Fungal enteritis is one of the important types of fungal diseases in the body. The digestive tract is the main route of transmission for fungi entering the body, posing a significant threat to health and life. In the past, this disease was quite rare, but in recent years, due to the widespread use of broad-spectrum antibiotics, hormones, immunosuppressants, antitumor drugs, radiotherapy, and other factors, the incidence of intestinal infections has also increased. The incidence of intestinal fungal infections is 1.6%, including Candida and Aspergillus. In China, the fungi causing enteritis mainly include Candida, Actinomycetes, Mucor, Aspergillus, Cryptococcus, and others, among which candidal enteritis is the most common.
English | 中文 | Русский | Français | Deutsch | Español | Português | عربي | 日本語 | 한국어 | Italiano | Ελληνικά | ภาษาไทย | Tiếng Việt |
Fungal enteritis
- Contents
-
1. What are the causes of fungal enteritis?
2. What complications can fungal enteritis lead to?
3. What are the typical symptoms of fungal enteritis?
4. How to prevent fungal enteritis?
5. What laboratory tests are needed for fungal enteritis?
6. Dietary restrictions for patients with fungal enteritis
7. The conventional method of treating fungal enteritis in Western medicine
1. What are the causes of fungal enteritis?
1. Etiology
The causative agents of fungal enteritis are mainly Candida, followed by Aspergillus, Mucor, Histoplasma, Paracoccidioides, and Geotrichum, among others. Occasionally, Coccidioides, Penicillium marneffei, and Cryptococcus neoformans are also seen.
Candida is widely present in nature and is also one of the normal flora in the human body, being the main genus among the opportunistic pathogenic fungi, with more than 150 species. The most common species are Candida albicans and Candida tropicalis, which are also highly pathogenic. Candida is a dimorphic fungus, with yeast cells being oval or round, bearing a single budding spore, with a diameter of 2.5 to 5 mm, which can connect to form pseudohyphae. The hyphal body is 5 to 10 mm long, and it is possible to see a string of spores. On culture media, a large terminal thick-walled spore can form within 24 hours, and bud formation can be observed within 1 to 3 hours at 37°C on Sabouraud's serum-containing medium. The mannoprotein contained in the cell wall of Candida is the target antigen for serological diagnosis.
Aspergillus belongs to the Ascomycota phylum, with sexual spores being ascospores and asexual spores being conidia, but some species are only capable of asexual reproduction. There are a total of 132 species and 18 subspecies of Aspergillus. The pathogenic strains are mainly Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger, and other 10 species. The size of the Aspergillus spores in the lesion is about 3 to 4 mm, irregular in shape, and densely clustered. The hyphae of Aspergillus are of varying lengths, mostly rod-shaped, with septa, slightly larger in diameter than the spores, with sharp branching and a tendency for multiple hyphae to branch repeatedly in the same direction, arranged in a radiate or coral-like pattern.
Mucor belongs to the Ascomycota phylum, with sexual spores being conjugation spores and asexual spores being sporangiospores. The hyphae are not septate, relatively thick and large, with walls that have refractive properties. They are about 2 to 3 times thicker than those of Aspergillus hyphae, with right-angle branching, visible swollen cells, and curved hyphae; the sporangial stalk grows directly from the hyphae. The pathogenic strains are most commonly found in the Mucorales family, including Rhizopus, Mucor, and Allomyces, among which Rhizopus oryzae and Rhizopus stolonifer are particularly common, often infecting the gastrointestinal tract.
Histoplasma includes Histoplasma capsulatum and Histoplasma africanum, belonging to the incomplete fungi subphylum, and is a dimorphic fungus. It appears in the form of yeast in tissues and in culture media at 37°C, with a diameter of 2-4mm; it grows slowly at room temperature, forming a white colonial mycelium with typical gear-shaped macroconidia. The hyphae are septate and highly infectious.
