Candidiasis of the lungs

Pathogen: yeast-like fungus of the genus Candida. The most important are Candida albicans, Candida tropicans. Candidiasis is widespread, but more common in the tropical zone. The main source of infection - a patient with acute forms of candidiasis of the skin and mucous membranes. Infection occurs with direct contact with an infected person and when using common objects of use (bath, underwear, etc.).

Pathogenesis Fungi of the genus Candida are commonly found in the oral cavity, in the feces and in the vagina. Local factors, as well as factors that depend on the state of the body, lead to the penetration of fungi into tissues through damaged skin and mucous membranes, with perforation of the gastrointestinal tract as a result of trauma or surgical intervention, with prolonged use of catheters and burns. In a potentially threatened situation, there are people with diabetes, HIV infection, oncohematological diseases, pregnant women, against antibiotics or glucocorticoids. Candidiasis is a frequent complication of neutropenia, thereby confirming the important role of neutrophils in protecting the body from infection.

Lung infection can occur as a primary and secondary, acute and chronic candidiasis. Primary usually proceeds in acute form, secondary - in chronic. Primary acute candidiasis of the lungs usually develops on the background of treatment with antibiotics, glucocorticosteroids, cytostatics and antimetabolites.

Clinical picture

The degree of severity of the disease can be mild, moderate, severe. Characterized by weakness, malaise, decreased performance, headache. Body temperature generally remains normal. In some patients, the disease begins acutely with a rise in temperature to high figures. There is a "scratching" dry cough, pain in the chest, associated with breathing.

With an easy flow in the initial stage, the disease resembles bronchitis with a strong cough without sputum or with a sparse, grayish color, sometimes with the smell of yeast sputum, with dry and moist large and medium bubbling rales.

In more severe and later periods, focal or lobar pneumonia, characteristic unstable volatile infiltrates, may appear.

In severe cases, candidiasis pneumonia can be complicated by pleurisy. The general condition is usually severe, high or moderate fever, almost constant cough, accompanied by the separation of abundant sputum, hemoptysis, often chest pains of blunt character.

Diagnosis

The changes in the hemogram are uncharacteristic. Possible leukopenia, basophilia, eosinophilia, neutrophilia, monocytosis and lymphopenia.

Radiological picture. On the roentgenogram, multiple spotted shading, caused by pneumonia of small size, and atelectasis. Larger foci are usually located in the lower parts of the lungs. Sometimes there are miliary shadows ("snow flakes").

The roots of the lung are enlarged. Sometimes shady shadows from the foci of shading appear to the basal lymph nodes. For the cavernous form, the appearance of thin-walled cavities is characteristic and their relatively rapid regression up to complete disappearance under the influence of antifungal treatment.

Specific diagnostics is based on the isolation of the causative agent from sputum, bronchial secretions and rinsing water of the respiratory tract. The complement fixation reaction, the agglutination reaction, is used. Highly sensitive is the method of fluorescent antibodies.  Apply an intradermal test with a candida allergen.

Treatment

1. With cutaneous candidiasis, local treatment with nystatin powder or cream containing cyclopyrox is performed.
2. Candidiasis of the oral mucosa reacts to tablets with clotrimazole (5 times a day) better than the suspension with nystatin.
3. Ketoconazole 200-400 mg / day or fluconazole 100-200 mg / day are effective in esophageal candidiasis.
4. In severe cases, amphotericin B is used at 0.3 mg / kg per day intravenously for 5-10 days. In HIV infection, fluconazole is considered the most effective drug in oral and esophageal candidiasis therapy.
5. With candidiasis of the bladder with a catheter in it, irrigation is carried out with a solution of amphotericin B in a dose of 50 mg / l; patients with candiduria inside appoint fluconazole.
6. With disseminated form, amphotericin B at a dose of 0.4-0.5 mg / kg per day or in a double dose every other day serves as a drug of choice.
7. Flucytosine 100-150 mg / kg per day is added to the treatment, reducing the dose of amphotericin B to 0.3 mg / kg per day, if the drug has no contraindications.
8. Fluconazole at a dose of 400 mg per day is used for prophylaxis in patients with immunodeficiency. It can be used to complete the treatment of patients with candidiasis of the liver, if they do not have neutropenia. Candida krusei is resistant to fluconazole.