Furthermore, histological examination of both the skin and the small bowel specimens using special histochemical stains (PAS, Gomori Silvermethenamine) showed severe inflammation and massive areas of necrosis containing fungal spores and numerous budding hyphae (Figure 2). Figure 2 Histological section. A) Necrotic tissue from the cutaneous specimen, with fungal
hyphae. B-C) Hyphae in the small bowel specimen. In C some of them appear to cross selleck inhibitor the vessel wall. PAS stain (A) ×200; GMS stain (B) ×400, PAS stain (C) ×200. Some yeasts were present across vessel walls of the small bowel, suggesting systemic blood dissemination (Figure 2C). These findings were in keeping with culture results of intraoperative specimens and serial drainage fluids, showing fluconazole-resistant Candida albicans, susceptible to echinocandin according to CLSI cut off values [8]. Echinocandin (70 mg on the first day, i.e., day 103, followed by 50 mg/day) was administered parenterally for a total of 21 days. The patient’s clinical conditions improved, fever disappeared and she was subsequently discharged in a good clinical state. Discussion We have reported two cases of
abdominal surgery patients who developed CA-4948 ic50 systemic candidiasis, and whose clinical symptoms improved following the initiation of therapy with 70/50 mg/day echinocandin. Oral thrush and esophageal candidiasis are the most common manifestations of Candida infection in the GI tract, with only occasional involvement of the colon and rectum. Despite the high concentration of Candida spp. in the lower GI tract, infection does not occur under normal circumstances, owing to innate defense mechanisms. In this manuscript, we have described abdominal lesions due to Candida albicans infection. In a previous case report, we described a vegetating gastric Candida albicans lesion in an immunocompetent
patient, endoscopically simulating a neoplasia [11]. This study reports two new cases of abdominal fungal infection in patients who had undergone abdominal surgery. Gastrointestinal candida lesions remain difficult to diagnose because of the prevalence of colonization without accompanying infection, non-specific symptoms, and variable presentation. In our two cases, despite blood cultures being negative for yeast, the histological analysis, performed with special histochemical stains, and culture Carnitine palmitoyltransferase II of specimens or drainage fluid allowed us to identify it. Although new, rapid and sensitive methods for diagnosing invasive fungal disease are available [12], histopathologic examination remains one of the major diagnostic tools in OSI-027 mycology because it permits rapid, presumptive identification of fungal infections [13, 14]. Newer fungal, invasive visceral candidiasis and multidrug-resistant bacteria involving hollow gastrointestinal viscera are emerging pathologies for abdominal surgery [11, 14, 15]. Minali et al. reported that stomach candidiasis was seen in 0.