Coccidioides immitis is also a dimorphic fungus, growing in the form of hyphae in the natural environment or on Sabouraud's agar at 25°C, with small colonies, and under the microscope, it can be seen that the hyphae are wide, 1-2mm in diameter, with septate branching hyphae, and lateral conidia of circular or oval shape, about 3-6mm in size, are present on both sides of the hyphae. In tissues or on blood agar at 37°C, it grows in the form of yeast, forming large oval or spherical yeast bodies with a diameter of 10-60mm, surrounded by multiple budding spores, the smaller ones being 1-2mm and the larger ones 10-30mm.
Trichosporon is a yeast-like fungus, belonging to the incomplete fungi subphylum, Moniliaceae, and the Trichosporon genus. Direct smears of feces and other specimens treated with 10% potassium hydroxide solution can be observed under a microscope to show fine septate hyphae, as well as rectangular arthrospores, about 4μm×8mm in size, Gram-positive, with no gap between two arthrospores, and sometimes a germ tube may emerge from one corner of the arthrospore. Occasionally, round spores with thickened cell walls are seen.
The precipitating factors for the onset of fungal enteritis include:
1. The use of broad-spectrum antibiotics causes a disorder of the intestinal flora.
2. The use of glucocorticoids, immunosuppressants, tumor chemotherapy or radiotherapy, etc., leads to impaired immune function of the body.
3. The presence of certain underlying diseases such as chronic liver disease, diabetes, AIDS, etc.
4. Intestinal malnutrition and surgical trauma.
2. Pathogenesis
The pathogenesis of fungal infections is relatively complex and not yet fully understood. The occurrence of infection is the result of the interaction between the pathogen and the human body.
1. Regarding the body:A weakened immune system, particularly damage to cellular immune function, a decrease in the number of phagocytes, loss of chemotaxis, and decreased杀菌 ability are the main factors for the onset of fungal enteritis. One characteristic of opportunistic fungal infections is that they often occur in patients with underlying diseases, and these patients share a common feature of weakened immune function.
2. Regarding the body of the fungus:The cell wall of Candida albicans contains mannose, which can enhance its adhesion, and Candida albicans often appears in the form of hyphae in tissues, making it less likely to be phagocytosed by macrophages compared to yeasts. For example, after Cryptococcus neoformans is phagocytosed by macrophages, it is not easily killed and can reproduce within macrophages, leading to the spread of infection. Meanwhile, the endotoxins of Aspergillus and proteases (such as trypsin) can cause necrosis of the surrounding tissue of the infection focus. Moreover, the number of fungi ingested at one time can also be a determining factor for the occurrence of infection. For instance, Krause once gave healthy people an oral dose of 10^12 CFU (colony-forming units) of Candida albicans, and intestinal infection occurred several hours later, followed by candidemia.
3、医源性因素:如应用广谱抗生素导致肠道菌群失调,条件致病性真菌过度生长,或肠道手术增加了感染机会。
