Effect of Candida colonization on human ulcerative colitis and the healing of inflammatory changes of the colon in the experimental model of colitis ulcerosa.

The influence of fungal colonization on the course of ulcerative colitis (UC) has not been thoroughly studied. We determined the activity of the disease using clinical, endoscopic and histological index (IACH) criteria in UC patients with fungal colonization and the healing process of UC induced by an intrarectal administration of trinitrobenzene sulfonic acid (TNBS) in rats infected with Candida, without and with antifungal (fluconazole) or probiotic (lacidofil) treatment. The intensity of the healing of the colonic lesions was assessed by macro- and microscopic criteria as well as functional alterations in colonic blood flow (CBF). Myeloperoxidase (MPO) content and plasma proinflammatory cytokines IL-1beta and TNF-alpha levels were evaluated. Candida more frequently colonized patients with a history of UC within a 5-year period, when compared with those of shorter duration of IBS. Among Candida strains colonizing intestinal mucosa, Candida albicans was identified in 91% of cases. Significant inhibition of the UC activity index as reflected by clinical, endoscopical and histological criteria was observed in the Candida group treated with fluconazole, when compared to that without antifungal treatment. In the animal model, Candida infection significantly delayed the healing of TNBS-induced UC, decreased the CBF and raised the plasma IL-1beta and TNF-alpha levels, with these effects reversed by fluconazole or lacidofil treatment. We conclude that 1) Candida delays healing of UC in both humans and that induced by TNBS in rats, and 2) antifungal therapy and probiotic treatment during Candida infection could be beneficial in the restoration and healing of colonic damage in UC.

Assessment of co-existence of Helicobacter pylori and Candida fungi in diseases of the upper gastrointestinal tract.

Candida spp. were found in the gastric mucosa of 27 (17%) patients, out of whom 18 (11%) showed co-existence of the fungi with H. pylori. Analysis of relationship between selected disorders of the upper gastrointestinal tract (non ulcer dyspepsia NUD, gastric ulcer, duodenal ulcer) and infection with H. pylori and/or Candida revealed a link between co-existence of H. pylori with Candida and gastric ulcers suggesting synergism of those microorganism in pathogenesis of the disease. On the contrary, according to quantitative studies performed, the fungi alone do not play a significant role in pathogenesis of the above mentioned disorders as they colonize only epithelium to the extent that is not pathologically significant (<10(3) CFU/ml). Genetical study was carried out on 57 Helicobacter pylori strains isolated from bioptates of the gastric mucosa. The genotypes of the strains (gene cagA and alleles of gene vacA - m1, m2, s1, s2) were determined using the PCR technique. As it was shown, the patients infected with H. pylori strains of genotype cagA+, vacA s1 are exposed to higher risk of peptic ulcer disease (PUD) as compared to the patients infected with cagA-, vacA s2 strains. In the case of the NUD patients a correlation with allele m2 was found only (p<0.001). This may suggest that in future some of the NUD patients infected with cagA+, vacA s1 strains will fall into the group at higher risk for PUD.

Are probiotics effective in the treatment of fungal colonization of the gastrointestinal tract? Experimental and clinical studies.

UNLABELLED: The influence of fungal colonization and probiotic treatment on the course of gastric ulcer (GU) and ulcerative colitis (UC) was not explored. Our studies included: 1) clinical investigation of 293 patients with dyspeptic and ulcer complaints and 72 patients with lower gastrointestinal (GI) tract: 60 patients with UC, 12 with irritable bowel syndrome (IBS) - the control group. Significant fungal colonization (SFC), over 10(5) CFU/ml was evaluated. Mycological investigation was performed, including qualitative and quantitative examination, according to Muller method, 2) experimental studies in rats included estimation of the influence of inoculation of Candida isolated from human GI tract on the healing process of GU, induced by acetic acid with or without probiotic Lactobacillus acidophilus (10(6) CFU/ml) introduced intragastrically (i.g.). At 0, 4, 15 and 25 day after ulcer induction. Weight, damage area, gastric blood flow (GBF) (H2 clearance), expression of mRNA for cytokines IL-beta, TNF-alpha (ELISA) were evaluated. Mycology: qualitative and quantitative examination was performed. MPO serum activity was measured. Results of clinical studies: 1) SFC was more frequent in patients with GU: 54.2% of cases and patients with over 5 years history of UC: 33.3% cases. 2) SFC delayed GU healing and influenced the maintenance of clinical symptoms in both diseases. Results of animal studies: 3) In Candida inoculated rats, the GBF was significantly lower than in the vehicle controls (saline administered group). Upregulation of TNF-alpha, IL-1 beta was recorded. The GUs were still present till 25 day in all rats inoculated with Candida, in contrast to vehicle group (reduction of ulcer in 92% at day 25). CONCLUSIONS: 1) Fungal colonization delays process of ulcer and inflammation healing of GI tract mucosa. That effect was attenuated by probiotic therapy. 2) Probiotic therapy seems to be effective in treatment of fungal colonization of GI tract. 3) Lactobacillus acidophilus therapy shortens the duration of fungal colonization of mucosa (enhanced Candida clearance is associated with IL-4, INF-gamma response).

Fungal colonization of gastric mucosa and its clinical relevance.

