
• urinary organs (bladder, urinary tract, kidneys);
• lower respiratory tract (trachea, bronchi, lungs).

The disease is also classified based on the rate of spread of infection and the presence of relapses. Candidiasis of the liver and spleen often takes a chronic form. The acute, generalized form is asymptomatic candidemia, candida septicemia, candida thrombophlebitis, myositis, arthritis, cerebral candidiasis and other forms.

Classification of candida lesions according to ICD-10

• Candidiasis.
• Candidal stomatitis.
• Pulmonary candidiasis.
• Candidiasis of the skin and nails.
• Candidiasis of the vulva and vagina.
• Candidiasis of other urogenital locations.
• Candidal meningitis.
• Candidal endocarditis.
• Candidal septicemia.
• Candidiasis of other locations.
• Candidiasis, unspecified.

Officially, the diagnosis is made in accordance with ICD-10. In practical healthcare, such a classification is not entirely convenient, so they use the classification of deep candidiasis, which is a deeper list. When making a diagnosis, first indicate the name and form of the infection with a description of all localization points.

Skin treatment is carried out by a pediatrician in children and by a dermatologist in adults. Therapy is also carried out by doctors of other specializations, depending on the affected organ. For example, this could be a dentist, neurologist, gynecologist, pulmonologist.

Suppositories Livarol

Suppositories for the treatment of fungal vulvovaginitis have ketoconazole as the active substance. This substance stops the vital activity of not only fungi, but also some bacteria, including staphylococcus and streptococcus. The substance helps well with primary infections. In the case of a chronic form of thrush, Livarol will not have the expected effect, because ketoconazole is a substance to which Candida fungi become resistant over time.

Livarol will cope with a mild form of thrush in 5 days. In special cases, the doctor may prescribe a 10-day course. The drug is sold in appropriate dosages: 5 and 10 suppositories per package.

The suppositories, once in the vagina, quickly take on a liquid form and envelop the mucous membranes of the organ. To achieve the maximum duration of contact of the substance with the contaminated surface, it is better to place suppositories at night. So that when the medicine becomes liquid, it does not leak out of the vagina.

Symptoms of candidiasis

The symptoms of the disease are directly related to the affected organ. Superficial forms have obvious signs, while systemic forms can be asymptomatic or be similar to other diseases. In the presence of chronic diseases (diabetes mellitus, HIV, AIDS, leukemia and other types of oncology), candidiasis may not be detected at all. Since its symptoms will be perceived by the patient as an unhealthy state due to the existing disease. To make matters worse, Candida susceptibility testing is not considered a routine procedure in many teaching hospitals and laboratories.

Candidiasis of the skin and nails

The infection is expressed in the form of allergic rashes (candidamycids), erythematous-squamous spots, urticarial and bullous type rashes. Nail pathologies are divided into:

• parochinia - purulent inflammation of the periungual and subungual spaces, absence of eponychium (skin at the base of the nail plate);
• onychia - purulent inflammation of the nail fold, deformation of the nail with discoloration and brittleness.

Candidal skin lesions may be accompanied by fever, inflammation and swelling of the lesions.

Candidiasis (thrush) of the oral mucosa

The fungus can affect both individual areas of the oral cavity and completely all mucous membranes: lips, gums, cheeks, palate, tongue, tonsils, uvula and pharynx. This is expressed in the presence of a white coating, compared to a curd mass. Swelling and redness may appear. There is often pain when swallowing, talking, or palpating. Saliva becomes viscous and bad breath appears.

Thrush may be accompanied by candidal cheilitis - damage to the lips and corners of the mouth. Painful cracks appear, covered with a white coating, and pieces of skin peel off from the lips. The disease is characterized by a long course with the possible addition of bacterial infections.

Intestinal candidiasis

Intestinal infection with fungi of the genus Candida can be an independent disease or develop as a result of damage to the oral cavity. Expressed as severe dysbacteriosis with the following symptoms:

• diarrhea;
• excessive gas formation;
• nagging pain in the rectum;
• an admixture of white flakes in the stool.

In most cases, symptoms are sluggish or completely absent. The disease is dangerous because the body does not receive enough vitamins and microelements, which is especially dangerous for a growing child.