真菌性肠炎之病理变化,主要见于真菌侵袭肠壁各层。毛霉菌、曲菌和少数由白色念珠菌所致的肠炎,而且还可侵犯浆膜下层及肠系膜的小动脉和小静脉,破坏管壁引起真菌性脉管炎和真菌性血栓的形成。这些病变在毛霉菌感染时尤为突出。本病有时还可由两种真菌混合感染,如白色念珠菌合并毛霉菌,或白色念珠菌合并曲菌感染。因此病理检查时,最好同时结合真菌培养,对病原菌进行分离鉴定,有利于诊断。而真菌感染所引起的肉芽肿和纤维性病灶,在真菌性肠炎中则少见。显微镜下所见:肠黏膜有局灶性坏死及溃疡形成。溃疡有的表浅,有的深达黏膜下层,有的表面有假膜形成。假膜有大量的真菌、纤维蛋白、坏死组织及少量炎性细胞组成。肠壁各层,尤其是黏膜下层呈充血、水肿及炎性细胞浸润。炎性细胞多少不一,以中性粒细胞为主,并有单核细胞和淋巴细胞。有时可见到脓肿。
2. 真菌性肠炎容易导致什么并发症
直肠放线菌可形成亚急性或慢性肛周脓肿、坐骨直肠窝脓肿或直肠旁脓肿。直肠周围病变多由腹内病变波及而来,表现为腹泻、便秘、里急后重或较稀带黄色颗粒的脓血便。由于肠道的真菌感染,可以造成局部抵抗力的下降,由此可以导致细菌感染形成感染性腹泻、甚至因此导致脓毒血症。
3. 真菌性肠炎有哪些典型症状
1、念珠菌肠炎
最常见,好发于儿童,尤其是营养不良或严重衰竭的婴儿,主要表现为腹泻,大便每天10~20次,呈水样或豆腐渣样,泡沫比较多且呈黄绿色,可伴有腹胀,低热,甚至呕吐,但腹痛少见,粪标本碘涂片可见大量出芽酵母和菌丝,培养多为白色念珠菌,患儿常伴有鹅口疮,有基础疾病的患者则往往于发病前有应用广谱抗生素史,免疫缺陷患者易发展为播散性念珠菌病,如按一般细菌性肠炎治疗,症状反而加剧,腹泻呈迁延性经过,常数月不愈,且愈后易复发。
2、曲菌肠炎
好发于有基础疾病的体力劳动者,多为烟曲菌所致,由于烟曲菌并非肠道正常菌群,故感染是外源性的,往往继发于肺曲菌病,曲菌有侵犯血管之倾向,菌丝可穿入血管壁导致血栓形成,曲菌肠炎的临床表现以腹痛和血便为主,可引起消化道大出血,而腹泻常不典型,也缺乏念珠菌肠炎的迁延性经过,侵犯血管后易发展为播散性曲菌病。
3. Mucor enteritis
Caused by ingesting food contaminated with fungal spores, it is more common in malnourished children or patients with chronic gastrointestinal diseases. The clinical manifestations vary greatly due to the affected site and the degree of infection. The characteristic is the manifestation of mucosal ulceration or perforation after vascular thrombosis, often accompanied by gastric infection and gastric ulcer. Abdominal pain, diarrhea, hematemesis, and melena may occur, or intestinal perforation may lead to peritonitis, or invasion of gastrointestinal blood vessels may lead to hematogenous dissemination. The disease progresses rapidly, with a high mortality rate.
4. Histoplasmosis enteritis
Endemic, more common in AIDS patients or children, caused by inhaling or ingesting spores from contaminated soil. The clinical course is similar to that of regional enteritis or ulcerative colitis, with a slow onset, fever, dyspepsia, diarrhea, melena, abdominal pain, and sometimes vomiting. It often has pulmonary infection foci, but the main manifestation is enteritis.
5. Coccidioidomycosis enteritis
Secondary to pulmonary infection foci or infection through hematogenous dissemination, this disease also has endemicity, mainly seen in the central highlands of Brazil. People who frequently come into contact with soil are more prone to this disease. The lesions are mostly located in the ileocecal region, causing ulcerative granulomas with abscess formation. The pathogen can spread to local lymph nodes, liver, and spleen through lymphatic dissemination. The main symptoms are abdominal pain, palpable mass in the lower right abdomen, accompanied by diarrhea, vomiting, and often misdiagnosed as tuberculosis or tumor due to the presence of ascites and abdominal lymph node enlargement.
6. Trichosporon enteritis
Trichosporon and Candida are similar, a type of endogenous opportunistic pathogen. Trichosporon enteritis is more common in patients with immunodeficiency, chronic diseases, and those using immunosuppressants, antibiotics, or corticosteroids. Symptoms include abdominal pain, diarrhea, purulent or mucous stools, similar to dysentery, but a large number of Trichosporon and rectangular arthrospores can be found in the purulent stools. Patients often have oral Trichosporonosis, similar to thrush.
