Gotowa bibliografia na temat „Intra-Abdominal candidiasis”

The goal in this case report is to discuss one presentation of the microbiology of the Candida species in an intra-abdominal abscess which is under reported. In general, the Candida species fungi is a common yeast found human beings as part of the microbiology. Common sites of candidiasis are often the oral cavity or the genitalia. Candida species have been found to have a mutualistic relationship with different species with the body [5]. When overproduction of Candida species occurs, it can cause pathological infections in patients. While it is common to see patients with Candida species in their gut micro biome, it is not well documented to have intra-abdominal abscesses that grow Candida species. Typically, bacterial causes are first on the differential for clinicians. This case presentation looks to discuss some of presenting factors seen in intra-abdominal candidiasis (IAC) and what leads to it being under diagnosed.

A 41-year-old woman with menorrhagia secondary to adenomyosis underwent an elective uncomplicated total laparoscopic hysterectomy after failed medical therapy. She developed fever, epigastric pain, nausea and diarrhoea on postoperative day (POD) 2. CT of abdomen and pelvis performed on POD 3 revealed an 8×3×3 cm fluid collection superior to the bladder. She did not respond to conservative treatment with intravenous antibiotics and therefore underwent an ultrasound-guided drainage on POD 7. The green-debris-laden fluid that was drained grewCandida. Investigations to screen for an immunocompromised state were negative. Her symptoms resolved after commencement of fluconazole and she was discharged home on POD 12. Repeat scans in 4 weeks’ time showed a marked reduction in collection. In a well patient, the presence of green intra-abdominal fluid should raise a suspicion for intra-abdominal candidiasis after ruling out bowel injury.

Abstract Candida albicans is a polymorphic fungus that causes mucosal candidiasis and life threatening, systemic and intra-abdominal disease in immunocompromised and transplant patients. In normal healthy adults, C albicans is maintained as a commensal mainly through the actions of innate cells. Secretion of the quorum-sensing molecule, farnesol, acts as a virulence factor for C. albicans during systemic infection, but is protective in oral models of infection. Despite the clinical importance of intra-abdominal candidiasis with a mortality rate as high as 65%, the role of farnesol in its pathogenesis has not been studied. In ongoing experiments, we found that introduction of farnesol into the peritoneal cavity (PC) of mice remodels the peritoneal microenvironment to promote innate inflammatory responses. Early following intraperitoneal injection, farnesol stimulates the rapid depletion of B cells followed by recruitment of inflammatory macrophages and neutrophils into the PC compared to thioglycollate and control mice. Kinetic analyses of the transcriptional profile of farnesol-elicited cells reveal an early increase in chemokines followed by increased proinflammatory cytokines consistent with macrophage recruitment and activation. In addition, farnesol-elicited macrophages and dendritic cells demonstrate hallmarks of innate immune activation through high surface expression of class II and co-stimulatory molecules. Current experiments aim to determine the impact of this innate immune recruitment on antifungal defenses and clearance in the PC. Defining the immunostimulatory properties of farnesol will inform development of more appropriate therapeutic strategies for treatment of intra-abdominal Candida infection.

