What is candida in the intestines. Candidal colitis of the intestine treatment once. Treatment of esophageal candidiasis

Therapeutic archive, 2003, No. 11, pp. 77-79.

M.A. Shevyakov

Diagnosis and treatment of intestinal candidiasis.

Research Institute of Medical Mycology. P.N. Kashkin St. Petersburg MAPO.

Keywords: lecture, candidiasis, intestines, dysbiosis, natamycin, Candida.

key words:lecture, candidiasis, intestine, dysbiosis, natamycin, Candida.

Today, humanity is experiencing an epidemic of opportunistic infections, among which mycoses occupy one of the leading places. Candidiasis of the mucous membranes of the digestive organs is one of the most common mycotic infections in people of all age groups. Diagnosis of intestinal candidiasis sometimes presents significant problems associated primarily with the lack of awareness of physicians in the field of clinical mycology and the difficulty of differential diagnosis between candidiasis and candidiasis.

The mucous membranes are "open systems" of the macroorganism, continuously in contact with the environment. In its turn, Candida spp. are widely distributed in nature, often contaminating soil, water, food, household surfaces. Mucosal contact between humans and Candida spp. - an ordinary fact, which explains the significant prevalence of transient candidiasis in the human population, for example, in feces - in 65 - 80% of the population of European countries.

Apparently Candida spp. does not pose a serious threat to the health of an immunocompetent person. At the same time, against the background of an increase in the number of patients with disorders in antimicrobial resistance systems, we are seeing a significant increase in the incidence of candidiasis. Many people see the reason for the increase in candidiasis in the spread of so-called risk factors, which will be discussed below. However, it cannot be ruled out that more frequent detection of candidiasis is also facilitated by improved diagnosis.

Candidiasis is a vivid example of an opportunistic infection, a kind of "immunological drama", where the factors of aggression and pathogenicity of the fungus and the factors of antifungal resistance of the macroorganism play their role. Of the seven groups of factors of aggression and pathogenicity of microorganisms according to N.P. Elinov Candida spp. detect some enzymatic (plasma coagulase) and non-enzymatic (endotoxin) proteins (1st group of factors), polysaccharides, such as mannans, (2nd group of factors), glucoconjugates (3rd group of factors), free lipids, (7th group of factors). Sometimes the pathogenicity factors of the fungus of the genus Candida consider only its ability to adhere and invade, followed by tissue cytolysis, and then to lymphohematogenous dissemination. Really, Candida spp. are capable of an invasive process in mucous membranes, primarily represented by stratified squamous epithelium, and less often by single-layer cylindrical epithelium (this is one of the paradoxes of mycology - to invade the cylindrical epithelium Candida spp. more difficult, although it is single-layered, not multi-layered as flat). This is the so-called invasive mycotic process, which we observe relatively often in the oral cavity, esophagus and much less frequently in the stomach and intestines.

However, the absolutization of the fact of invasion and the associated transformation of the fungus of the genus Candida into a filamentous form (pseudomycelium) leads to an erroneous formula - "invasion means candidiasis, everything else is just contamination (candidiasis)."

Recently, evidence has been obtained for the existence of the so-called non-invasive form of candidiasis. As it turned out, even without penetration deep into the epithelium, Candida spp. can cause pathology in humans.

Contact of surface and corpuscular antigens of the fungus with immunocompetent cells of the macroorganism can lead to the production of increased amounts of specific IgE and sensitized lymphocytes, which serves as a pathogenetic basis for mycogenic sensitization. Allergens candida albicans primary metabolites are also alcohol dehydrogenase and acidic P 2-protein. This is potentially dangerous in terms of the development of mycogenic allergic diseases - specific bronchial asthma, atopic dermatitis, urticaria. Resorption in the intestine of metabolic products of fungi of the genus Candida its plasmacoagulase, proteases, lipophosphorylase hemolysin and endotoxins can cause specific intoxication and secondary immunodeficiency. Finally, through interaction with representatives of the oblate normobiota and opportunistic pathogens Candida spp. can induce dysbiosis and mixed infection of the mucous membranes.

The key factor in the onset of the infectious candidiasis process is the violation of nonspecific and specific resistance of the organism, both at the local and at the general level.

The factors of nonspecific resistance traditionally include an adequate balance of desquamation and regeneration of epitheliocytes, mucus mucopolysaccharides, normal microbiota of the mucous membranes, ( Bifidumbacterium spp., Lactobacillus spp., Escherihia coli, Peptostreptococus spp.,), peristaltic activity and the acid-enzymatic barrier of the digestive tract. It has been shown, for example, that the treatment of patients with preparations containing bifidobacteria significantly reduces the content of fungi of the genus Candida in the feces of patients.

Nonspecific factors also include secretory IgA, lysozyme, transferrin, complement components. However, the most important are the number and function of polymorphonuclear mononuclear phagocytes, in particular their ability to chemotaxis, attraction, keeling, and fungal antigen presentation. It is in conditions of neutropenia that life-threatening forms of candidiasis develop, including visceral lesions (liver, gallbladder, pancreas).

The specific immune response in candidiasis is represented by the production of specific anti-candidiasis antibodies of the IgA, IgG, IgM classes, which inactivate the invasion enzymes and endotoxins of the fungus, and also, together with the complement components, are involved in opsonization.

The role of T cells in candidiasis is reduced to the activation and regulation of nonspecific and immune responses.

The conflict between pathogenicity factors of the fungus and antifungal resistance factors leads to the development of one form or another of candidiasis. The mechanisms of pathogenesis of two fundamentally different forms of candidiasis (invasive and non-invasive) formed the basis for the classification of intestinal candidiasis. For practical purposes, it is necessary to distinguish three forms of damage. The first is invasive diffuse intestinal candidiasis, the second is focal (secondary with duodenal ulcer, with ulcerative colitis), the third is non-invasive (the so-called candidal dysbiosis). Separately, perianal candidodermatitis is isolated, caused by the invasion of pseudomycelium of micromycetes into the skin of the perianal region. However, the main symptom of this disease - recurrent anal itching causes a greater frequency of visits not to a dermatologist, but to a gastroenterologist.

To suspect candidal lesions of the intestine allows the patient to have characteristic risk factors. The latter include childhood and old age, therapy with glucocorticosteroids and antibacterial drugs, intensive cytostatic polychemotherapy, diabetes mellitus and other diseases of the endocrine system, AIDS, severe debilitating diseases, nutritional status disorders, genetically determined immunodeficiencies.

Undoubtedly, the diagnosis of candidiasis using purely clinical methods is impossible due to the fact that its clinical manifestations do not have absolute specificity. At the same time, the diagnosis cannot be based on laboratory data. For each mycological research method, there are limitations in specificity and sensitivity.

The fundamental drawback of cultural mycological research is that this method does not differentiate the invasive candidiasis process from candida carriers. And Candida- commensals, and Candida-pathogens on Sabouraud's medium form identical milky-white colonies. However, only the cultural method allows you to determine the species and sensitivity of the pathogen to antimycotics.

Morphological methods (histological, cytological) aimed at finding pseudomycelium Candida spp .- active tissue form of the fungus, have limited sensitivity. In the event that the fragment of the biomaterial under study (scraping from the mucous membranes, brush biopsy, forceps biopsy) does not contain pseudomycelium, a false-negative result of the study is possible, since there is no guarantee of the absence of candidal invasion in neighboring tissue areas. Let us add to the above that the histological method is laborious and expensive, as it requires special stains (CHIC reaction, Gomory-Grocott staining).

Using serological methods (for example, ELISA with Candida) cannot achieve high sensitivity and specificity, and these methods are not available outside the walls of specialized clinics.