4. How to prevent fungal enteritis
1. Avoiding predisposing factors
Firstly, the application of broad-spectrum antibiotics must be controlled to avoid universal use, reduce long-term use, and for those who inevitably need long-term use due to the condition, antifungal drugs should be added at intervals to prevent dysbacteriosis leading to excessive growth of opportunistic fungi. Other measures such as strengthening nutrition for chronic disease patients, improving the body's resistance; using corticosteroids and immunosuppressants with caution; protecting the integrity of the physiological barrier of the oral and intestinal mucosa in immunocompromised patients; and reducing trauma are all helpful in preventing the occurrence of fungal enteritis.
2. Preventing fungal contamination and treating the primary focus of disease
The wards for malignant tumors and hematological diseases should maintain good ventilation and dryness, prevent the growth of fungi, and reduce the opportunities for exogenous infection. For patients with AIDS and other immunocompromised patients, timely detection and treatment of candidiasis and other fungal infections in other parts should be carried out to prevent secondary fungal enteritis. For patients receiving parenteral nutrition and those undergoing vascular catheter examination and surgery, strict aseptic operation should be implemented to prevent hospital-acquired fungal infections.
3. Drug prevention
For high-risk groups such as patients with AIDS, intestinal surgery, and organ transplantation, short-term adequate or long-term low-dose prophylactic medication can be administered.
1. Patients with hematological diseases and malignant tumors:Nystatin 2 million U daily orally, taken for 5-7 days, can be used once a month.
2. AIDS patients:Fluconazole or itraconazole 100-200mg daily orally, applied for 5-7 days per month, or amphotericin B 100mg weekly orally plus nystatin suspension gargle, 3 times a day, to be persisted for a long time.
3. Patients with organ transplantation and intestinal surgery:Nystatin 500,000 U, 3 times a day orally, or fluconazole 200mg daily orally, used for 3 days before surgery and 7 days after surgery.
4. Low birth weight neonates or preterm infants:Fluconazole 12.5mg/kg orally. Taken for 4-8 weeks, it can prevent neonatal candidal enteritis.
5. Prevention of recurrence:Fungal enteritis, especially paracoccidioidomycosis enteritis, is prone to recurrence after treatment, especially in patients with AIDS and other chronic patients with low immune function. Prevention can be achieved by using amphotericin B 50mg intravenously once a week, or itraconazole 200mg once a day orally. During the medication period, liver function should be checked regularly 1-2 times a month, and attention should be paid to the toxic and side effects of drugs.
5. What laboratory tests are needed for fungal enteritis?
First, pathogenic examination
Since fungi are widely distributed in nature, even the air often contains flying spores. During the collection of fecal specimens and examination procedures, it is necessary to minimize contamination, and the specimens should be fresh. Some fungi are highly infectious, such as Cryptococcus, and safety precautions should be taken to avoid infection of laboratory personnel.
1. Direct microscopic examination of specimens:Preparation with 10% potassium hydroxide or physiological saline, and the presence of a large number of hyphae and spores under high magnification has diagnostic significance. For dimorphic fungi, the presence of spores alone may be a normal carriage, and in most cases, direct microscopy can be used to identify the 6 common pathogens of fungal enteritis. However, spores, hyphae, and other background substances may sometimes be confused with each other, making it difficult to identify.
(1) Hyphae and spores: Hyphae are uniform in thickness, except for Mucor, which are segmented, and branches are visible from different angles. The cytoplasm is uniform, containing particles of varying sizes, and spores are mostly circular or oval, mostly uniform in size, with a regular edge, and cellular structure is visible.
(2) Cell wall: In specimens treated with potassium hydroxide solution, the cell wall often becomes wider, connecting into arcs, similar to hyphae, but without the structure of hyphae.
(3) Asbestosis: finer than hyphae, not segmented, without hyphal granules.
(4) Plant fibers: Undigested food residue, irregular edges, without branches.
(5) Lipocytes: Circular, with blurred structure, without cell wall.
