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Infectious colitis

Candida

Author: Nalini Bansal, M.D.

Editorial Board Member: Raul S. Gonzalez, M.D.

Last author update: 1 March 2017

Last staff update: 7 December 2020

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PubMed Search: colon candida

Table of Contents

Cite this page: Bansal N. Candida. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/coloncandida.html. Accessed December 26th, 2024.

Definition / general

Candida colonies are normal commensals of the gastrointestinal tracts and rarely pathogenic in gut
Candida infections are usually seen in immunocompromised and debilitated patients due to concurrent chronic diseases, malnutrition, use of immunosuppressive drugs or old age (Int J Contemporary Medical Research 2017;4:76)
In immunocompetent patients, low pH, regular use of antacids as well as hyperglycemia can cause the yeast to break through the intestinal mucosal barrier and lead to invasive candidiasis and candidemia (Dtsch Arztebl Int 2009;106:837)

Essential features

Candida colonies are normal commensals of gastrointestinal tracts
Infections are usually seen in immunocompromised and debilitated patients
Factors favoring fungal proliferation include: regular antacid use, which lowers pH; use of antibiotics, which diminish useful bacteria; and hyperglycemia, as seen with diabetes
Candida usually causes mucosal lesions; rarely perforations
Esophagus is the most commonly affected site in GI
Gold standard test for diagnosis is culture
Antifungals are treatment of choice

ICD coding

B37.8 - Candidiasis of other sites

Epidemiology

Patients usually middle aged to elderly, with an average age of 65 years

Sites

Most commonly affected organ is the esophagus, followed by the stomach, the small intestine and the large intestine (Medicine (Baltimore) 1972;51:367, Nihon Shokakibyo Gakkai Zasshi 1986;83:2341)

Pathophysiology

Under normal conditions, there is homeostasis between C. albicans and the host; however, if the balance is disrupted by low pH, regular use of antacids or hyperglycemia, the yeast can break through the intestinal mucosal barrier and cause invasive candidiasis and candidemia (Dtsch Arztebl Int 2009;106:837)

Etiology

Candida albicans most commonly; rarely C. tropicalis, C. parapsilosis and C. kefyr (Emerg Med (Los Angel) 2015;5:264)

Diagrams / tables

Images hosted on other servers:

Fungal colonization
in patients with
GI tract disease

Clinical features

Invasive Candida infections are characterized by fever and shock along with low blood pressure, abdominal pain, rigors, an elevated heart rate, respiratory distress and multiorgan failure (Emerg Med (Los Angel) 2015;5:264)

Diagnosis

Histopathology showing fungal hyphae and spores
Gold standard is culture for fungi

Laboratory

Eosinophilia
Positive fungal culture
Elevated levels of proinflammatory cytokine IL17 (Curr Opin Microbiol 2011;14:386)

Radiology description

With intestinal perforation, chest Xray and Xray abdomen in erect view demonstrate gas under right hemidiaphragm

Prognostic factors

Prognosis of Candida peritonitis is very poor in critically ill surgical patients, with a mortality rate between 52% and 75% (Curr Opin Crit Care 2007;13:195)
Risk factors associated with increased mortality in Candida peritonitis include: extremes of age, upper GI tract infection as well as patient comorbidities, such as cardiac insufficiency, cirrhosis, diabetes mellitus, renal failure and multiorgan failure (Medicine (Baltimore) 2011:90:69)

Case reports

50 year old man diagnosed with acute peritonitis caused by a gastrointestinal perforation (J Clin Diagn Res 2012;6:1564)
50 year old man with invasive gastric candidiasis causing perforation and peritonitis (J Krishna Inst Med Sci Univ 2015;4:183)
54 and 62 year old women who developed systemic candidiasis (World J Emerg Surg 2013;8:38)

Treatment

The antifungal agents for Candida peritonitis include polyenes, azoles, echinocandins and flucytosine
Azoles are fungistatic against most Candida species, whereas the polyenes and echinocandins are fungicidal
Fluconazole is recommended for patients without prior azole exposure and not at high risk, such as elderly, diabetic and cancer patients (Clin Infect Dis 2009;48:503, Perit Dial Int 2009;29 Suppl 2:S161)

Gross description

Candida tends to cause mucosal lesions and produce ulcers of varying configuration, mucosal flecks, sloughed mucous membranes, polypoid masses and segmental lesions (J Clin Pathol 1992;45:806)
With perforation, bowel may be covered by a thick, black, serosal exudate (Acta Paediatr 2003;92:258)

Microscopic (histologic) description