From the foregoing, it follows that in case of candidiasis of the digestive organs, a comprehensive clinical and laboratory examination of the patient is required for diagnosis, including the identification of predisposing factors, objective clinical and endoscopic signs of candidiasis, detection Candida spp ., in a series of biosubstrates and biopsy materials with confirmation of their participation in this infectious process. Quite often, candidiasis of the digestive system proceeds as in the form of a mixed infection - Candida- bacterial, Candida - herpetic, Candida-protozoal, which makes the clinical picture of the disease quite variable.

Invasive intestinal candidiasis develops in patients with hematological and oncological diseases during high-dose cytostatic and / or immunosuppressive therapy, as well as in patients with AIDS. The clinical picture is characterized by a serious condition, abdominal pain syndrome, diarrhea (but not always!), fever. An endoscopic examination reveals a pronounced erosive-pseudomembranous colitis. It is characteristic that candidal colitis is "included" in the picture of candidasepsis, that is, at the same time, specific lesions of the lungs, skin, oral cavity and esophagus, hepatosplenar candidiasis are detected. Morphological examination of the mucous membranes reveals filamentous forms Candida spp. Note that invasive intestinal candidiasis is unlikely in immunocompetent subjects.

The course of duodenal ulcer or ulcerative colitis can also be complicated by candidiasis. In this case, the invasion of pseudomycelium Candida spp. occurs exclusively in areas of the intestine, de-epithelialized due to the underlying disease. Such forms of damage are called focal.

However, in medical practice, intestinal dysbiosis with overgrowth is more common. Candida spp. That one is interesting the fact that there is still no unity in the issue of nosological terminology regarding intestinal candidiasis. Thus, we were able to find several terms used to refer to conditions associated with the detection of fungi in the intestine: excessive intestinal growth Candida(intestinal candida overgroth), candida-associated diarrhea (candida-associated diarrhea), candida-associated syndrome (candida-associated syndrom), candida hypersensitivity syndrome (candidiasis hypersensitivity syndrome), candidal enteritis, translucent pre-invasive candidiasis or candida colonopathy, intestinal dysbacteriosis with increased proliferation Candida spp. .

At the heart of the pathogenesis of intestinal dysbiosis with overgrowth Candida spp. lies the action of metabolites of fungi resorbed in the intestine with a massive growth of the latter in the lumen of the intestine. With candidal intestinal dysbacteriosis, the condition of patients is usually satisfactory. Detect symptoms such as flatulence, abdominal discomfort, changes in stool consistency and frequency, signs of moderate intoxication, and a tendency to exacerbate allergic diseases.

The diagnoses of "intestinal dysbiosis with increased proliferation of fungi of the genus Candida" and "irritable bowel syndrome". The commonality of these nosological units is the absence of pronounced morphological changes in the intestine, but their pathogenesis and treatment differ significantly. Apparently, a certain proportion of patients with irritable bowel syndrome suffer from intestinal dysbiosis, and correction of the latter improves the quality their lives.

It is important to note that mucosal candidiasis often occurs as a mixed infection. Thus, the frequency of mixed infection in intestinal dysbiosis with increased proliferation of fungi of the genus Candida according to our data is 63%. At the same time, an association with a significant number of bacteria with the so-called proteolytic main metabolic pathway (conditionally pathogenic) is more often found - Escherichia coli, Ristella, Clostridium perfringens, Klebsiella, Morganella , Bacteroides, Staphilococcus aureus, Pseudomonas aeruginosa.

Signs of mycogenic sensitization are detected in 10.4% of patients with intestinal dysbiosis with overgrowth of fungi of the genus Candida.

Diagnosis is based on the presence of the following criteria: intestinal dyspepsia syndrome, laboratory-confirmed intestinal dysbiosis, growth Candida spp. over 1000 CFU / g when sowing feces. Endoscopic studies with cytological examination of preparations are not very informative, since most often pathological changes are not detected. Differential diagnosis is carried out with infectious colitis, fermentopathy, tumors, irritable bowel syndrome.

Rectal candidiasis is an invasive mycotic process, described in detail as a specific proctitis in homosexual men with AIDS. At the same time, mixed infection with herpesvirus infection (the so-called "gay gut") is often noted. Diagnosis is based on the detection of pseudomycelium Candida spp., in a smear-imprint of the rectal mucosa.

In immunomorphological studies of biopsies of the colon mucosa in patients with intestinal dysbiosis with overgrowth Candida spp. according to our data, they reveal a decrease in the density of IgA-synthesizing cells and, conversely, an increase in the density of IgM- and IgG-synthesizing cells. Observations show that a non-invasive (dysbiosis) process in the intestine can become a precursor to an invasive and even septic process.

Perianal candida dermatitis develops in 6.5% of patients with candidal intestinal dysbiosis. The main symptom of this disease is persistently recurrent anal itching. The criterion for diagnosing perianal candida dermatitis is the detection of pseudomycelium Candida spp. in scrapings of skin scales.

The choice of treatment method for a patient with candidiasis of the digestive system should pursue three main goals - correction of background diseases, rational prescription of an antimycotic drug, and immunocorrective therapy.

When choosing a treatment for a particular patient, the doctor should take into account the clinical form of candidiasis, the nature of the comorbidity, the risk of side effects.

In principle, as the actual antifungal agent, the doctor can choose either polyene (slightly resorbable) or azole (resorbable) antimycotics. Proven invasive candidiasis of the mucous membranes is an indication for the use of azole drugs (ketoconazole, itraconazole, fluconazole). The daily dose of, for example, fluconazole should be at least 3.0 mg/kg of the patient's weight. However, in some cases (pregnancy, pathology of the liver and kidneys), there are contraindications to azole preparations.

Intestinal dysbiosis with increased proliferation of fungi of the genus Candida does not require the appointment of resorbable antimycotics. In this case, polyene preparations (natamycin and nystatin) are considered the basis of treatment. A good effect is achieved, for example, with the appointment of Pimafucin at a dose of 400 mg per day (1 tablet 4 times a day) for 10 days. It is advisable to add symbiotics (live cultures of the normobiota) to the treatment, according to indications - immunomodulators, antibacterial enteroseptics, enzymes, intestinal function regulators.

The advantages of polyene antimycotics are as follows: the absence of significant resorption and serious side effects, they do not inhibit the normobiota of the intestines and genitals, and fungi do not develop resistance to them.

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Yeast fungus is a full-fledged part of the microflora of the mucous membranes in the human body. It is involved in maintaining the level of microbiocenosis, helping to regulate the number of other microorganisms in the intestine. It is found in laboratory swabs from household items, furniture, home textiles and food. In a small amount, Candida does not appear and does not cause discomfort to a person. But when conditions favorable for reproduction arise, a condition occurs, better known as intestinal thrush.

Candida albicans under the microscope

Causes of candidiasis

The etiological factor of intestinal candidiasis are yeast-like fungi. Several representatives belong to the genus Candida. The most common types:

Candida glabrata;
Candida albicans;
Candida parapsilosis;
Candida tropicalis;
Candida lusitaniae;
Candida dubliniensis;
Candida krusei.

Under conditions of a healthy body and adequate local immunity, the growth of fungal colonies is moderate. It is restrained by other inhabitants of the intestinal mucosa: bifidum and lactobacilli, E. coli, enterococci. But the main barrier that preserves health is local immunity: a layer of mucin and glycocalyx - a specific glycoprotein on the surface of enterocyte cell membranes.

Interesting to know! The glycocalyx performs a receptor function, recognizing foreign microorganisms and giving a signal to other parts of the cellular and humoral immune response.

Glycocalyx cells

In case of dysfunction of the immune system due to congenital or acquired causes, for example: human immunodeficiency virus, or transient physiological conditions in an elderly person or an infant, these defenses are depressed and are not able to fully function. The antifungal resistance of the intestine is rapidly decreasing, so the fungal infection spreads through the mucous membranes throughout the body, leading to candidiasis.