(6) Phospholipid vesicles: Irregular in size and shape, without cellular structure.
(7) Potassium hydroxide crystals: Snowflake or coral-like, with jagged edges, strong refractive power.
(8) Small blisters: Circular, translucent, without cellular structure.
2. Common staining methods used in stained microscopy:
(1) Gram staining: Suitable for Candida, spores, and hyphae are stained blue, but the staining is not uniform.
(2) Periodic acid-Schiff staining (PA5): Fungal spores and hyphae are stained red.
(3) Acridine orange staining: Fungal spores appear bright green under fluorescence microscopy.
(4) Giemsa staining and Wright staining: Suitable for Cryptococcus neoformans. The body is stained red under oil immersion before fixation with methanol, with budding at the smaller end and a ring of capsule-like structure around the body, which is the cell wall of this bacterium. The body is usually located within macrophages or monocytes, and a few are located outside the cells.
(5) Lactophenol cotton blue staining: Suitable for various fungal culture smears, the body is stained blue.
3. Fungal culture:Direct microscopic examination of fecal specimens is usually not easy to determine the strain, and it is necessary to refer to the results of fecal culture, observe the morphology of the colonies, and then pick the colonies for staining and microscopic examination. Sandbach medium and blood agar medium are commonly used, and for dimorphic fungi, it is necessary to culture at different temperatures (25℃ or 37℃) separately to observe the changes in morphology.
(1) Large culture: It is one of the main methods for identifying fungi, which can observe the growth of colonies and preliminarily identify the strain according to the growth speed, morphology, color, etc. of the colonies.
A. Slant tube: The agar plane is pierced with a platinum ring, and the specimen is inoculated at three points on the slant culture medium in the tube, which is not easy to be contaminated, but the colony is small.
B. Culture dish: The specimen is inoculated at three points in the center of the plate culture medium, inverted and placed in an incubator, observed once every 3 days for the growth of colonies.
(2) Small culture: The well-grown colonies in the large culture are inoculated on the slide culture medium, cultured for 1 to 3 days, and observed under the microscope for the characteristics of the body.
A. Spot method: First, a small amount of culture medium is formed in the center of the slide, then the strain is inoculated at the edge of the medium, covered with a cover glass, placed in a glass petri dish with a U-shaped tube, and observed under the microscope or stained and observed at different times after culture.
B. Spreading method: The strain is inoculated on the slant or plate culture medium in the test tube, covered with a cover glass to allow the body to grow on the cover glass. Then, it is taken out and placed on a slide under the microscope at an appropriate time.
2. Histopathological examination
Some fungi belong to the normal flora of the human intestines, such as Candida albicans, and fungal contamination problems are widespread. Therefore, the diagnostic value of pathogenic examination of fecal specimens is limited, and sometimes it is necessary to combine the results of colonoscopy biopsy for comprehensive judgment.
1. Pathological changes of Aspergillus infection:It has diagnostic significance, including:
(1) Inflammation: Acute exudative inflammation.
(2) Ulcer formation: Due to the invasion of Aspergillus into blood vessels, causing vascular destruction, thrombosis, and tissue necrosis; ulcers vary in size and shape, can extend deeply into the muscular layer, with a rough and uneven bottom surface, and have purulent exudation.
(3) Granuloma: Composed of epithelial cells and macrophages, accompanied by neutrophils, lymphocytes, or plasma cell infiltration.
(4) Suppurative changes: Submucosal abscess formation, with a large number of neutrophils infiltrating, in which hyphae can be seen.
2. Pathology:The presence of fungal spores and hyphae in the sections is direct evidence of invasive colitis, with definite diagnostic significance. The staining methods include:
(1) Periodic acid-Schiff staining: Fungi appear red.
(2) Urotropine silver staining: Fungi appear black.
(3) Acridine orange fluorescence staining: Fungi show yellow or red fluorescence.