BACKGROUND: The aim of our study was to evaluate the incidence of fungi in the stomach in patients with gastric ulcer and chronic gastritis in comparison to healthy humans, and to identify the fungus species isolated from these patients and their susceptibility to antifungal agents. We also assessed the coincidence of the presence of antifungal antibodies and fungal mannan antigen in serum with the concentration of fungi in the stomach. MATERIAL AND METHODS: We investigated 293 patients, aged 20-80, who visited the Gastroenterology Outpatient Clinic at the Jagellonian University's Collegium Medicum in Cracow, complaining of dyspeptic symptoms or clinical manifestations of ulcer disease. The examinations included endoscopy of the upper part of the alimentary tract with sampling of gastric contents, as well as surface brushing and biopsy from the bottom of the ulceration for mycological analysis. Also, biopsy specimens from the margin of the ulceration or inflammatory mucosa were collected for histological examination and urease testing. RESULTS: Gastric mucosa and stomach contents are often an area of fungal colonization, which was detected in 54.2% of the gastric ulcer cases and 10.3% of the chronic gastritis cases. The most frequently isolated fungus species was Candida albicans, although other fungi, previously considered rare or uncommon, were also found. A difference in growth in vitro between the C. albicans, C. tropicalis and C. lusitaniae strains was discovered: C. albicans and C. tropicalis grew from pH 2.0, while C. lusitaniae grew from pH 3.0. This finding suggests differentiation in the properties of these fungi. CONCLUSIONS: The lack of correlation between the concentration of fungi, the titre of antifungal antibodies and the presence of fungal antigen in serum suggests that fungal colonization is secondary in nature.

Effect of fungal colonization of gastric mucosa on the course of gastric ulcers healing.

BACKGROUND: The aim of the study was to evaluate the effect of fungal colonization on the course of gastric ulcer disease with particular regard to regression of clinical symptoms and reduction in ulcer niche size. MATERIAL AND METHODS: The study was performed on the group of 293 patients, aged 20-80, with clinical symptoms of peptic ulcer disease, who attended Gastroenterology Outpatient Department of Collegium Medicum of Kraków Jagiellonian University. Endoscopy of the upper gastrointestinal tract was performed before and following a-4-week period of a standard anti-ulcerous treatment. During the examination aspirate of the stomach contents and surface brushing were collected. Moreover, biopsy specimens from the bottom of the ulcer or inflamed gastric mucosa were taken for mycological and histopathological examinations. According to contemporary recommendations eradication treatment of Helicobacter pylori was introduced in urease-positive patients with endoscopy-proved gastric ulcer. RESULTS AND CONCLUSIONS: The results of our research showed that fungal colonization of gastric ulcers impairs the course of ulcer healing. Moreover, it results in clinical symptoms maintenance as compared with ulcers with non-significant fungal cells count.

Fungal colonization of the stomach and its clinical relevance.

The aim of this study was to estimate the frequency of fungal colonization of the stomach of patients suffering from gastric ulcer (GU) and chronic gastritis (CG) and the influence of fungal colonization of the stomach on the process of ulcer healing. We investigated 293 patients aged 20-80 years. Before and after 4 weeks of sucralfate treatment they underwent endoscopy of the stomach, histological examination of biopsies taken from the ulcer margin or inflamed gastric mucosa and mycological examinations of the gastric juice, surface brushing and biopsies. The studies revealed a high concentration of fungi in 54.2% patients with GU and 10.3% with CG. Candida albicans was the most frequently isolated organism. Fungal colonization of the stomach impairs the process of gastric ulcer healing. Control examination after 4 weeks of sucralfate therapy showed the ratio of GU healing in 62% of patients with a high concentration of fungi in comparison with 78% of patients not colonized with fungi (P < 0.05). A significantly longer duration of ulcer symptoms in the group of patients with a high concentration of fungi in the stomach was also observed. There was no correlation between the level of fungal antibodies, of Candida antigen in the serum and the concentration of fungi in the stomach.

[Fungal infections in heart transplant patient]. / Zakazenia wywolane przez grzyby u chorych po transplantacji serca.

Considering imparied immunity in heart transplant patients as a result of immunosuppressive therapy, they are often exposed to the fungal infections. These infections are especially important because they still stay the main reason of death in transplant patients. Besides immunosuppressive therapy also antibiotics therapy, prolonged artificial ventilation of lungs, passed infections for example tuberculosis, or cytomegalovirus infection and Diabetes mellitus are the factors, which increase possibility of fungal infections in heart transplant patients. Fungal infections are the most often between first and sixth month after heart transplantation. They are caused mostly by species of Candida and Aspergillus fungi. Later than six months after heart transplantation also Cryptococcus fungi can develop fungal infection. The most often fungal infections in heart transplant patients is candidiasis. These kind of fungi colonize a skin and a mucose membrane and can very easy cause infection in friendly conditions. Infections caused by Aspergillus proceed as invasive aspergillosis, allergic, bronchopulmonary aspergillosis and aspergilloma. Depend on kind of infection we use pharmacologic or surgical therapy.

[Evaluation of mycologic and myco-serologic studies of materials derived from the respiratory tract of patients in the years 1986-1990]. / Ocena wyników badan mykologicznych i mykoserologicznych materialów z dróg oddechowych pacjentów w latach 1986-1990.

The material for mycological studies consisted of 7146 samples of respiratory tract material derived from 7764 patients (6495 samples of sputum, 235 bronchial rinsings and 416 throat smears). Serological studies were performed with 684 samples of serum by application of indirect immunofluorescence (IF) and gel immunodiffusion (ID) tests. Candida- like fungi in amounts which were diagnostically significant (10(6) cells/ml) were found in 16.7% samples of sputum. among fungi isolated from sputum there were 14 species of Candida- like fungi, mainly C. albicans (76%) and 7 species of moulds (including A. fumigatus-0.7%). Fungi were isolated from bronchial washings in 23.4% of samples. Among the isolated strains, 12.6% of Candida albicans were resistant to 5-fluorocytosine and 14.1% were resistant to amphotericin B. Antibodies against C. albicans by application of both IF and ID were found in 2.2% samples of serum. Antibodies against A. fumigatus were present in 11.6% of samples.