There are pathological conditions that contribute to intestinal candidiasis. Doctors distinguish:

diabetes mellitus, especially in advanced form with complications;
oncological diseases, tumors of the immune system and intestines, antitumor chemotherapy;
HIV infection and acquired immunodeficiency syndrome;
autoimmune diseases: thyroiditis, lupus, multiple sclerosis - and the treatment of these diseases with steroid hormones;
prolonged irrational antibiotic therapy;
violations of digestion and assimilation of food, the use of food products that contain a small amount of fiber and therefore leave the intestinal cavity untimely, deteriorate, linger and lead to the start of fermentation and decay, against which candidiasis actively develops;
non-compliance with the regime of work and rest, prolonged stressful conditions, the period of pregnancy.

Symptoms of bowel disease

Depending on the reasons that contributed to the development of a fungal infection, the intensity of the manifestations of the disease changes. Therefore, there are several forms of intestinal candidiasis:

non-invasive candidiasis, when colonies of fungi affect only the mucous membrane and do not spread to adjacent tissues;
invasive focal candidiasis, when several layers of the intestinal wall are affected by candidiasis, but the process is limited to a small area;
diffuse candidiasis.

Diffuse candidiasis of the digestive tract

Usually, at the beginning, the clinical picture of candidiasis is not specific, similar to intestinal flu. The patient is concerned about weakness, fever, which indicates intoxication. Patients complain of a decrease in appetite, heaviness and discomfort in the abdomen, a feeling of incomplete emptying of the intestines, itching in the anus, white cheesy blotches may appear in the stool. Further, severe pain in the abdomen without a clear localization and diarrhea, sometimes with an admixture of blood, joins.

The doctor conducts a physical examination, consisting of examination, palpation of the intestines and percussion. During the examination, additional symptoms of intestinal candidiasis are revealed in the form of abdominal asymmetry, increased gas formation, rumbling, local pain and signs of concomitant diseases, pathological conditions of immunity. Such complaints require a detailed study and additional examination, since often instead of candidiasis, irritable bowel syndrome is mistakenly diagnosed.

Flatulence and pain in the abdomen with candidiasis

Note! Sluggish intestinal candidiasis due to inadequate treatment can lead to the occurrence and exacerbation of allergic reactions in the form of rashes on the face and throughout the body.

Diagnosis of pathology

Diagnosis of candidiasis begins with a conversation with a doctor. He finds out the circumstances under which the symptoms began, the dynamics of their development.

A non-invasive form of gastrointestinal candidiasis is common among men and women of working age. This form of candidiasis is characterized by a course against the background of complete well-being and a satisfactory condition of patients. Actively growing colonies of fungi from the inside destroy the surface of the large and small intestine, which is accompanied by a massive release of toxic metabolic products that are absorbed into the blood from the intestine and lead to mycotoxicosis.

Diagnosis of focal candidiasis requires a targeted histological study followed by staining with chromic acid, and microbiology to determine the exact type of Candida fungus in order to select an antifungal drug. For sowing, swabs from the intestinal wall and analysis of the patient's feces are used. The diagnosis is considered legitimate in case of detection of more than 10 5 colony-forming units per gram of the test material, for example: in feces.

Fungus colonies in a petri dish

Additionally, an endoscopic examination is prescribed, which shows defects in the intestinal mucosa, which is covered with a white curdled coating.

Attention! Intestinal x-rays for candidiasis are uninformative and are used only in adults in the absence of access to more reliable diagnostic methods.

Possible complications of candidiasis

If left untreated, the fungal infection will spread to the mouth, esophagus and all parts of the intestine, especially quickly this can happen in infants. In places of the most active growth, defects in the layers of the intestinal wall, its perforation, perforation through the wall into nearby organs, massive bleeding and the development of fungal sepsis are possible. Due to the huge amount of toxins that enter the bloodstream, the condition of such patients with intestinal candidiasis is extremely difficult.

In people with background immunodeficiencies, damage to the liver and pancreas quickly develops, which exacerbates the course of candidiasis. Invasive localized candidiasis occurring against the background of defects in the mucous membrane of the intestine and stomach due to nonspecific ulcerative colitis, gastric ulcer and duodenal ulcer complicates their course. And these diseases themselves can act as a provocative factor that can lead to thrush.

Treatment

Candidal colitis of the intestine is treated once only if the doctor's recommendations are followed. The treatment regimen for candidiasis is complex and long-term to prevent relapse and resume the growth of fungal colonies in the intestine. Therefore, traditional medicine methods are used, which are aimed at several links in the chain of candidiasis pathogenesis at once. Many patients resort to folk recipes for the treatment of the disease.

Antimycotic treatment

The main drugs that are used to treat candidiasis are antifungal drugs. The most famous is Fluconazole Solutab. Often doctors prescribe its analogues: Ketoconazole, Diflazon, Futsis, Pimafucin, Flucostat. With an uncomplicated course of candidiasis, a single dose will cure a chronic focus of infection. Forms are used that are absorbed and have a systemic effect, for example: capsules or tablets, non-resorptive drugs that have the property of being in the patient's intestine for a long time and having a therapeutic effect. Of the antibiotics, drugs of the polyene group are used: Nystatin and Flemoxin.

Important! Drugs that are not absorbed in the intestine for a long time are safer in terms of side effects and for use in candidiasis in babies and newborns.

Treatment of dysbacteriosis

Restoration of intestinal microbiocenosis is carried out with the help of a probiotic and dietary supplements that contain bifidum and lactobacilli, their list is wide:

Linex.
Yogurt.
Bifiform.
Acipol.

Dairy products help restore intestinal microflora

Application of enzymes

The appointment of additional enzymes for candidiasis is aimed at improving the processes of digestion in the intestines and more complete absorption of nutrients from food. This facilitates the patient's condition, helps to fight candidiasis and discomfort. More often than others, doctors recommend Mezim, Creon, Festal and Pancreatin.

Restoration of immunity

In case of severe dysfunction of the immune system, immunomodulatory drugs that contain immunoglobulins are added to the treatment of intestinal candidiasis: Viferon, Genferon. Assign complexes that contain trace elements and vitamins A, E, C, which supports immunity and allows you to quickly cure candidiasis.

Alternative therapy methods

Folk recipes for candidiasis contain garlic. It should be consumed as part of salads, in its pure form, 2 cloves once a day. According to the advice from women's magazines, decoctions of medicinal herbs help to cure the disease: sage, yarrow, chamomile, calendula and St. John's wort. Pour boiling water over dry raw materials for half an hour, take once a day. It is useful to chew propolis and rinse your mouth with soda.

diet for candidiasis

A balanced diet is a fundamental method in the treatment of intestinal candidiasis. The diet should include a sufficient amount of vegetables, fruits and berries: strawberries, blueberries and blueberries. With candidiasis, salads from kale and greens are useful. To improve intestinal motility, it is important that food is fresh, unprocessed, and high in fiber. Such properties have cereals from cereals: buckwheat, wheat, pearl barley, barley.

Prevention of candidiasis

To prevent candidal colitis, it is necessary to treat diseases of the gastrointestinal tract, maintain the normal composition of the microflora, and prevent a weakening of the immune system. You need to lead a healthy lifestyle, diet and harden.

Mycosis of the intestine is a serious disease that requires urgent diagnosis and full treatment, otherwise severe complications may occur.

Video on the topic of the article:

For citation: Shulpekova Yu.O. Intestinal candidiasis // BC. 2002. No. 1. S. 25

In recent decades, opportunistic infections caused by opportunistic fungi have taken a special place in the practice of clinicians of various specialties.