3. Immunological examination
1. Fungizone skin test:Skin allergy tests are performed with different dilution ratios of the mycelium or vaccine of Candida, Aspergillus, Histoplasma, Paracoccidioides, and other fungi. Hard nodules or erythema with a diameter greater than 5mm appearing 48 hours later is considered positive. It has reference value for the diagnosis of patients with atypical clinical symptoms.
2. Serum antigen detection:After the pathogenic fungi are processed and degraded by human phagocytes and other cells, the cell wall and cytoplasm antigens are released into the blood circulation. Those not cleared can be detected by enzyme immunoassay (EIA), indirect hemagglutination test, immunoblotting, etc. Heat shock protein belongs to fungal cytoplasmic antigen. Walsh et al. detected 50% positive in the serum of patients with invasive candidiasis concurrent with tumor within 24 hours after onset, with a specificity of up to 96%. For example, using ELA to detect the cell wall antigen and the related antigen that can bind to concanavalin A in the serum of patients with aspergillosis enteritis has early diagnostic value. When the antigen level reaches 100μg/ml, a diagnosis can be made for those with negative fungal culture.
3. Serum antibody detection:Complement fixation test is of certain value for the diagnosis of histoplasmosis enteritis, and the results of skin tests can be referred to for comprehensive judgment to exclude false positives. Indirect fluorescent antibody quantitative test can be used for the diagnosis of candidiasis enteritis. In addition, there are other commonly used methods such as immunoelectrophoresis, latex agglutination test, ELA, etc., among which the latter is the most sensitive. However, for patients with immune function suppression such as AIDS, antibody detection is prone to false negatives.
4. Agglutination reaction:Candidiasis patients' serum contains a factor that aggregates and a substance that inhibits aggregation, which can inhibit the vitality of Candida in tubes. Agglutination reaction in serum is普遍存在于正常人中,but it is suppressed after infection with Candida due to the increase of interfering substances.
Four, animal inoculation test
The pathogenicity of the colonies from the faecal specimen fungal culture can be further identified by animal inoculation.
1. Inoculation method:Scrape the colonies on the culture medium, crush them, add physiological saline and slightly shake, filter out the hyphae, and prepare a spore suspension with a concentration of about 108/ml. Inject it into the animal's body. The dose is 0.2-1.0ml depending on the size of the animal and the route of inoculation. It can be inoculated repeatedly multiple times to enhance the pathogenicity to the animal.
2. Selection of animals and inoculation routes:Due to the difference in the pathogenicity of different strains, different animals and inoculation routes should be selected:
(1) Candida albicans: Intravenous injection in rabbits or intraperitoneal injection in mice is selected.
(2) Aspergillus: Rabbits and chicks are selected for intravenous or intraperitoneal injection.
(3) Mucor: Intravenous injection into rabbits is selected.
(4) Histoplasma capsulatum: The culture fluid is added with 5% gastric mucin, and intraperitoneal injection into rats or mice is selected.
(5) Paracoccidioides brasiliensis: It is injected into the testicles of guinea pigs.
(6) Geotrichum: It is not pathogenic to animals.
3. Animal dissection:Before dissection, the animal should be disinfected in a 5% phenol solution, and then the pathological changes of the corresponding tissues and organs should be examined under sterile conditions. The lesion material should be taken for direct smears and fungal culture. The dissected animal carcass should be cremated and not buried in the ground to prevent the spread of pathogenic fungi.
Using gas chromatography to measure the concentration of fungal metabolic products or degradation products in serum has certain reference value for the diagnosis of invasive fungal enteritis. For example, after hydrolysis of mannose on the cell wall of Candida, the serum concentration is often greater than 800μg/ml in candidemia, between 600~800μg/ml in candidal enteritis, and lower than 600μg/ml in normal people. The rapid development of modern molecular biology technology has also opened up new paths for the diagnosis of deep fungal infections, such as probe hybridization and PCR techniques, which can detect specific gene fragments of fungi. They are sensitive, rapid, and have been conducted worldwide. For example, as reported by Buchman et al., the coding gene of the ergosterol demethylase of Candida albicans is a specific gene fragment of fungi, which can be used for clinical diagnosis of deep fungal infections by PCR.
