Rodea RH, López RSC, Aristi UG, Athié GC, Pérez TE

Language: Spanish
References: 27
Page: 56-61
PDF size: 294.97 Kb.

ABSTRACT

Objective: To report a case of extensive gastric necrosis and perforation secondary to Candida spp. infection.
Setting: General Hospital of Mexico (Third level health care hospital).
Design: Presentation of a case.
Description of the case: Man, 51 year-old, with a 5-day history of illness characterized by rejecting food and abdominal distension, who was admitted presenting acute abdomen, dehydration, and arterial hypotension; leukocytosis and pneumoperitoneum, as relevant signs. He was subjected to exploratory laparotomy, which revealed generalized peritonitis secondary to necrosis and perforation of the gastric fundus. Treatment to control the septic focus consisted of total gastrectomy with Roux–en-Y esophagus-jejunum anastomosis, lavage and drainage of the abdominal cavity, and re-operation to repair the partial dehiscence of the esophagus-jejunum anastomosis. The pathology report led to the diagnosis of chronic ulcerated acute gastritis with perforation due to Candida spp. infection and secondary ischemic pangastritis. During follow-up, esophageal candidiasis recurred that responded to medical treatment.
Conclusions: Primary gastric lesions associated to Candida spp. invasion consist of ulcers and gastritis; gastric perforation is very rare and implies secondary peritonitis and potentially secondary sepsis, which are hard to eradicate if not suspected and the presence of Candida spp. is not treated. Morbidity is related to timely treatment with anti-mycotics during the acute stage and a long-term follow up to detect potential recurrences of digestive tract candidiasis, mainly of the esophagus.

REFERENCES

1. Hidalgo JA, Vazquez JA, Shepp DH, Talavera F, Stuart MB, Mylonakis E, Cunha BA. Candidiasis: Last Update: February 27, 2006: Localizable en www.emedicine.com – eMedicine-Candidiasis – Article by José A Hidalgo MD.

2. Edwards JE Jr: Candida species. En: Mandell, Bennett & Dolin. Principles and practice of infectious diseases, 6a. ed. 2005, Churchill Livingstone Ed: pp 2938-57.

3. Zwolinska-Wcisto M, Budak A, Bogdat J, Trojanowska D, Stachura J. Fungal colonization of gastric mucosa and its clinical relevance. Med Sci Monit 2001; 7: 982-988.

4. Naglik J, Albrecht A, Bader O, Hube B. Candida albicans proteinases and host/pathogen interactions. Cell Microbiol 2004; 6: 915-26.

5. Staib P, Kretschmar M, Nichterlein T, Hof H, Morschhäuser J. Differential activation of Candida albicans virulence gene family during infection. Proc Natl Acad Sci U S A 2000; 97(11): 6102-7.

6. Scott BB, Jenkins D. Gastro-oesophageal candidiasis. Gut 1982; 23: 137-139.

7. Loffeld RJ, Loffeld BC, Arends JW, Flendrig JA, Van Spreeuwel JP. Fungal colonization of gastric ulcers. Am J Gastroenterol 1988; 83: 730-3.

8. Piken E, Dwyer R, Zablen MA. Gastric candidiasis. JAMA 1978; 240: 2181-2.

9. de Repentigny L, Phaneuf M, Mathieu LG. Gastrointestinal colonization and systemic dissemination by Candida albicans and Candida tropicalis in intact and immunocompromised mice. Infect Immun 1992; 60: 4907-4914.

10. Sari R, Altunbas H, Mahsereci E, Meric M, Gelen T, Karayalcin U. Multiple gastric ulcers caused by gastric candidiasis in a diabetic patient: a rare cause of upper GI bleeding. Gastrointest Endosc 2003; 58: 309-11.

11. Trier JS, Bjorkman DJ. Esophageal, gastric, and intestinal candidiasis. Am J Med 1984; 77: 39-43.

12. Rodea RH, López LJ. Abdomen agudo en pacientes con VIH/SIDA. En: Aguirre Rivero E, Diagnóstico y tratamiento actual del abdomen agudo. Alfil Ed. México DF, 2006: 469-93.

13. Höchter W, Wagner N, Hemmer E, Kunert H, Ottenjann R. Fungal infestation of gastroduodenal ulcers: incidence and significance. Dtsch Med Wochenschr 1982; 107: 845-8.

14. Minoli G, Terruzzi V, Butti GC, Benvenuti C, Rossini T, Rossini A. A prospective study on Candida as a gastric opportunistic germ. Digestion 1982; 25: 230-5.

15. Di Febo G, Miglioli M, Calò G, Biasco G, Luzza F, Gizzi G, et al. Candida albicans infection of gastric ulcer frequency an correlation with medical treatment. Results of a multicenter study. Dig Dis Sci 1985; 30: 178-81.

16. Lee SC, Fung CP, Chen HY, Li CT, Jwo SC, Hung YB, et al. Candida peritonitis due to peptic ulcer perforation: incidence rate, risck factors, prognosis and susceptibility to fluconazole and amphotericin B. Diagn Microbiol Infect Dis 2002; 44: 23-7

17. Eras P, Goldstein MJ, Sherlock P. Candida infection of the gastrointestinal tract. Medicine (Baltimore) 1972; 51: 367-79.

18. Gotlieb-Jensen K, Andersen J. Occurrence of Candida in gastric ulcers. Significance for the healing process: Gastroenterology 1983; 85: 535-7.

19. Khuroo MS, Naik SR, Sehgal SC, Naik S, Kaushik SP, Katariya RN, et al. Candida infection of upper gastrointestinal tract superadded upon chemical injury with acids. Am J Gastroenterol 1979; 72: 276-81.

20. Morishita T, Kamiya T, Munakata Y, Tsuchiya M. Radiologic and endoscopic studies of gastric ulcers associated with Candida infection. Acta Gastroenterol Latinoam 1993; 23: 223-9.

21. Denning DW, Kibbler CC, Barnes RA. British Society for Medical Mycology. British Society for Medical Mycology proposed standards of care for patients with invasive fungal infections. Lancet Infect Disc 2003; 3: 230-40.

22. Solomkin JS, Flohr AB, Quie PG, Simmons RL. The role of Candida in intraperitoneal infections. Surgery 1980; 88: 524-30.

23. Solomkin JS. Pathogenesis and management of Candida infection syndromes in non-neutropenic patients. En: Solomkin JS, ed. Williams and Wilkins, Baltimore 1993: 202-13.

24. Neeman A, Avidor I, Kadish U. Candidal infection of benign gastric ulcers in aged patients. Am J Gastroenterol 1981; 75: 211-3.

25. Faure-Fontenla MA, Bracho-Blanchet E, Yañez-Molina C, Barragan-Tame L. Gastric perforation with Candida tropicalis invation in previously healthy girl. Mycoses 1997; 40: 175-7.

26. Wittmann DH, Schein M, Condon RE. Management of secondary peritonitis. Ann Surg 1996; 224: 10-18.

27. Rodea RH, Athié GC, Guízar BC, Zaldívar RR. Experiencia en el manejo integral de 602 pacientes con sepsis abdominal. Cir Gen 1999; 21: 131-5.