bubble_chart Overview

Fungal enteritis is one of the significant types of systemic fungal diseases in the body. The digestive tract serves as a primary route for fungal invasion, posing a considerable threat to health and life. This condition was relatively rare in the past, but in recent years, due to the widespread use of broad-spectrum antibiotics, hormones, immunosuppressants, anti-tumor drugs, and radiation therapy, intestinal infections have become increasingly common. In China, the main fungi causing enteritis include Candida, Actinomyces, Mucor, Aspergillus, and Cryptococcus, with Candida albicans enteritis being the most frequently observed.

bubble_chart Etiology

Fungal enteritis is primarily caused by inflammation of the intestinal mucosa due to Candida albicans Chinese Taxillus Herb. However, the disease is prone to secondary occurrence under the following conditions: ① When the body suffers from severe liver and kidney diseases, agranulocytosis, or malignant tumors leading to cachexia, the immune function of the body can be reduced. Long-term use of antibiotics, adrenal corticosteroids, chemotherapeutic anticancer drugs, immunosuppressants, and radiotherapy can all weaken the body's and tissues' resistance to disease, or cause intestinal flora imbalance, allowing fungi to invade and multiply in large numbers, attacking tissues and easily causing intestinal fungal diseases. ② Fungal enteritis can also be secondary to certain gastrointestinal diseases, such as dysentery, intestinal obstruction, and esophageal abscess. These diseases destroy the integrity of the intestinal mucosa, creating conditions for fungal invasion.

Fungal enteritis can occur at any age but is more common in infants and young children with poor constitution, malnutrition, or thrush, as well as in children with low resistance.

bubble_chart Pathological Changes

The pathological changes of fungal enteritis are mainly seen in the invasion of the intestinal wall layers by fungi. Enteritis caused by Mucor, Aspergillus, and occasionally Candida albicans can also invade the submucosal layer and the small stirred pulses and small veins of the mesentery, destroying the vessel walls and causing fungal vasculitis and the formation of fungal thrombi. These lesions are particularly prominent in Mucor infections. This disease can sometimes be caused by mixed infections of two fungi, such as Candida albicans combined with Mucor, or Candida albicans combined with Aspergillus. Therefore, during pathological examination, it is best to combine it with fungal culture to isolate and identify the pathogenic fungi, which is beneficial for diagnosis. The granulomas and fibrotic sexually transmitted disease foci caused by fungal infections are rare in fungal enteritis.

Microscopic findings: The intestinal mucosa shows focal necrosis and ulcer formation. Some ulcers are superficial, while others extend deep into the submucosal layer, with some surfaces forming pseudomembranes. The pseudomembranes consist of a large number of fungi, fibrin, necrotic tissue, and a small number of inflammatory cells. All layers of the intestinal wall, especially the submucosal layer, show congestion, edema, and inflammatory cell infiltration. The number of inflammatory cells varies, with neutrophils being predominant, along with monocytes and lymphocytes. Abscesses can sometimes be observed.

bubble_chart Clinical Manifestations

Candida albicans affects the colon, with approximately 85.5% of patients experiencing abdominal distension and fullness, frothy diarrhea, or alternating constipation. In the early stage, the stool is mucus-like, occasionally accompanied by hematochezia or blood streaks, characterized by a sticky, egg-white-like mucus adhering to the stool or entirely mucus-like stool. In the late stage [third stage], the stool becomes purulent or purulent-bloody and loose, or there may be no obvious purulent-bloody stool. When bleeding is significant, the stool appears as a dark red, paste-like mucus. Abdominal pain and tenderness are not prominent.

When actinomyces invades the ileocecal region, it manifests as dull pain in the right lower abdomen, often accompanied by a firm and tender mass. When the psoas muscle is irritated by inflammation, a right iliac flexion deformity may occur. After appendectomy, some patients may develop one or more chronic persistent fistulas. Therefore, this condition is easily confused with appendicitis, appendiceal abscess or mass, ileocecal subcutaneous node, cecal amoebiasis, cecal cancer, psoas abscess, or female reproductive adnexal tumors. Rectal actinomycosis can form subacute or chronic perianal abscesses, ischiorectal fossa abscesses, or pararectal abscesses. Perirectal lesions often result from intra-abdominal lesions, presenting as diarrhea, constipation, tenesmus, or loose, yellowish, granular purulent-bloody stool.