Candidiasis of the genitourinary system (urogenital candidiasis)

Unlike sexually transmitted diseases, candidiasis of the genitourinary system is often hidden and asymptomatic. The fungus is discovered during a planned infection or against the background of other diseases. Symptoms begin to appear against the background of declining immunity, ongoing pathological processes of microflora destabilization and re-infection. In women, candidiasis manifests itself as follows:

• itching and burning of the external genitalia;
• swelling and redness;
• white, cheesy discharge;
• pain during sexual intercourse.

In men, the symptoms are similar:

• itching and burning of the head of the penis;
• white plaque and discharge:
• pain during sexual intercourse and urination.

Fungal infections of the bladder, excretory tract and kidneys are characterized by frequent urination, including false urges, pain in the suprapubic region. Candidiasis can be accompanied by bacterial infections. Complications include: cystitis, pyelonephritis, necrosis of the papillae, abscesses, formation of mycelium in the renal pelvis. Without proper treatment, against the background of chronic diseases, there is a risk of developing kidney failure.

Fungal infection in gastrointestinal pathology

Lapina T.L., Ivashkin V.T.

The importance of fungal infection in gastroenterology is either overestimated, or, conversely, is not properly appreciated. There is often a clear overdiagnosis. For example, based on the presence of Candida fungi in the culture of a smear from the oral mucosa in a person without signs of stomatitis, or in a stool test “for dysbacteriosis” of a patient with irritable bowel syndrome, a diagnosis of candidiasis or even “systemic mycosis” is established. It does not take into account at all that the fungus is a human commensal and is widespread in the environment (such as Candida, Aspergillus). Therefore, the isolation of, say, Candida representatives from the surface of the skin, oral cavity, sputum, urine and feces must be interpreted with caution.

You should always take into account that many fungi do not exhibit pathogenic properties if the host’s body is not weakened. Violations of the anatomical, physiological and immunological mechanisms of the body's defense create conditions for the development of an infectious process caused by its own, under normal conditions, non-pathogenic microflora or saprophytic microorganisms from the environment.

Conditions for the development of opportunistic infections include: treatment with corticosteroids, immunosuppressants, antimetabolites, antibiotics; AIDS and other immunodeficiency conditions; serious metabolic disorders (for example, diabetes mellitus, renal failure); neoplasms and antitumor therapy. Fungal infection, including the gastrointestinal tract, developing against the background of a serious illness, must be recognized in time and adequately treated, since this infection can have a negative impact on the prognosis of the underlying disease. Correctly recognized fungal infection of the gastrointestinal tract often provides the main diagnosis. Thus, candidiasis of the oral cavity and esophagus is one of the “calling cards” of AIDS. One of the important gastroenterological aspects of the problem under consideration is also the fact that fungal infection can be a complication of enteral and especially parenteral nutrition.

Clinical picture

Most often, patients with suppressed immunity experience infection with Candida albicans, less often with other representatives of the genus Candida.

Candidal stomatitis is characterized by a white coating that slightly rises above the mucous membrane of the oral cavity and resembles curdled milk or cottage cheese. When the plaque is removed, a hyperemic surface is exposed, which may bleed slightly (pseudomembranous form). In the atrophic form, the lesions have the appearance of erythema. Symptoms include dryness, burning, and frequent loss of taste sensitivity. Candidal stomatitis is widespread among patients with AIDS (one of the most common manifestations of the disease), as well as with the use of antibiotics, corticosteroids and antitumor drugs.

Fungal esophagitis - most often candidiasis. They develop in immunodeficiency states, antibiotic therapy, often in patients with diabetes mellitus (a high concentration of glucose in saliva is favorable for fungal growth), in elderly people or with impaired trophological status. Fungal esophagitis also occurs with achalasia cardia, other motor disorders, for example, as part of scleroderma, and with stenosis of the esophagus. Clinically, fungal esophagitis is manifested by dysphagia and odynophagia (painful swallowing). In severe cases, specific esophagitis may be complicated by bleeding, perforation, stricture of the esophagus, or the development of candidomycosis sepsis. An endoscopic examination reveals yellow-white raised deposits on the hyperemic mucous membrane of the esophagus. X-ray examination can reveal multiple filling defects of various sizes. The diagnosis is confirmed by microscopic examination of smears obtained during esophagoscopy.

Complaints of dysphagia and chest discomfort in a patient with AIDS serve as the basis for a broad differential diagnosis, since damage to the esophagus in these patients can be caused by viruses (herpes simplex, cytomegalovirus), and the development of Kaposi's sarcoma, and other reasons. However, the diagnosis of candidal esophagitis cannot be called difficult. The presence of fungal stomatitis in an HIV-infected patient with dysphagia will most likely indicate the correct etiology of esophagitis, and endoscopy with microbiological or histological examination clearly establishes the diagnosis in 95.5% of cases (I. McGowan, IVD Weller, 1998).

