bubble_chart Overview

The main pathogen of pulmonary candidiasis is Candida albicans, followed by Candida tropicalis, Candida guilliermondii, and Candida stellatoidea.

bubble_chart Pathogenesis

Candida albicans colonizes the human oral cavity, throat, upper respiratory tract, vagina, and intestinal mucosa, and generally does not cause disease. When suffering from severe chronic diseases, or long-term use of broad-spectrum antibiotics, hormones, or immunosuppressants that reduce the body's resistance, the pathogen invades the bronchi or lungs, causing disease. Therefore, this disease is mostly a secondary infection.

Candida albicans proliferates extensively in the lower respiratory tract, producing toxicity to cells and causing inflammatory reactions. The mycelium may increase as the lesion becomes chronic. Pathological changes vary with the course of the disease. In the initial stage [first stage], the lesions are mainly acute suppurative inflammation accompanied by abscess formation. Macroscopically, large areas of consolidation are observed, with gray-white coagulative necrosis at the center; microscopically, extensive caseous necrosis with abscess formation is seen, surrounded by mycelium and infiltrating phagocytes. In the late stage [third stage], caseous necrosis, cavity formation, fibrosis, and granuloma are observed.

bubble_chart Clinical Manifestations

(1) Bronchitis Type: The general condition is good, with mild symptoms and usually no fever. The main manifestation is severe coughing, with a small amount of white sticky sputum or purulent sputum. Examination reveals scattered punctate white membranes covering the oral cavity, pharynx, and bronchial mucosa, and occasional dry rales can be heard in the chest.

(2) Pneumonia Type: Mostly seen in immunocompromised patients or those in extremely poor general condition. It presents as acute pneumonia or sepsis, with symptoms such as fear of cold, fever, cough, expectoration of white sticky jelly-like sputum or purulent sputum, often with blood streaks or necrotic tissue, and a yeast-like odor, and even hemoptysis and dyspnea. Dry and wet rales can be heard in the lungs.

bubble_chart Auxiliary Examination

The lung markings are increased, with diffuse small patchy or speckled shadows, some of which may coalesce into large dense shadows with blurred edges, variable morphology, and rapid progression. The lesions are mostly located in the middle and lower lung fields. Some cases are accompanied by changes in the pleura. Chronic sexually transmitted disease presents as fibrous cord-like shadows and compensatory lung emphysema.

bubble_chart Diagnosis

The diagnosis can be confirmed by direct smear or culture of Candida from lower respiratory tract secretions, lung tissue, pleural fluid, blood, urine, or cerebrospinal fluid obtained through cricothyroid membrane puncture aspiration or via a protected specimen brush through a fiberoptic bronchoscope. The presence of Candida in a direct smear or culture of sputum does not diagnose a fungal disease, as approximately 10-20% of healthy individuals may have Candida albicans in their sputum. However, if the same species of Candida is cultured three consecutive times from deep-coughed sputum after gargling with 3% hydrogen peroxide three times, it has diagnostic reference value.

bubble_chart Treatment Measures

First, treat the primary disease and remove inducing factors, such as discontinuing antibiotics, hormones, and immunosuppressants. Strengthen supportive therapy to enhance the body's immune function. For antifungal treatment, refer to "Candidiasis."