Paradoxically, this is partly due to the successes that modern medicine has achieved in the treatment of cancer and in the fight against pathogens of serious infections. In addition, it is obvious that in recent decades there has been an increase in the intensity of the impact on the human body of external factors that cause the development of immunosuppressive conditions. In addition, the end of the 20th century was marked by a significant spread of a fatal disease - HIV infection.
Pathological conditions caused by the influence of fungi of the genus Candida on the human body also belong to the category of opportunistic mycoses.
Exciter characteristic
Members of the genus Candida are yeast fungi related to Ascomycetes.
The genus Candida includes a variety of species (Candida spp.), among which the most important as causative agents of candidiasis are: Candida albicans, Candida tropicalis, Candida parapsilosis, Candida glabrata, Candida dubliniensis, Candida lusitaniae, Candida krusei.
Candida spp. are a component of the microflora, symbiotic for humans. In 10-25% of the population without clinical signs of fungal infection, Candida spp. are inconsistently detected in the oral cavity, in 65-80% - in the contents of the intestine. Candida spp. are found in the detritus of gastroduodenal ulcers in about 17% of cases.
According to modern concepts, under normal conditions, the main "habitat" of Candida spp. in the human body is the intestines. In the microbial population of the intestine, the proportion of these fungi is negligible. Growth of colonies of Candida spp. in the human body is partly regulated due to the work of immunity links. The main place in this process is occupied by links of nonspecific immunity - mononuclear phagocytes (monocytes / macrophages) and polymorphonuclear leukocytes.
A very important role in limiting the growth of the Candida population also belongs to bacteria - intestinal symbionts. The normal microflora that inhabits the lumen of the gastrointestinal tract produces substances with antibacterial activity (in particular, bacteriokines and short-chain fatty acids), which prevent the introduction of pathogenic microorganisms and overgrowth, the development of opportunistic flora. Escherichia coli, enterococci, bifidobacteria and lactobacilli have the most pronounced antagonistic properties.
The term "candidiasis" implies a pathological process, the basis of which is the overgrowth of Candida, primarily in the gastrointestinal tract and secondarily in other areas (on the mucous membrane of the genitals, bronchi, in parenchymal organs).
Candida virulence factors
Fungi of the genus Candida are adhesive to epithelial cells. Attachment to the mucous membrane is one of the conditions for further invasion of the microorganism into the underlying tissues. The ability to adhere in representatives of different species of Candida varies significantly; this ability is the highest in C.albicans, C.tropicalis, C.dubliniensis; the smallest - in Candida glabrata, Candida krusei. Mucin, a glycoprotein of the cell wall of epithelial cells, plays an important role as a protective barrier that prevents the microbe from attaching to the mucous membrane.
Aggression factors of these microorganisms include proteases and glycosidases capable of intensively degrading mucin.
As a virulence factor, the ability to rapidly form pseudomycelium filaments is also considered; this feature is most pronounced in C.albicans.
The virulence of microorganisms is subject to intraspecific variability, depending on the genotype.
Risk Factors for Candidiasis
As common factors predisposing to the development of candidiasis of the digestive organs and subsequent lympho-hematogenous dissemination of fungi, as in cases of other opportunistic infections, there are conditions in which there is a lack of immune defense of the body. These include:
1) Physiological immunodeficiencies (newborn period and early childhood, senile immunodeficiency, pregnancy, stressful conditions).
2) Congenital immunodeficiencies (Di-George syndrome, Nezelof, Shediak-Higashi, etc.).
3) Infection with the human immunodeficiency virus in the terminal stage (acquired immunodeficiency syndrome). Mycoses account for 70% of the clinical manifestations of HIV infection.
4) Oncological diseases (including hemoblastoses); chemotherapy of malignant tumors, accompanied by severe granulocytopenia (<1х109 гранулоцитов в л). Развитие кандидоза на фоне противоопухолевой терапии обычно связывают с подавлением функций иммунной системы, наблюдающимся как нежелательный эффект лечения. В то же время существуют предположения, что цитостатики и лучевая терапия угнетают защитные функции эпителиального покрова кишечника и способствуют транслокации Candida в другие органы. При проведении химиотерапии возрастает процент грибковых микроорганизмов, адгезированных к энтероцитам.
5) Autoimmune and allergic diseases, especially when prescribing glucocorticosteroids.
6) Organ transplantation (use of immunosuppressants in the post-transplant period). More than half of patients who are scheduled for bone marrow transplantation have a picture of systemic candidiasis even before transplantation.
7) Endocrinopathy (decompensated diabetes mellitus, autoimmune polyglandular syndrome).
8) Other diseases and conditions (shock conditions, anemia, hepatitis, liver cirrhosis, chronic infections, malabsorption syndrome, etc.). In pathological conditions, accompanied by a decrease in the blood supply to the intestine, the translocation of fungi to other tissues increases. Violation of digestion and absorption is accompanied by excessive growth of microorganisms in the intestinal lumen.
9) Antibiotic therapy (usually long-term use of broad-spectrum drugs). The introduction of antibacterial drugs can lead to an imbalance in the microbial biocenosis of the intestine, as a result of which an excessive development of the candidal population in the intestine is possible. The appointment of tuberculostatic drugs for 3-4 months. accompanied by the development of intestinal candidiasis in 58-62% of cases. The risk of developing idiopathic antibiotic-associated diarrhea depends on the dose of antibiotic administered; this disease usually occurs without fever and leukocytosis in the blood and in the absence of laboratory evidence of Clostridium difficile infection. It is believed that in about a third of cases, the development of idiopathic antibiotic-associated diarrhea is due to intestinal candidiasis.
10) Unbalanced nutrition (deficiency in the diet of proteins, vitamins). In an animal experiment, it has been shown that insufficient intake of protein in the body is accompanied by a decrease in the phagocytic and bactericidal activity of the macrophage link, incomplete phagocytosis, and an increase in the permeability of the intestinal barrier to Candida albicans.
According to autopsy data, candidiasis of the duodenum, small and large intestine is found in approximately 3% of dead patients (only macroscopic changes were taken into account). At the same time, half of the cases occur in patients who received chemotherapy for malignant neoplasms.
developmental pathogenesis
intestinal candidiasis
Recent studies have to a large extent clarified the patterns of interaction between Candida fungi and the host organism. According to modern concepts, two fundamentally different mechanisms of the pathogenesis of candidiasis of the digestive organs can be distinguished: invasive and non-invasive candidiasis.
Invasive candidiasis is caused by the introduction of a filamentous form of the Candida fungus into the tissues. The first stage of candidiasis, as an infectious process, is adhesion to epitheliocytes, then invasion into the epithelial layer occurs, penetration beyond the basement membrane. These manifestations of microbial aggression correspond macroscopically to erosive and ulcerative defects of the intestinal wall of various sizes and shapes, cracks, membrane overlays (similar to those in pseudomembranous colitis), polypoid or segmental circular formations.
With progressive invasion, the development of lympho-hematogenous dissemination of fungi is possible (systemic candidiasis with damage to the mucous membranes of other organs; generalized candidiasis with damage to visceral organs). In an experimental model on animals orally infected with C. albicans under conditions of immunosuppression, the initial occurrence of erosions and ulcers of the mucous membrane in the ileum, colonization of intestinal lymphoid formations, their necrosis and further dissemination was shown. The absence of macroscopic changes, apparently, should not be considered as evidence against invasive candidiasis.
In disseminated forms of candidiasis, multinucleated giant cells containing fungi are found in the lymph nodes and ducts, which probably reflects the phenomenon of incomplete phagocytosis.
Invasive candidiasis is more often observed in organs lined with stratified squamous epithelium (oral cavity, esophagus), and less often with columnar epithelium (stomach, intestines), which is probably due to the peculiarities of local immune defense.
Non-invasive candidiasis is not accompanied by the transformation of the fungus into a filamentous form; there is an excessive growth of its colonies in the lumen of a hollow organ - the intestines. It is assumed that in this case, disturbance of abdominal and parietal digestion, penetration of microbial components and metabolites into the systemic bloodstream, and the development of a pronounced systemic immune-inflammatory reaction to one degree or another are of great pathogenetic importance.
Based on the foregoing, it should be emphasized once again that mucosal candidiasis of extraintestinal localization or generalized candidiasis with damage to parenchymal organs is a manifestation of the translocation of fungi from the intestinal lumen, where the bulk of these saprophytic fungi are present. Candidiasis of extraintestinal localization (for example, the oral cavity or genitals) is a manifestation of systemic candidiasis, "originating" from the intestine.
The following is a classification of candidiasis of the digestive system:
1. Oro-pharyngeal candidiasis (cheilitis, gingivitis, seizures, glossitis, stomatitis, pharyngitis).
2. Candidiasis of the esophagus (complications - bleeding, stricture).
3. Candidiasis of the stomach:
- diffuse (specific erosive-fibrinous gastritis);
- focal (secondary to gastric ulcer).
4. Candidiasis of the intestine:
- invasive diffuse;
- focal (secondary for duodenal ulcer, with ulcerative colitis);
- non-invasive (excessive growth of Candida in the intestinal lumen).
5. Ano-rectal candidiasis:
- invasive candidiasis of the rectum,
- perianal candidiasis dermatitis.
The main manifestations of candidal lesions of the intestine are described below, which, as mentioned above, is the basis for the development of systemic manifestations.
Clinical picture
intestinal candidiasis
Features of the course of intestinal candidiasis are not clearly defined, not well studied and little known to most practitioners. It is characteristic that in patients who died from various causes, in whom macroscopic changes in the intestines corresponding to invasive candidiasis were found during autopsy, during life, as a rule, there were very poor symptoms from the gastrointestinal tract, and endoscopic diagnosis was often erroneous. Often, when single ulcerations of the intestinal wall are detected, the doctor finds it difficult to interpret them, and based on the results of a morphological study, a conclusion is given about nonspecific inflammatory changes in the edges of ulcerative defects, while a targeted mycological study is not carried out.
Clinical manifestations of intestinal candidiasis may be different depending on the level of the lesion.
With diffuse invasive intestinal candidiasis, there are manifestations of enterocolitis: complaints of spastic abdominal pain, flatulence, the presence of pathological impurities in the stool (blood and mucus), there are usually signs of systemic candidiasis (damage to the mucous membranes of the oral cavity, genitals). Endoscopic examination reveals changes in the type of fibrinous-ulcerative colitis.
