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Medical diagnostics of intestinal Candidiasis (detailed)

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Published: 12 years ago

Medical diagnostics of intestinal Candidiasis (detailed)

I have recently read this Russian article written by mainstream Russian gastroenterologists, talking about intestinal candidiasis and its effect on the system. They go into great detail about diagnostics. I know this Moscow lab does all these tests. Do you think a local doctor might refer us to a facility with the same capability or would we have to go to a major medical center that has doctors like the ones that wrote this article that actually recognize this problem?

Question of the diagnosis of intestinal candidiasis and determining indications for antifungal therapy is extremely important.

In recognition of mucosal candidiasis is necessary to distinguish between physiological "Candida" and the infectious process caused by this fungus.

For diagnosis of candidiasis absolutely informative detection of Candida in the sterile fluids (cerebrospinal, lavazhnoy, peritoneal, etc.) or the detection of fungi in tissues (often detect changes in the type granulomas with necrosis).

To increase the sensitivity of cultural and morphological diagnosis of candidiasis is recommended to explore multiple mucosal biopsy.

Tissue biopsies collected in 2 sterile Petri dishes or sterile jars with screw-top lid, pour in one sample of 10% solution of formaldehyde and sent for histological examination, the second is used for mycological research.

Material is transported to the microbiology laboratory, protected from direct sunlight. It is essential that the material was delivered to the mycological study no later than 1 h after the seizure of storage at room temperature or not more than 3 h when stored at +4 ° C.

Microscopic examination should be conducted in native and stained preparations.

PAS-reaction (treatment with chromic acid) or its modifications - painting by Gridley - reveal the parasite in tissues or blood smears by staining the polysaccharide components of cell walls, to suppress the color of the surrounding tissues used "kontrokraska" light green, yellow metanilovym, etc .

In this case, found only invade the cells of fungi, while at the same time, it is impossible to judge the reaction from the surrounding tissue. It is therefore necessary to evaluate drugs, "dokrashennye" hematoxylin and eosin.

Pseudomycelia Candida also can be identified in smears or mucosal smears from the bottom of the ulcer (painting on Romanovsky-Giemsa).

On the surface of a dense nutrient medium in a petri dish makes imprint investigated with a cloth, then make screening loop. The same piece of tissue placed in 50 ml of liquid nutrient medium (Wednesday Saburo, must) and incubated at +37 ° C for 5 days.

Widely used methods for rapid identification of C.albicans. This form of Candida is able to form tubes and sprout short strings pseudomycelia for 2-4 hours at +37 ° C in the blood serum, egg whites and other similar environments. For a species C.albicans, this phenomenon is typical in 90% of cases.

Effective treatment should seek to identify the species origin of fungi Candida and determination of individual sensitivity of the strain to antimikoticheskim Drugs; some strains of Candida lusitanlae resistant to amphotericin, Candida krusei and Candida glabrata - to fluconazole.

Detection of Candida in the blood allows the diagnosis of generalized candidiasis only in conjunction with relevant clinical symptoms (especially informative re-discovery of Candida in the blood). It should be remembered that in 70-80% of patients actually suffering from generalized candidiasis, to identify fungi in blood cultures can not.

The value of serological methods is mainly to identify patients with probable invasive mycosis. False positive results of serological tests are possible at mikonositelstve and in healthy people, sensitized antigens fungi; false negative samples can be observed in immunodeficiency.

Original proposed the detection of antigens and antibodies of some metabolites of fungi cells, created special diagnostic kits. As an example Pastorex Candida, - to determine the reaction of "latex-agglutination" repetitive oligomannoznyh epitopes of antigenic structures expressed on a large number of macromolecules of the fungus.

Set Platelia Candida can be used to determine the antigen-mannan Candida, for example, in the serum of the patient with circulating microorganism. With the first set threshold determination of antigenic structures is 2.5 ng / ml, with the second in conjunction with the method of determining the threshold - 0.5 ng / ml.

In non-invasive diagnosis of intestinal candidiasis, in which there is no tissue biopsy material for mycological research, as a standard for diagnosis is proposed to use the following criteria: growth of more than 1000 CFU / g of Candida spp. plated intestinal contents, taken in sterile conditions, combined with signs of intestinal dyspepsia and positive clinical and laboratory dynamics in the treatment antimikoticheskimi drugs [1].

Unfortunately, the correct intake of intestinal contents for culture studies is technically difficult, is prevalent in our country technique "seeding feces of dysbiosis" can not serve as a basis to assess the actual composition of intestinal microflora [1,3,5].

In the diagnosis of any form of candidiasis of the digestive system is important to take into account the presence of the patient's predisposing risk factors. "Accidental" Identification of candidiasis should be an incentive to seek such a background factor. It is important to remember that candidiasis can act as an early manifestation of common diseases involving the development of immunodeficiency.

Given the above, it would probably be not entirely correct to formulate a diagnosis briefly, as "Candida", without specifying the background state.

The differential diagnosis of invasive gastrointestinal candidiasis (in detecting macroscopic changes in the intestines) must hold with chronic inflammatory bowel diseases, antibiotikoassotsiirovannoy diarrhea caused by infection C. difficile, malignant lesion, ischemic colitis.

Non-invasive form of candidiasis should be differentiated from a wide range of enteritis and colitis of different etiology. Indirect evidence for the presence of candidiasis can act kishechika extraintestinal manifestations of systemic candidiasis.

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