With suppression of the immune system and general weakening of the body, the development of fungal gastritis is possible, the most common pathogens of which are representatives of the genus Candida, Histoplasma, Mucor.

Candidiasis affecting the small and large intestines as a cause of diarrhea is not as common as it might seem at first glance. Diarrhea is one of the most common symptoms of immunodeficiency conditions, and not only infectious agents cause it. However, the role of fungal infections (including Candida) as a cause of diarrhea is small. Thus, in AIDS, the causative agents of the infectious process in the small and large intestine, accompanied by diarrhea, are, first of all, protozoa - Cryptosporidium, Microsporidium (Enterocytozoon beineusi), Isospora belli, Giardia lamblia. Viruses associated with the development of diarrheal syndrome in AIDS include cytomegalovirus and herpes simplex virus, and among bacteria, Salmonella, Shigella, Campylobacter spp.

It is important to pay attention to a well-differentiated nosological entity - pseudomembranous colitis. This is an acute inflammatory bowel disease associated with antibiotic therapy. Its clinical presentation ranges from transient diarrhea to a severe form with fever, dehydration and complications. Cases of this disease have been described in uremia, after cytostatic therapy. Colonoscopy reveals fibrinoid deposits on the mucous membrane, from which the disease gets its name. Despite the superficial similarity with candidiasis (the onset of the disease is provoked by antibiotics, white deposits are detected on the mucous membrane), pseudomembranous colitis has nothing to do with this fungal infection. The causative agent of antibiotic-associated colitis (synonymous with pseudomembranous colitis) has been identified. This is Clostridium difficile - a gram-positive anaerobe. Antibiotic therapy, suppressing its own microflora, creates conditions for the proliferation of C. difficile and the manifestation of its pathogenic properties. Diagnosis is made by identifying the pathogen in stool or by detecting C. difficile toxin. This digression on pseudomebranous colitis once again emphasizes the need for an adequate assessment of the clinical picture, instrumental examination data and laboratory tests. The diagnosis of fungal infection, including candidiasis, should be based on the most complete information possible.

Diagnostics

The most common fungal infections of the gastrointestinal tract - candidiasis of the oral cavity and esophagus - have quite characteristic symptoms. For a correct diagnosis, obtaining a culture of the pathogen must be confirmed by characteristic clinical symptoms, excluding other etiologies, as well as histological signs of tissue invasion. In the case of systemic candidiasis, the diagnosis is helped by culture of the fungus from the blood, cerebrospinal fluid or tissue, such as a liver biopsy, which will clarify the clinical signs - septicemia, meningitis or liver damage.

Cryptococcus and Histoplasma are of much less importance in gastroenterology. As a rule, involvement in the pathological process of these fungal infections of the gastrointestinal tract and liver occurs in patients with immunodeficiency in the disseminated form of the disease. Histoplasma capsulatum, with hematogenous spread from the lungs, affects the liver and spleen with symptoms of hepato- and splenomegaly, and damage to the gastrointestinal tract is accompanied by ulceration (especially often in the oral cavity). In AIDS, Cryptococcus neoformans and Histoplasma spp. with disseminated cryptococcosis and histoplasmosis, the liver is affected by the type of granulomatous hepatitis. Clinically and biochemically, cholestasis syndrome occurs. To establish an accurate diagnosis, a liver biopsy is necessary, which will prove fungal tissue invasion.

Treatment

Modern antifungal agents represent a very impressive arsenal.

Fluconazole (water-soluble triazole) highly selectively inhibits fungal cytochrome P450 and blocks the synthesis of sterols in fungal cells. Today there is a domestic fluconazole - Flucostat. It is almost completely absorbed from the gastrointestinal tract, allowing adequate serum concentrations to be rapidly achieved. It is used for candidiasis and cryptococcosis. For AIDS, for the treatment of cryptococcosis after a preliminary course of amphotericin B (without fluorocytosine or in combination with it, which is preferable), fluconazole is prescribed 200 mg per day.

Ketoconazole (imidazole derivative) has a wide spectrum of antifungal activity, but unlike fluconazole, it can cause a temporary blockade of the synthesis of testosterone and cortisol.