With invasive focal intestinal candidiasis, the manifestations of the disease may resemble persistent, resistant to traditional therapy, the course of duodenal ulcer or nonspecific ulcerative colitis.
With non-invasive intestinal candidiasis, patients complain of unformed stools, flatulence, abdominal discomfort, with positive clinical and laboratory dynamics in the treatment with antimycotic drugs.
With invasive candidiasis of the rectum, symptoms of proctitis (pain, tenesmus, pathological impurities in the feces) may occur. In some cases, this is accompanied by the phenomena of perianal candida-dermatitis.
Intestinal candidiasis is often accompanied by subfebrile fever.
Complications
As complications of intestinal candidiasis, the development of intestinal perforation, penetration of ulcers into surrounding organs, bleeding, generalization with damage to parenchymal organs, and the development of fungal sepsis are possible.
The defeat of parenchymal organs (liver, gallbladder, pancreas, etc.) is often accompanied by deep neutropenia (less than 500 neutrophils per mm3 of blood) and is observed in the terminal phase of AIDS.
Mortality in invasive candidiasis reaches 25-55%. For some categories of patients (transplant recipients, patients with acute leukemia), invasive fungal infections are the main cause of death.
Diagnostics
The issue of diagnosing intestinal candidiasis and determining indications for antifungal therapy is extremely important.
In recognizing mucosal candidiasis, it is necessary to distinguish between physiological "candidiasis" and the infectious process caused by this fungus.
For the diagnosis of candidiasis, the detection of Candida in sterile fluids (spinal, lavage, peritoneal, etc.) or the detection of fungi in tissues is absolutely informative (changes in the type of granulomas with necrosis are often found).
To increase the sensitivity of cultural and morphological methods for diagnosing candidiasis, it is recommended to examine several biopsies of the mucous membrane.
The biopsied tissue is collected in 2 sterile Petri dishes or sterile screw cap jars; one sample is poured with a 10% formaldehyde solution and sent for histological examination, the second is used for mycological examination. The material is transported to the microbiological laboratory, protected from direct sunlight. It is necessary that the material be delivered for mycological examination no later than 1 hour after taking when stored at room temperature or no more than 3 hours when stored at +4°C.
Microscopic examination should be carried out in native and stained preparations.
CHIC reaction (treatment with chromic acid) or its modification - Gridley's stain - allows you to identify the pathogen in the tissue or smear by staining the polysaccharide components of the cell wall; to suppress the coloring of surrounding tissues, “counter-staining” is used with light green, methanil yellow, etc. In this case, only invading fungal cells are detected, while it is impossible to judge the reaction from the surrounding tissues. Therefore, it is also necessary to evaluate preparations “re-stained” with hematoxylin and eosin.
Pseudomycelium Candida can also be detected in a mucosal impression smear or an impression smear from the bottom of an ulcer (Romanovsky-Giemsa stain).
On the surface of a dense nutrient medium in a Petri dish, an imprint is made with a piece of tissue to be examined, then a loop is sieved. The same piece of tissue is placed in 50 ml of liquid nutrient medium (Saburo's medium, wort) and incubated at +37°C for 5 days.
Methods for the rapid identification of C. albicans are widely used. This type of Candida is able to form germ tubes and short filaments of pseudomycelium within 2-4 hours at +37°C on blood serum, egg white and other similar media. For the species C.albicans this phenomenon is typical in 90% of cases.
For effective treatment, it is necessary to strive to determine the species of Candida fungi and determine the individual sensitivity of the strain to antimycotic agents; some strains of Candida lusitanlae are resistant to amphotericin, Candida krusei and Candida glabrata are resistant to fluconazole.
The detection of Candida in the blood makes it possible to make a diagnosis of generalized candidiasis only in combination with the corresponding clinical symptoms (re-detection of Candida in the blood is especially informative). It should be remembered that in 70-80% of patients who actually suffer from generalized candidiasis, it is not possible to identify fungi during blood culture.
The value of serological methods is mainly in identifying patients with probable invasive mycoses. False-positive results of serological tests are possible with mycocarriage and in healthy people sensitized with fungal antigens; false-negative tests can be observed in immunodeficiency.
Original procedures for the detection of antigens and antibodies of some metabolites of fungal cells have been proposed; special diagnostic kits have been created. Pastorex Candida can be cited as an example, - to determine in the reaction of "latex agglutination" repeated oligomannose epitopes of antigenic structures expressed on a large number of macromolecules of the fungus. The Platelia Candida kit can be used to detect Candida mannan antigen, for example, in the serum of a circulating patient. Using the first set, the threshold for determining antigenic structures is 2.5 ng/ml, using the second set in conjunction with the method, the threshold for determining is 0.5 ng/ml.
In the diagnosis of non-invasive intestinal candidiasis, in which there is no tissue biopsy material for mycological examination, it is proposed to use the following criteria as a diagnostic standard: growth over 1000 CFU/g Candida spp. when sowing intestinal contents taken under sterile conditions, in combination with symptoms of intestinal dyspepsia and positive clinical and laboratory dynamics during treatment with antimycotic drugs. Unfortunately, correct sampling of intestinal contents for culture is technically difficult; The method of “stool culture for dysbacteriosis”, which is widespread in our country, cannot serve as a support in assessing the real composition of the intestinal microflora.
In the diagnosis of any form of candidiasis of the digestive system, it is important to take into account the presence of predisposing risk factors in the patient. The "accidental" detection of candidiasis should serve as an incentive to search for such a background factor. It is important to remember that candidiasis can act as an early manifestation of common diseases accompanied by the development of immunodeficiency.
Given the above, it would probably not be entirely correct to formulate the diagnosis briefly, as "Candidiasis", without indicating the underlying condition.
Differential diagnosis of invasive intestinal candidiasis (if gross intestinal changes are detected) should be carried out with chronic inflammatory bowel diseases, antibiotic-associated diarrhea due to C. difficile infection, malignant lesions, ischemic colitis. The non-invasive form of candidiasis should be differentiated from a wide range of enteritis and colitis of other etiologies. Indirect evidence in favor of the presence of intestinal candidiasis may be extraintestinal systemic manifestations of candidiasis.
Treatment
It should be emphasized once again that the mere detection of fungi of the genus Candida in the bacteriological analysis of feces (according to the accepted method in Russia), regardless of the presence or absence of symptoms of intestinal dyspepsia, cannot serve as an indication for prescribing antimycotic agents to the patient.
For the treatment of intestinal candidiasis, it is necessary to prescribe drugs that are not adsorbed from the intestinal lumen.
Today, there are a variety of antimycotic agents. Drugs such as amphotericin B, itraconazole, ketoconazole, fluconazole, have a systemic effect, can be used topically, orally and intravenously. When administered orally, these drugs are almost completely absorbed from the upper gastrointestinal tract and do not reach the level of the ileum, where the main population of fungi is concentrated. In addition, the use of "systemic" antifungal drugs is often accompanied by side effects, in particular, the development of toxic hepatitis.
Practically non-absorbable antimycotics include levorin, nystatin, and natamycin (Pimafucin). The appointment of levorin and nystatin with a fairly high frequency is accompanied by the development of side effects (dyspepsia, allergies, toxic hepatitis).
Pimafucin (natamycin) is a broad-spectrum antifungal polyene antibiotic. It has fungicidal potential. Pimafucin binds sterols of cell membranes, violating their integrity and function, which leads to the death of microorganisms. Most pathogenic yeast fungi are sensitive to natamycin, most of all - Candida albicans. Pimafucin is more effective than nystatin. There were no cases of resistance to natamycin in clinical practice; with repeated use of this drug, its minimum inhibitory concentration against C. albicans does not change. Pimafucin in tablets acts only in the intestinal lumen, is practically not absorbed from the gastrointestinal tract.
When using tablets in the first days of treatment, dyspeptic symptoms are possible - nausea and diarrhea, which do not require discontinuation of the drug and resolve on their own during treatment. The only contraindication to the appointment of Pimafucin is hypersensitivity to the components of the drug. Pimafucin can be prescribed during pregnancy and lactation, as well as newborns.
For the treatment of intestinal candidiasis, a course of treatment with non-absorbable antifungal drugs is necessary for 7-10 days. Nystatin is prescribed at 250,000 units 6-8 times a day (daily dose - up to 3 million units) for 14 days. It is prescribed 100 mg (1 tablet) 2-4 times a day for 7-10 days.
Based on the above provisions and clinical experience, we have to admit that the tactics of treating candidiasis of the mucous membranes of extraintestinal localization only with local antifungal agents or systemic drugs absorbed by the gastrointestinal tract are inherently erroneous. Since the source of the lympho-hematogenous spread of virulent Candida strains that cause systemic candidiasis is the intestine, without suppressing the growth of fungi in its lumen, antifungal therapy is ineffective or only a short-term unstable effect is observed. With systemic candidiasis, the dose of nystatin can be increased to 4-6 million units / day, while a locally acting antifungal agent is prescribed. With systemic candidiasis, Pimafucin is used in the same dose while prescribing a locally acting antifungal agent. In severe cases, drugs with a systemic effect are added to complex therapy.
Timely recognition and treatment of intestinal candidiasis is especially important as a prevention of systemic and generalized candidiasis in patients at risk, which primarily include patients receiving antitumor radiation and / or chemotherapy, anti-tuberculosis drugs, patients preparing for elective abdominal surgery. In these situations, it is most preferable to prescribe non-absorbable antifungal drugs, since their long-term and repeated use does not significantly affect the pharmacodynamics of other drugs.
The main criterion for the effectiveness of therapy is not obtaining a negative result of seeding for fungi, but first of all, the disappearance of the main manifestations of the disease, the normalization of the number of fungi according to mycological studies (if it is possible to adequately culture the intestinal contents). To achieve the effect, it is often necessary to resort to repeated courses of treatment.
In this article, the goal was to expand the ideas of practitioners about the flexibility of the interaction of the human body with symbiotic microflora, about the pathogenic potential of the harmless intestinal commensal - Candida. Internists and specialists in medical mycology are faced with the urgent tasks of clearly determining the prevalence and clinical significance of fungal infections in clinical practice, developing a diagnostic algorithm and indications for the treatment of intestinal candidiasis.

