Pulmonary candidiasis

　　To date, more than 270 species of Candida have been found, among which the pathogenic Candida to humans mainly include white Candida (C. albicans), tropical Candida (C. tropical), pseudotropical Candida (C. pseudotropicalis), parapsilosis Candida (C. parapsilosis), Krusei Candida (C. kruseii), stellatoidea Candida (C. stellatoidea), glabrata Candida (C. glabrata), and guilliermondii Candida (C. guilliermondii). All are opportunistic pathogens, among which white Candida has the strongest virulence and is the most common. Candida grows rapidly on general culture media, forming oval budding cells, and forms hyphae on special culture media. The identification of species requires biochemical tests.

　　The pathogenicity of Candida is related to the morphology and adhesion ability of the菌体, with the yeast form generally not pathogenic and the hyphal form being pathogenic. The pathogenicity of Candida with strong adhesion ability is also strong. Some Candida can secrete toxins and hydrolytic enzymes to destroy tissues.

　　Normal human skin, oral cavity, gastrointestinal tract, etc., are all colonized by Candida, which does not cause disease under normal circumstances. When the body's immune defense function decreases, Candida colonizing the oral cavity and upper respiratory tract can invade the respiratory tract and cause endogenous infection. Unhygienic diet and hospital cross-infection can lead to exogenous infection. Catheters, mucosal ulcers, and other factors that destroy the integrity of the mucosa can also allow Candida to enter the body. The lung can be the primary site of infection, or part of the hematogenous spread of Candida.

　　Occasionally, it can be complicated with exudative pleurisy, main bronchial obstructive atelectasis, etc. Blood源性 pneumonia can be complicated with myocarditis and bacteremia. Therefore, once found, active treatment should be carried out, and preventive measures should also be taken in daily life.

　　1. Bronchitis type:Symptoms are relatively mild, with cough and expectoration of a small amount of white mucous sputum or purulent sputum; examination of the oral cavity, throat, and bronchial mucosa shows scattered white patches. Dry rales can occasionally be heard in both lungs.

　　2. Pneumonia type:Presenting with acute pneumonia or accompanied by sepsis, with symptoms such as chills, fever, cough, expectoration of white sticky mucus or sputum, with blood streaks, and even hemoptysis, dyspnea, etc.; generally with poor general condition, dry and moist rales can be heard in the lungs.

　　3. Allergic type:Symptoms such as dyspnea, nasal itching, runny nose, sneezing, and wheezing can be heard in both lungs.

　　First, consider the possibility of pulmonary candidiasis when the following conditions occur:

　　1. There is a history of pneumonia but the evolution is atypical, and the efficacy of antibiotics used correctly is poor.

　　2. Elderly and weak individuals, especially those with pulmonary infections after extensive use of antibiotics, corticosteroids, or cytotoxic drugs.

　　3. X-ray shows patchy shadows in the lower two lungs, which have not absorbed or improved after treatment.

　　4. Pay attention to pulmonary candidiasis infection if there are typical symptoms of thrush, sputum appears milky or grayish-white, sticky and transparent like jelly, and there is a cough. Treatment should first remove the predisposing factors and treat the primary disease, enhance the body's immune function. At the same time, antifungal drugs should be selected. For refractory cases, immunotherapy such as vaccine injection, or levamisole and transfer factor can be supplemented.

　　Second, main measures:

　　1. Do not abuse broad-spectrum antibiotics.

　　2. For those who take antibiotics, corticosteroids, and immunosuppressants for a long time, regular stool, urine, and sputum examinations should be conducted, and a thorough physical examination should be performed. Chest X-ray examination should be performed regularly if necessary.

　　3. For those who must take antibiotics and corticosteroids for a long time, antifungal drugs can be administered intermittently for prophylaxis, such as nystatin, ketoconazole, and fluconazole.

　　4. Health care workers should wash their hands before and after contacting patients to avoid cross-infection.

　　First, etiology examination

　　1. Direct smear microscopy or Gram staining, Iemsa staining, or PAS staining of throat swabs, sputum, bronchoalveolar lavage fluid, pleural effusion, and blood, etc., can be used for diagnosis if budding spores, pseudofungi, and hyphae are found in the specimens.

　　2. Since normal people can carry bacteria in the throat, it takes three or more positive sputum cultures to have a certain diagnostic significance.

　　3. Sampling and culture with protective brush (PSB) through fiberoptic bronchoscope is relatively reliable. Due to the short duration of bacteremia, the positive rate of blood culture is relatively low.

　　Second, histopathological examination:Bronchoscope biopsy or percutaneous lung biopsy, histopathological examination with evidence of candidal hyphae invasion can confirm the diagnosis.

　　Third, immunological examination:Immunological detection of ant甘露聚糖 antibody has poor sensitivity and specificity, and false negatives often occur in severe patients and immunodeficient patients. The main antigens detected for candidiasis are mannose antigen, 47KD antigen, and heat-labile antigen. However, there are common antigens among different species of the genus Candida, and some protein components in human serum have similar antigenic determinants to the antigens of Candida, so there are problems with the purification and standardization of antigens. There is a need to further improve sensitivity and specificity.

　　Fourth, imaging examination:The chest X-ray of bronchopneumonia type shows deepening of pulmonary纹理 in both lungs, and diffuse spotted and small patchy shadows in the middle and lower lung fields. The X-ray manifestation of pneumonia type is patchy and nodular infiltration, which can affect the entire lung lobe, and there may be enlargement of hilar or mediastinal lymph nodes, or present as pulmonary edema, with significant changes in shadows in a short period of time. Blood source is often manifested as multiple indistinct granular nodular shadows, and as the condition progresses, granular lesions can fuse into nodules of different sizes.

　　First, what foods should pulmonary candidiasis patients eat that are good for their bodies

　　Diet should be light, eat more vegetables and fruits, reasonably match the diet, and pay attention to adequate nutrition.

　　Second, what foods should pulmonary candidiasis patients avoid eating

　　Avoid smoking and drinking, avoid spicy and greasy foods, avoid smoking and drinking, avoid eating cold foods.

　　First, treatment principles

　　1. Treat the primary disease and remove the trigger.

　　2. Strengthen supportive therapy.

　　3. Antifungal drug application: choose to use amphotericin B (AmB) - 5-fluorocytosine (5-Fc) and ketoconazole.

　　Second, principles of medication

　　1. For mild cases, vitamin supplementation should be provided, especially vitamin B group and C. Or, while discontinuing broad-spectrum antibiotics and corticosteroids, antifungal drugs can be taken orally or inhaled in the form of nebulization.

　　2. For severe cases, intravenous administration is mainly used, and one or two antifungal drugs can be combined, and supportive therapy should be strengthened.

　　3. For refractory cases, immunotherapy can be given, such as vaccine injection and comprehensive treatment.