Fluorocytosine is incorporated into fungal cells, where it is converted into 5-fluorouracil and inhibits thymidylate synthetase. Typically, the drug is used to treat candidiasis, cryptococcosis, and chromomycosis.

Amphotericin B acts on the sterols of the fungal membrane, disrupting its barrier functions, which leads to lysis of the fungi. Indications for its use are systemic mycoses - candidiasis, aspergillosis, histoplasmosis and others.

Given the severity of the diseases, against which opportunistic infections are possible, antifungal therapy often requires a combination of drugs, repeated courses, or maintenance treatment.

Diagnosis of candidiasis

The study is based on the isolation and identification of a species of fungus of the genus Candida. Currently, there are about 150 species, differing in morphological and biochemical properties. The most common fungus is C. albicans, accounting for up to 80% of cases of candidiasis of the digestive tract and up to 70% of genital infections. Before prescribing treatment, it is also necessary to determine the sensitivity of the isolated strain to antimycotics (antifungal medications): amphotericin B, voriconazole, itraconazole, fluconazole, flucytosine.

Microscopic diagnostics

1. Microscopy of a smear is taken from the area of ​​the affected mucosa. Allows for comparative characterization of blastospores and pseudomycelia. During the study, fixed and native preparations that stain microorganisms are used. To increase the information content, pseudomycelia of cells are treated with dyes. The contrast in staining of microorganisms makes it easy to distinguish candida from other forms, including bacteria, under a microscope.

2. Bacterial culture allows you to identify the causative agent of infection and determine its concentration. The analysis is used to monitor the effectiveness of treatment, as well as to identify the sensitivity of candida fungi to various antimycotics.

Diagnostics by ELISA and PCP

1. Enzyme-linked immunosorbent assay (ELISA) is based on the determination of antibodies that are produced by the immune system in response to foreign substances in the blood. This technique allows you to identify the pathogen and the degree of its development, establishing whether the disease occurs in an acute or chronic stage.

2. Polymerase chain reaction (PCR) is a highly sensitive test that allows you to directly detect the infectious agent. Thanks to it, it is possible to differentiate Candida fungi with pseudomycelium from those that do not have it. These data are important for subsequent interpretation of results and deeper diagnosis.

Types of intestinal candidiasis

The following types of intestinal candidiasis are distinguished:

• Non-invasive is the most common type. Due to decreased immunity and disruption of normal intestinal microflora, favorable conditions arise for the growth of fungal infections. Candida fungi multiply in the intestinal cavity without forming threads and without growing into the organ cavity.
• Invasive (diffuse) is an extremely severe type of candidiasis, which mainly occurs in immunodeficiency and cancer diseases. In this case, Candida fungi behave more aggressively; they form threads with the help of which they grow into the thickness of the intestine. With a pronounced decrease in immunity, a fungal infection can spread throughout the body and cause candidal sepsis.

Interpretation of results

If there are clear signs of candidiasis (thrush), and during a laboratory test blastospores and pseudomycelia of the fungus were identified, the study ends here. A diagnosis is made and treatment begins.

If a microscopic examination gives a negative result, this does not indicate the absence of infection. The disease can occur in a latent chronic form. It is necessary to carry out a number of other tests, for example, microscopic examination of scrapings, determination of Candida DNA in scrapings, urine, and prostate secretions. Also prescribed:

• Clinical blood test.
• Test for HIV infection.
• Determination of trace element reserves in the body.
• Test for glucose and carbohydrate metabolism metabolites.

These laboratory tests can help identify conditions that may be causing the fungus to grow.

Treatment of intestinal candidiasis

This disease should be treated by a gastroenterologist. The doctor will be able to evaluate the symptoms, diagnostic results and prescribe correct and effective therapy. The principle of treating candidiasis is as follows:

• antimycotic therapy during the period of clinical manifestations;
• normalization of intestinal microflora;
• diet therapy - if you have candidiasis, you should not eat sweets, baked goods, sweet carbonated drinks, or alcohol;
• treatment of the underlying disease that caused the fungal infection.

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Analyzes

• Bacteriological study for opportunistic pathogenic flora (OPF)
• NC yeasts of the genus Candida: C.albicans, C.krusei, C.glabrata
• Study of the biocenosis of the urogenital tract in women (“Femoflor 13 - screening”)
• Candida albicans
• Mycoses: identification of clinically significant fungi with determination of sensitivity to antimycotic drugs (only for fungi of the genus Candida and Cryptococcus neoformans)
• Specific immunoglobulin E - Candida albicans

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