6. Dietary preferences and taboos for patients with fungal enteritis
Section 1: Foods to Eat
1. Ginger can prevent nausea and stomach discomfort and should be eaten before and during travel.
2. Mint tea can soothe stomach discomfort, and a drop of mint oil on the tongue can relieve motion sickness.
3. Taking a moderate amount of vitamin B6 one hour before travel can alleviate symptoms.
4. Try to eat food you like as much as possible.
5. Have a little biscuit with olive oil. Olive oil can reduce saliva secretion, preventing nausea.
Section 2: Foods to Avoid
Eat less of the food you don't like. Spices and fats in food should not be too much, and fried foods should not be consumed.
7. Conventional methods of Western medicine for treating fungal enteritis
Deep fungal infections are different from superficial fungal infections, as patients often have obvious precipitating factors and accompanying underlying diseases. Therefore, the treatment of fungal enteritis must consider the removal of precipitating factors and the treatment of accompanying diseases, as using only antifungal drugs results in suboptimal efficacy. Moreover, the existing antifungal drugs with good efficacy all have varying degrees of toxic and side effects, and the combination of medication and the integration of Chinese and Western medicine is needed to reduce side effects and improve efficacy.
Section 1: General Treatment and Symptomatic Treatment
Rest in bed, isolate the digestive tract. Provide easily digestible, high-calorie, high-vitamin, low-fat diet. Limit milk intake to prevent bloating. Avoid刺激性 food and fibrous food to prevent triggering intestinal perforation. Use physical methods for fever reduction. Discontinue the use of existing antibiotics. Avoid antidiarrheal drugs. Microecological preparations can be used.
Section 2: Fluid Therapy
1. Intravenous Rehydration:Patients with reduced food intake and significant dehydration should receive intravenous fluid therapy to replenish fluids and calories, promptly correct acid-base balance and electrolyte imbalances. The principle is to replace what is lost, following the guidelines of 'replace salt before sugar, quick before slow, correct acid and replenish potassium'.
2. Oral Rehydration:Applicable to mild cases of dehydration and those whose conditions have improved after intravenous fluid administration.
Section 3: Traditional Chinese Medicine and Herbs
Using the holistic perspective of traditional Chinese medicine, treating diseases through differentiation of symptoms and reinforcing the healthy and expelling the pathogenic factors, effective antifungal medication is administered while improving the body's immunity and overall condition. Particularly in cases of AIDS complicated by fungal enteritis, the integrated approach of Chinese and Western medicine has unique advantages.
Traditional Chinese medicines such as garlic, coptis, Cortex mimosae, Zingiber officinale, etc., all have certain antifungal effects. The injection prepared from the active ingredient of garlic, allicin, can be infused intravenously and can also be taken orally. Recently, some people have used concentrated decoction of traditional Chinese medicine for enema, which has also achieved good results.
Four, Antifungal treatment
Nystatin oral administration is the first choice. For severe cases or those who have difficulty taking oral medication, fluconazole or amphotericin B combined with flucytosine (5-fluorocytosine) intravenous infusion should be selected.
1. Nystatin:A polyene antifungal antibiotic that is not soluble in water and not absorbed orally, therefore with fewer side effects. Adults take 1 million U per dose, 3 times a day, children should be reduced accordingly, the course of treatment is 10 to 14 days. It can be used in combination with allicin.
2. Allicin:An effective volatile oil obtained by vacuum distillation of garlic, chemically named trithia-2-propene, which can also be artificially synthesized. Injection, 90 to 150mg per day for adults, infused into 5% glucose solution, and infused within 4 to 5 hours. Oral capsules, 40 to 60mg per dose for adults, 3 times a day, taken after meals. The dosage for children should be reduced accordingly. The course of treatment is 2 to 4 months.