Literature
1. Zlatkina A.R., Isakov V.A., Ivanikov I.O. Intestinal candidiasis as a new problem in gastroenterology. // Russian Journal of Gastroenterology, Hepatology, Coloproctology. - 2001. - No. 6. - P.33-38.
2. Danna P.L., Urban C., Bellin E., Rahal J.J. Role of Candida in pathogenesis of antibiotic-associated diarrhoea in elderly patients.//Lancet/-1991.-Vol.337.-P.511-514.
3. Prescott R.J., Harris M., Banerjee S.S. Fungal infections of small and large intestine.//J.clin.Path.-1992.-Vol.45.-P.806-811.
4. Redmond H.P., Shou J., Kelly C.J. et al. Protein-calorie malnutrition impairs host defense against Candida albicans.//J.Surg.Res.-1991.-Vol.50.-P.552-559.
5. The Merck Manual. sixteenth edition. Copyright (c) 1992 by Merck & Co., Inc.

A sharp increase in the number of yeast-like fungi in the digestive tract can provoke the development of intestinal candidiasis. Pathology refers to infectious, and causes pain and constant discomfort in the abdomen. If untreated, the fungus spreads to neighboring tissues and organs. Symptoms of intestinal candidiasis vary depending on the type of mucosal lesion. Some features of the course of the disease allow a specialist to determine it at an early stage.

Opportunistic fungi of the genus Candida are present in small amounts in the body of every person. Their uncontrolled development and spread is inhibited by the immune system and other beneficial microorganisms.

Violation of the intestinal microflora occurs due to certain factors

An imbalance can occur against the background of a decrease in the protective functions of the system and some predisposing factors. In addition to the mucous membranes, fungi affect the skin, nail plates, and internal organs.
Intestinal candidiasis is most often a sign of serious disorders in the immune system.

Pathology is most often encountered by patients with the following health problems:

Frequent viral infections
Endocrine Disorders
State of physiological immunodeficiency
Diseases of the hematopoietic system
Immunodeficiency virus (congenital and acquired)
Autoimmune diseases
The presence of chronic infectious processes in the body
Digestive problems
Oncological pathologies

Another common cause of the development of candidiasis of the digestive tract is the uncontrolled use of antibiotics. After all, powerful drugs have a detrimental effect not only on non-pathogenic microorganisms, but also on beneficial bacteria necessary for the body. Therefore, before using such drugs, you should consult a doctor.

Improper nutrition is also considered a provoking factor.

It is not necessary to eat fast food at all. A large amount of quickly digestible carbohydrates and a lack of healthy proteins in the diet almost always lead to a fungal infection of the mucous membrane of the digestive tract.

The main reason for the development of intestinal candidiasis is the weakening of the immune system.

Learn about fungal infection of the intestine from this video.

Depending on the cause that caused the development of candidiasis of the intestinal mucosa, there are several forms of the disease. A characteristic symptom for all species is pain in the abdomen. Unfortunately, not all patients pay attention to such a “signal” of the body, which often leads to a neglected pathology and a longer recovery process.