bubble_chart Diagnosis

This disease is caused by deep fungal infection and is relatively rare in clinical practice. It generally lacks specific symptoms and signs, making the diagnosis of fungal enteritis somewhat challenging. The diagnosis is primarily based on a history of long-term mucoid diarrhea alternating with constipation that does not respond to prolonged treatment with antibiotics or sulfonamides. Patients who are cured with antifungal medications may exhibit colonic spasms or a significant amount of yellowish-white viscous secretions under colonoscopy. Some may also show multiple yellow-surfaced ulcers on the intestinal wall. Definitive diagnosis, apart from identifying fungi in colonic mucosal tissue samples, mainly relies on repeated fungal cultures that are positive and confirm the same fungal species. In fungal tissue staining examinations, fungi are often overlooked due to their low numbers and poor staining with Sappan Wood and eosin. However, the use of PASD and Gram special staining techniques yields a high positive rate, facilitating easier diagnosis.

bubble_chart Treatment Measures

(1) General Treatment: A small number of patients may fall ill when their health condition is poor. Generally, supportive therapies such as high-nutrition, easily digestible food, electrolyte balance regulation, or blood transfusion are provided. If combined with other chronic diseases such as subcutaneous node disease or diabetes, necessary treatments should be administered simultaneously.

(2) Antifungal Treatment:

1. Candida albicans infection: Generally, oral clotrimazole is administered, 1g each time, three times a day. Nystatin 1 million units, orally three times a day. It has been reported that ketoconazole 0.4g/day, taken for three weeks, can cure the condition. Other treatments include saturated potassium iodide solution (50g potassium iodide and 50ml distilled water), 10 drops three times a day, increasing by 5 drops each day until 30-40 drops, taken with warm water. Garlic extract capsules, 3-4 capsules, three times a day after meals, can effectively control the lesions. Sophora 30g boiled in 200ml water to 60-70ml, once a day for retention enema, 10 times as a course, has also shown significant efficacy. Some patients have a tendency to relapse, possibly related to low cellular immune function, and transfer factor therapy may be tried.

2. Mucormycosis enteritis: Early stages can be treated with X-ray irradiation. In advanced stages, surgical resection and coagulation therapy can be used. Usually, oral isoniazid 0.1g, three times a day. Vitamin D ₂ 10,000-20,000 units, three times a day, along with iodine preparations, such as sodium iodide 1g intravenously, once a day, gradually increasing to 3g. Long-term injection of amphotericin B, 0.1-0.2mg/kg, intravenous drip, once or twice a day, gradually increasing to 1mg/kg each time. When intravenous drip is used, it should be diluted with distilled water or 5% glucose, not saline, to avoid precipitation. 4-8 weeks as a course, the total amount can reach 3g. During treatment, if blood urea nitrogen is greater than 0.6g/L, the medication should be temporarily stopped. This dermatitis medicamentosa has significant side effects, which can cause phlebitis, nausea, vomiting, anorexia, and in severe cases, general discomfort, renal dysfunction, renal tubular necrosis and liquefaction, proteinuria, cylindruria, anuria, etc.

3. Aspergillus enteritis: Can be treated with amphotericin B injections. At the same time, take a large dose of potassium iodide solution, 20-30g daily, for 3-4 weeks. If it is granulomatous damage, surgical resection can be used.

4. Cryptococcal enteritis: There is no specific treatment for this disease. Amphotericin B, clotrimazole, nystatin, oral potassium iodide, sulfadiazine, or local X-ray irradiation can be tried. Or both can be applied simultaneously. Localized cases can also be treated with surgical resection.

bubble_chart Prevention

(1) Try to avoid the prolonged use of high doses of antibiotics, corticosteroids, and immunosuppressive drugs, especially broad-spectrum antibiotics, or the simultaneous use of several antibiotics or antibiotics combined with hormones. Vitamin C should be taken more frequently.

(2) Always pay attention to maintaining skin cleanliness and hygiene. In case of infection after abdominal surgery or tooth extraction, active treatment should be pursued.

(3) In skin folds, try to avoid moisture or soap-based preparations.

(4) Those who frequently engage in washing work should pay attention to changes in the nail bed and nail groove, and seek early examination and treatment.

(5) Local necrotic tissue and purulent sexually transmitted disease lesions should be treated according to surgical principles.