3. Fluconazole:A new generation of triazole chemical preparation to replace ketoconazole, with much less toxic side effects to the liver than ketoconazole. Dosage: 200 to 400mg per day for adults, 5 to 10mg/(kg·d) for children, taken orally or intravenously once a day. The course of treatment is 10 to 14 days. This drug should be avoided when taken with alkaline drugs that reduce gastric pH, as it may affect the absorption of the drug; it should also be avoided when used with hypoglycemic drugs, cyclosporine A, phenytoin sodium, rifampin, H2 antagonists, etc., to avoid interference with each other, accelerating metabolism, and reducing efficacy.
4. Itraconazole:The action is similar to that of fluconazole and is only for oral use. Dosage and precautions are the same as fluconazole. It is used to treat geotrichum enteritis, and the course of treatment needs 6 to 12 months.
5. Amphotericin B and its liposome preparations (Ambisone):Polyene antifungal antibiotics for intravenous use, with a broad spectrum of antibacterial activity, but with significant side effects, suitable only for severe patients. This drug is ineffective against Geotrichum. Dosage: Amphotericin B, 50mg per vial, diluted with sodium deoxycholate, added to 5% glucose solution, to a concentration of 0.1mg/ml, and infused within 6 hours. On the first day, 0.25mg/kg, and then increase by 0.25mg/kg each day, to 0.75mg/kg per day, and then change to once every other day. It is usually used in combination with 5-fluorocytosine, for 5 to 7 days or until the condition improves, then switch to fluconazole or other drugs with fewer toxic side effects. The main side effects include: headache, chills, fever, nausea, anorexia, thrombophlebitis, hemolytic anemia, acute nephritis, myocarditis, arrhythmia, etc., which can be alleviated by the use of anesthetics, corticosteroids, aspirin, antihistamines, and alkalinization of urine. If amphotericin B liposome is used, the toxic side effects are significantly reduced, which is conducive to increasing the dosage and extending the application time. The method of application:
(1) Dilute amphotericin B liposomes with sterile distilled water to a concentration of 4mg/ml, and shake vigorously to disperse evenly.
(2) Dilute with 5% glucose solution to a concentration of 0.2-2.0mg/ml, and filter through a sterile filter membrane with a pore size of 5mm, avoid light, intravenous infusion within 30-60 minutes.
(3) Dosage: Increase from 1.0mg/kg per day to 3.0mg/kg per day every day, course of treatment 2-4 weeks; newborns 1-5mg/kg per day, course of treatment 1 month. Not suitable for use in the same infusion line with electrolyte solutions and other drugs.
6. Fluorocytosine (5-fluorocytosine):It is a broad-spectrum antifungal drug synthesized chemically, which interferes with the synthesis of fungal nucleic acids by converting 5-fluorouracil through the unique cytosine deaminase of fungi. The effect of single use is poor, and when used in combination with amphotericin B, it can reduce the dosage of the latter to reduce its toxicity and reduce the production of drug-resistant strains. Commonly used oral capsules, also can be used 1% solution for intravenous injection. Dosage: Adults and children, 50-150mg/(kg·d), taken orally in 4 divided doses.
7. Methylthionine:Applicable to enteritis caused by Enterobius spp. Dosage: Methylthionine capsules, 30mg per dose, 3 times a day. Can be used in combination with nystatin or fluconazole.
8. Sulfonamide drugs:Applicable to enteritis caused by Paragonimus spp. Dosage: Sulfadiazine, 4-6g per day for adults, 60-100mg/kg per day for children, taken orally in 3-4 divided doses. Or sulfamethoxazole/trimethoprim, 2 tablets per day for adults, 1 tablet per day or as appropriate for children, taken orally once. The course of treatment should be more than 6 months.
Recommend: Inflammatory bowel disease , Anisakiasis Migrans , Infantile abdominal distal fat malnutrition , Abdominal fullness , Tumor polyps , Metastatic small intestinal tumors