La candidose intra-abdominale est une pathologie associée à une morbi-mortalité élevée en réanimation. A ce jour, on ne sait pas si cette mortalité élevée est directement imputable à Candida ou si le fait d'isoler du Candida dans le liquide péritonéal est un témoin indirect de la gravité sous-jacente et/ou du terrain du patient. Une des sources de la controverse relève du pathogène lui-même : Candida est un microorganisme de la flore commensale du tube digestif qui lui confèrerait un statut de colonisant. Sur la base d'autres pathologies cliniques impliquant Candida, ce postulat nécessite un microbiote et des défenses immunitaires intacts. L'hypothèse de recherche est que, dans les péritonites, Candida passe d'un statut de pathogène colonisant à infectant sous l'influence d'un stress environnemental représenté par le liquide péritonéal et les coinfections bactériennes. L'objectif principal de cette thèse est d’objectiver la virulence de Candida par une approche multimodale : phénotypique, moléculaire et métabolique à partir de prélèvements microbiologiques de patients de réanimation atteints de péritonite. Les objectifs secondaires sont d’optimiser le diagnostic de cette infection par l’utilisation de méthodes dites « non basées sur la culture » et le traitement antifongique par une approche pharmacocinétique et pharmacodynamique. Au cours de ce travail, deux études évaluant des approches diagnostiques novatrices fondées sur le 1,3 beta-D-glucan péritonéal et l’approche par microcalorimétrie indirecte ont été menées. L’aspect thérapeutique comporte une revue narrative sur les particularités pharmacocinétiques et pharmacodynamiques de la candidose intra-abdominale et leurs impacts sur les posologies d’antifongique. Savoir identifier les patients qui nécessitent un traitement antifongique et optimiser ce traitement en termes de posologies et durée s’intègrent dans le cadre du « bon usage des antifongiques ». Ce concept est développé dans ce travail, avec une applicabilité pour la candidose intra-abdominale. Enfin, l’immunité locale péritonéale et systémique joue probablement un rôle important sur l’expression de virulence de Candida. Une revue de la littérature centrée sur l’immunité péritonéale est rapportée afin de mieux appréhender son rôle dans les candidoses intra-abdominales.Ce travail pose donc les bases des futures études pour la candidose intra-abdominale : typologie de patients à inclure, analyse de la virulence de Candida, adéquation du traitement antifongique et évaluation du statut immunitaire. L’objectif in fine est de tendre vers une médecine personnalisée afin d’administrer un traitement antifongique au patient qui le nécessite, à la bonne posologie et pendant une durée adéquate
Intra-abdominal candidiasis in the critically ill patient is a pathology burdened with high morbidity and mortality. To date, it is not known whether this high mortality is directly attributable to Candida or whether the fact of isolating Candida in the peritoneal fluid is an indirect witness to the patient's underlying conditions (severity or comorbidities). One of the sources of controversy relates to the pathogen itself: the Candida yeast is a pathogen of the commensal flora of the digestive tract which gives it a colonizing status. Based on other clinical pathologies involving Candida, this premise requires an intact microbiota and immune response. We hypothesised that, during intra-abdominal candidiasis, Candida changes from a colonizing pathogen to an infecting pathogen under the influence of environmental stress (peritoneal fluid, coinfection with bacteria) and in the absence of eradicator immunity. The main objective of this research is to demonstrate the change in Candida status by a multimodal approach. The Candida morphology and growth (phenotype), the expression of the gene involved in its pathogenicity (molecular) and metabolic activity (heat production) will be evaluated in peritoneal samples from critically ill patients with peritonitis. Secondary objectives encompass (i) the evaluation of “non-culture” based method to rule in or out the presence of Candida during severe intra-abdominal infections the 1.3 beta-d-glucan to rule out the presence of intra-abdominal candidiasis, and (ii) the optimisation of antifungal dosing using a pharmacological approach. The diagnostic optimisation will focus on the interest of peritoneal 1.3 beta-d-glucan and the evaluation of an innovative microcalorimetry method to rule out and in the presence of Candida in the peritoneal fluid. To optimise the drug dosing, a narrative review of all study evaluating antifungal dosing regimens and pharmacokinetic data will be performed. Diagnostic and therapeutic optimisation belong to the antifungal stewardship which will be described in the context of intra-abdominal candidiasis. Last, the immune status appears to have a major role in the control of Candida infection. The state of art of the immune aspects of fungal control will be performed. Thus, this study lays the groundwork for future research on intra-abdominal candidiasis, including the identification of relevant patient populations, analysis of Candida virulence factors, assessment of the adequacy of antifungal treatment, and evaluation of immune status. The ultimate goal is to work towards personalized medicine, aiming to provide antifungal treatment to the patients who really need it, with the right dosage and duration