The most common form is non-invasive candidiasis, which is characterized by an increase in the number of Candida fungi in the intestinal lumen.

The pathogen does not penetrate through the mucous membranes. The waste products of yeast-like fungi are toxic and have an extremely negative effect on the digestive system and the body as a whole.

The invasive diffuse form of the disease in medical practice is extremely rare. This type of disease is quite difficult. Invasive candidiasis is characterized by damage to tissues and organs. This form is more common in patients with HIV and cancer.

Against the background of ulcerative pathology, patients may develop focal intestinal candidiasis. Candida fungi in this case affect certain areas of the mucous membrane. Another type of ailment, which usually occurs as an independent disease, in which the mucous membrane of the rectum and anus suffers, is perianal candidiasis.

With candidiasis of the intestine, people complain of pain

The main symptom for all types of fungal infection of the intestine is pain. In addition, you should pay attention to the following signs:

Persistent bloating
Heaviness in the stomach
Painful bowel cramps after eating
Diarrhea
Slight increase in body temperature (up to 37-37.5)
Loss of appetite
General weakness
The appearance of a rash on the skin
The presence of blood, mucus in the feces
Feeling of incomplete emptying of the rectum

It is not difficult for an experienced gastroenterologist to recognize the disease, because certain symptoms are characteristic only of intestinal candidiasis.

Depending on the form of fungal infection, the symptoms of the disease will have a different degree of severity.

A fungal infection is especially dangerous for expectant mothers. The immune system in women in position works only half-heartedly. This is necessary for the normal course of pregnancy and fetal development. At the same time, a decrease in the protective functions of the body is a predisposing factor for the development of various diseases.

Fungi of the genus Candida are able to penetrate the placental barrier, which leads to infection of the fetus and can cause spontaneous abortion.

In pregnant women, the development of intestinal candidiasis is more often observed against the background of vaginal infection with yeast-like fungi.

It is important to identify the disease in a timely manner and begin therapy in order to avoid serious consequences. Given this, the doctor selects the most benign drugs for the treatment of the pathological condition.

Intestinal dysbiosis often occurs in children

A common problem among infants is intestinal dysbiosis. Quite often, fungi of the genus Candida cause an ailment, which begin to actively multiply against the background of a violation of the normal microflora of the digestive tract.

One of the first signs of a fungal infection is an upset stool. The stools may contain white flakes, mucus.

Candidiasis of the digestive tract in children is often observed after long-term antibiotic treatment. An external sign of the manifestation of the disease in this case should include the appearance of tubercles in the anus, which eventually begin to unite and form foci of infection.

Intestinal candidiasis caused by Candida often develops in pregnant women and infants.

With timely detection, a fungal infection responds well enough to therapeutic effects. Therefore, when identifying characteristic symptoms, you should contact a gastroenterologist. Sometimes pathology is detected by chance during a routine or preventive examination.

Diagnosis begins with an examination of the patient

A medical examination begins with an examination of the patient, familiarization with the anamnesis and the appointment of the necessary tests. In the process of laboratory diagnosis, blood, urine and feces should be taken. It is also recommended to do a bacterial culture for the presence of a fungal pathogen in the rectum. If, as a result, a significant increase in opportunistic microflora, including fungi of the genus Candida, and a reduced number of beneficial bacteria are found, we can talk about the development of intestinal candidiasis.

A general blood test (if there is an infectious process) will show a decrease in the level of hemoglobin and red blood cells, an increase in the number of white blood cells. With a fungal infection, the erythrocyte sedimentation rate (ESR) will be overestimated up to 40 mm / h.

Serological blood tests allow you to determine the level of antibodies to fungal pathogens. If this figure continues to grow, then the pathology is progressing. An increased number of leukocytes and squamous cells in the general urine test indicates the presence of an inflammatory process in the system.

The most accurate methods for diagnosing a fungal infection of the intestine are colonoscopy and fibrogastroduodenoscopy.

In the first case, the mucous membrane of the large intestine is subject to examination for the presence of white plaque, erosion. FGDS is an endoscopic examination of the esophagus, the inner surface of the stomach and duodenum.
Laboratory and instrumental methods of medical examination help to make an accurate diagnosis.

To determine the method of treating the infection, first of all, the form of the course of the disease is established. Each individual case is considered by a specialist on an individual basis, the presence of concomitant pathologies is taken into account.

Some drugs have many side effects

Some drugs used to eliminate fungi cause severe side effects, so it is not recommended to use them without medical advice. In the case of diffuse invasive lesions of the intestines and internal organs, the patient should be hospitalized.

With the help of antifungal drugs, the vital activity of pathogenic pathogens is suppressed. Such medicines are prescribed without fail. The duration of their use is determined by the attending physician. The most effective antimycotic agents include:

Pimafucin. The drug acts exclusively in the intestinal lumen and is practically not absorbed into the systemic circulation. The active active ingredient - nitamicin - does not cause resistance and addiction in fungi.
Ketoconazole. The drug belongs to the 3rd generation antifungal drugs and effectively fights various fungal pathogens of candidiasis in the digestive tract.
Mycomax. An antifungal drug disrupts the synthesis of the walls of pathogens, which leads to their death. Available in the form of tablets (capsules), granules for suspension and solution for infusion.
Levorin. The medicine belongs to antibiotics with antifungal action.
Intraconazole. The antifungal drug is effective for infection with yeast-like fungi, dermatophytes and molds.

After antifungal therapy, the normal intestinal microflora should be restored. To do this, drugs based on bifidobacteria and lactobacilli are used: Linex, Bifidumbacterin, Biosporin, Acylact.

These medicines allow you to restore the balance of beneficial bacteria in the intestines and improve the digestion process.

Treatment for fungal infection of the intestine is determined by the attending physician.

With candidiasis of the intestine, it is important to follow proper nutrition

Proper nutrition in combination with drug therapy can quickly eliminate the symptoms of a fungal infection of the digestive tract. The main task of the diet is to limit the nutrition of pathogenic microorganisms.

To do this, quickly digestible carbohydrates, sweets, honey, pastry, flour products, semi-finished products, spices are completely excluded from the diet.

At the time of therapy, the use of various citrus fruits should be excluded. Lemons, oranges, grapefruits create the necessary alkaline environment for the reproduction of fungi. It is necessary to limit the number of pickles, smoked meats, marinades, potatoes in the daily menu.

It is allowed to use yeast-free pastries, unsweetened sour-milk products, boiled lean meat, vegetables (zucchini, cauliflower, beans, green salad). Experts recommend increasing the amount of garlic and onions in the diet. They significantly reduce the development of fungi. Dietary nutrition during candidal lesions should be based on sufficient intake of essential amino acids, vitamins, trace elements and proteins.

Fungal infections often affect the mucous membranes of the digestive tract. The pathological condition causes a number of symptoms, the main of which is pain in the abdomen and a change in the nature of the stool. Having found violations, you should consult a doctor and undergo an examination, during which the form of the disease and the degree of its development are established. The basis of therapy for intestinal candidiasis are antifungal drugs, which can only be prescribed by a specialist. Accelerate recovery and dietary nutrition.

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Symptoms of intestinal candidiasis are diverse. It is not difficult to determine the disease. Despite the fact that candidiasis is a disease caused by opportunistic flora, it is impossible to do without a full-fledged treatment.

Intestinal candidiasis is a pathological condition of the gastrointestinal tract caused by pathogenic mycoses of the genus Candida. Normally, microorganisms are found in the normal flora of a healthy person. The development of the disease occurs against the background of the indomitable growth of fungi. The appearance of symptoms is due to the negative influence of the waste products of candida.

The main manifestation of thrush in the intestine will be a pronounced pain syndrome, in addition to which you should pay attention to the following signs of invasion:

bloating becomes chronic;
patients complain of heaviness in the epigastric region (in the stomach);
after eating, intestinal spasms are observed;
impaired motor function of the intestine (diarrhea);
subfebrile body temperature (from 37 to 37.5 0);
patients complain of lack of appetite;
in the feces, impurities of blood and pus are found;
in the area of the anus and feces, curdled discharge with a fetid odor can be found;
after a bowel movement there is no feeling of relief;
pain during bowel movements;
false urge to defecate;
a rash appears on the skin.

In addition to the primary signs of pathology, fatigue, insomnia and various forms of skin diseases (acne, dermatitis, urticaria) may appear.

Regardless of the severity of the clinical picture, intestinal candidiasis is easily determined by an experienced doctor (gastroenterologist).

As the pathological spread of fungi progresses, all symptoms increase. Lack of treatment allows the pathology to spread to various departments, most often the disease affects the genitourinary organs and the oral cavity. In addition to spreading, candidiasis provokes an exacerbation of existing diseases of the gastrointestinal tract.

The transition of thrush from the intestines to the genitals in a woman has the following symptoms:

curdled discharge is determined on the genitals and underwear, which have an unpleasant odor;
unbearable itching of the vagina, turning into a burning sensation, can be observed at rest, during urination or sexual intercourse;
in severe forms of the disease, menstrual dysfunction is possible, a long-term infection can cause secondary infertility.

Symptoms in men do not have big differences:

itching and burning of the penis and scrotum;
curdled discharge (outwardly resemble cottage cheese);
violation of urination, pathogenic fungi are determined in the urine (visually, the urine has a cloudy whitish sediment).

When the oral cavity is affected, inflammation of the mucous membrane, white plaque, easily removed with a spatula or gauze swab, and pain during meals are determined.

Advice. When determining the first signs of intestinal candidiasis (or simply long-term pain), you should contact a gastroenterologist in order to find out the cause of negative sensations and timely treatment of the infection.

In the absence of adequate treatment, serious complications may occur. The most dangerous for the life and health of the patient is considered to be perforation and penetration of the ulcer (a breakthrough of the ulcer into the surrounding tissues with the subsequent entry of its contents into the cavity of the damaged organ).

Intestinal fungus does not cause problems with a good immune response. For the development of the disease, certain conditions are necessary that favor the development of mycosis:

a decrease in the body's resistance to the development of pathogenic flora under adverse environmental conditions (a sharp change in the time zone, temperature changes, high or low humidity);
chronic infections;
diseases of internal organs;
immunodeficiency (congenital or acquired);
uncontrolled antibiotic treatment;
suppression of immunity in the treatment of oncological processes (chemotherapy or radiation exposure);
imbalance in the hormonal background (the cause may be diseases of the endocrine system, hormone intake, menopause, pregnancy);
malnutrition (favorable conditions for candidiasis are created by lovers of flour products with a rare and not constant diet).

Important. Candidiasis develops only against the background of a weakened immune response of the body. This indicates the need for an integrated approach to the treatment of pathology. In addition to the use of antifungal agents, a necessary condition for recovery is the elimination of the root cause of the pathological growth of candida.

The determination of yeast fungi in the intestine is carried out by sowing the contents of the secretions on a nutrient medium. After the detection of fungi, the type of mycosis is differentiated.

In addition to sowing, sigmoidoscopy can be used as a diagnostic method, which makes it possible to isolate plaque on the intestinal wall and confirm the preliminary diagnosis established on the basis of the patient's sting.

How to treat intestinal candidiasis can only be determined by a doctor. The elimination of pathology should be comprehensive and carried out in two directions:

cessation of the growth of mycoses and the destruction of an already expanded network;
treatment of a disease that caused a decrease in immunity.

When choosing a tactic for treating a condition, the doctor takes into account the form of the disease, the severity, the risk of a complicated course, the state of the immune system and the underlying disease that gave rise to thrush.

To stop the development of the fungus in the intestine, antimycotic drugs are prescribed (the effect on the growth of Candida). When choosing a remedy, preference is given to a topical preparation (the most commonly used form is rectal suppositories). Most commonly used:

In severe forms of infection, systemic drugs are used: Fluconazole, Itraconazole, and others. These medicines can be given in the form of tablets (oral), solutions (intravenously), or suppositories (rectal). A combination of forms of local and systemic influence is possible.

Important. The choice of drug and treatment regimen is selected individually. The use of rectal suppositories should be only after a thorough hygiene procedure (should be washed with baby soap without any additives).

In addition to the destruction of Candida fungi in the intestines, treatment of the disease is impossible without restoring a healthy intestinal microflora.

When choosing prebiotics and prebiotics at the time of antifungal therapy, drug resistance should be taken into account. This group helps to eliminate intestinal dysbiosis, which leads to the normalization of the digestive system. Preparations suitable for the normalization of microflora after antimycotic therapy:

To relieve symptoms while treating thrush of the gastrointestinal tract, the gastroenterologist may prescribe enzymes. The rapid breakdown of food under the action of enzymatic action allows you to save the patient from flatulence and improve the motor function of the intestine.

With a decrease in the body's immune response, immunocorrective or immunomodulatory drugs are included in the therapy of the fungus. The choice of drugs is carried out by the immunologist after determining the level of imbalance and identifying the cause of the pathology.

Treatment of intestinal candidiasis with folk remedies is of an auxiliary nature and is selected by a specialist.

Important. Self-treatment of thrush with folk remedies can have irreversible consequences, especially during pregnancy and in the treatment of young children.

Sea buckthorn oil helps against fungal infections of the intestines. In addition to the anti-inflammatory effect, this remedy stimulates the immune system (strengthens the body's resistance) and has a protective effect on irritated walls of the digestive tract.

Sea buckthorn oil is considered one of the best traditional medicines that trigger the mechanism of tissue regeneration (healing and recovery). Take 1-2 teaspoons per day (depending on the complexion of the patient) for up to 10 days during a meal.

Advice. To improve the absorption of sea buckthorn oil, include more raw vegetables in your diet.

For local treatment of thrush, baths in a soda solution with potassium permanganate are used. It is also effective to wash the external genital organs in case of fungal infection.

The course of treatment is at least 10 days. Even with the disappearance of symptoms after the first procedures. This will prevent the recurrence of the disease.

From plant materials, you can choose drugs that have anti-inflammatory, regenerating or immunocorrective properties.

The most common intake is white chamomile, sage, St. John's wort, oak bark, bird cherry, pomegranate peel, blackcurrant leaves, etc.

With a fungal infection of the digestive tract, a prerequisite for a favorable outcome of the disease in a short time will be the normalization of nutrition.

What not to eat with intestinal candidiasis:

white bread and muffins (increases the development of yeast fungi);
sugar and sweets;
semi-finished products;
potato;
citrus fruits (oranges, lemons, grapefruit);
spices.

To improve digestion, you should forget about overeating and establish a diet in small portions and at least 4-5 times a day.

it is better to choose dairy products low-fat and low in sugars;
meat boiled or steamed (preference is given to low-fat varieties);
zucchini and pumpkins;
cauliflower;
various greens (lettuce, spinach, dill, parsley);
garlic and onions contribute to the formation of bifidobacteria and lactobacilli in the intestine;
carrot juice (it is better to take with the addition of oil);
seafood (squid, shrimp) and fish.

Compliance with the diet will significantly speed up the elimination of the main symptoms of intestinal candidiasis and speed up the recovery of the body after the disease.

Important. Treatment of thrush of the gastrointestinal tract should be carried out in combination, the loss of one of the aspects of therapy slows down the healing process. Discontinuation of prescribed medications is not acceptable when the disturbing symptoms disappear. Reception of drugs should be carried out strictly according to the scheme chosen by the attending physician. With timely diagnosis and the fulfillment of all the requirements of a specialist, the prognosis is favorable.

According to ozhivote.ru