Fungal diseases of the urinary and reproductive systems

　　First, Pathogenic Factors

　　Not everyone with Candida necessarily develops the disease, and not everyone who comes into contact with the bacteria is infected. People are prone to disease under the following conditions:

　　1, Decreased body resistance: suffering from long-term, chronic consumptive diseases, such as leukemia, diabetes, pulmonary tuberculosis, cachexia, etc.

　　2, Large-scale use of broad-spectrum antibiotics;

　　3, Long-term use of corticosteroid hormones or long-term use of immunosuppressive drugs and chemotherapy, radiotherapy, etc.

　　4, Vitamin B deficiency;

　　5, Long-term use of various drainage tubes: tracheotomy, suprapubic fistula tube, indwelling catheter, intravenous hyperalimentation tube, peritoneal dialysis tube, etc.

　　6, Multiple thoracic and abdominal surgeries, severe burns, or immune deficiency: such as AIDS, etc.

　　Second, Pathogenesis

　　Whether Candida invasion leads to disease depends on many factors, in addition to being related to the body's immune function, it is also related to the number, virulence, and local environmental changes of Candida. Generally, the pathogenicity of Candida albicans includes the following 5 factors:

　　1, Adhesion: Adhesion is proportional to virulence, and Candida albicans has the strongest adhesion. Currently, the most studied mechanism of Candida infection is the adhesion mechanism of Candida albicans;

　　2, Dimorphism: Yeast cell type or hyphal type;

　　3, Toxins: There are bacterial glycoproteins and Candida toxins on the surface of the bacterial cells, which may be pathogenic factors;

　　4, Cell surface components;

　　5, Extracellular enzymes: Candida can secrete some enzymes, such as phospholipase, hemolytic phospholipase, and acidic hydrolytic enzyme, which can hydrolyze keratin and collagen to promote the adhesion function of Candida albicans.

　　Renal infection often leads to abscess formation. In rare cases, it can form a fungal mass blocking the renal pelvis or ureter, leading to hydronephrosis or anuria. Due to increased intracystic pressure, the glomerular filtration rate decreases, resulting in decreased clearance of creatinine and urea nitrogen, which can cause renal insufficiency. Severe cases may lead to renal failure. When patients present with symptoms such as oliguria or anuria, attention should be paid to monitoring renal function.

　　1, Candidal balanoposthitis:Erythema and dryness of the inner plate of the prepuce and the glans are common symptoms in those with long prepuce and uncircumcised, accompanied by white cheesy plaques at the inner plate of the prepuce and the corona glandis. Some may present with superficially red erosions and thin-walled pustules, with明显itching. Erythema and scattered small papules may also be seen on the prepuce and glans. When the scrotum is involved, scaly erythema can be seen on the surface contacting the penis. Urethral meatus舟状窝 involvement can lead to frequent urination and dysuria.

　　2. Lower urinary tract candidiasis:Including candidiasis of the ureter, bladder, and urethra, most of this disease is caused by localized dissemination from retained urethral catheters or reproductive and gastrointestinal tracts, and is more common in patients with diabetes and urinary tract abnormalities or injuries. The clinical manifestations vary when involving the ureter, bladder, or urethra, but they are all different from bacterial infections. Many patients may only have candiduria without any symptoms. Candida albicans is still the most common pathogen, but smooth Candida infections resistant to antifungal treatment also account for up to 30%.

　　3. Renal candidiasis:This disease is caused by hematogenous dissemination more than by ascending infection, and at least 80% of disseminated candidiasis patients will develop renal candidiasis. Therefore, patients with neutropenia, candiduria, and fever symptoms should be suspected of disseminated candidiasis. The main symptoms include fever, chills, back pain, and abdominal pain. Oliguria or anuria is a common sign of infection in infants. In addition to the fungal masses in the renal pelvis and ureter, there are no specific imaging features.

　　Prevention:

　　1. Keep clean in daily life.

　　2. Before and after sexual activity, if possible, urinate and do not hold urine.

　　3. You can try drinking cranberry juice, as it has the effect of reducing bacteria sticking to the urinary tract.

　　4. You can also drink a lot of water to effectively avoid the possibility of bacterial invasion.

　　5. During daily activities, it is necessary to maintain the habit of urinating every 2-3 hours. In addition, it is more important to add vitamin B group and lactic acid bacteria, etc.

　　1. Microscopic examination of urine sediment or secretion can find pseudofilaments or spores; Gram staining of filaments, spores appear blue, with uneven staining; iodine acid staining of filaments, spores appear red; and the bacterial body stained with acridine orange at a dilution of 1/1000 appears bright green under a fluorescence microscope.

　　2. Urine culture of Candida shows budding spores in the culture medium, and acute urinary system infection can be diagnosed when the bacterial colony count in urine culture is over 1000/ml.

　　3. Serological tests can be used for candidal antibody detection, but a single positive result has no diagnostic significance. It is necessary to regularly detect serum samples obtained over a period of time, and high or gradually increasing antibody titer has certain diagnostic significance. In recent years, some specialized laboratories have adopted immunoblotting to detect some candidal antigens (such as a 48-KDa antigen of an enolase and a 47-KDa antigen of a 90-KDa heat shock protein product)。

　　4. X-ray examination: When there is renal fungal infection and fungal masses appear in the renal pelvis, IVU and retrograde pyelography can show changes in renal pelvis filling defects, and biopsy tissue examination and fungal ball pathological examination can find pseudofilaments or spores.

　　What kind of food is good for the body with urinary and reproductive system fungal diseases

　　Pay attention to nutrition in food, eat more light foods such as vegetables and fruits, and supplement necessary vitamins and trace elements, such as eating more cucumbers, bitter melon, and portulaca.

　　2. What foods should be avoided for urinary and reproductive system fungal diseases?

　　Try to avoid drinking strong alcohol, eating spicy foods, and avoid fatty, fried, moldy, and preserved foods.

　　One, Candidal Balanoposthitis

　　Local treatment is mainly used, and sexual partners should be treated simultaneously. Use a 2% sodium bicarbonate solution or a 0.1% rifampicin solution to rinse the skin lesions, and then apply a 1%-2% crystal violet solution (gentian violet) or mercuric red glycerin externally after rinsing. It is also possible to use imidazole antifungal preparations externally, and itraconazole or fluconazole can be taken orally if necessary.

　　Two, Lower Urinary Tract Candidiasis

　　For patients without signs of pyelonephritis or obstruction of the kidney and ureter, but with persistent candiduria due to retained urethral catheter, local irrigation with antifungal drugs is reasonable. These patients usually have intermittent irrigation (200-300ml of sterile solution of amphotericin B at a concentration of 50mg/L, administered once every 6-8 hours) or continuous infusion of amphotericin B (50mg/L sterile water solution) after changing the catheter, and improvement is observed after 5-7 days. Oral fluconazole (100-200mg/d) for 2-4 weeks is the simplest and best treatment plan for cystitis in patients without retained catheters. However, it cannot be used for infections caused by smooth Candida and Cryptococcus species.

　　Three, Candidiasis of the Kidney

　　There are three basic methods for the treatment of candidiasis of the kidney:

　　1. Local irrigation of antifungal drugs in the renal pelvis;

　　2. Oral or intravenous infusion of antifungal drugs;

　　3. Surgical removal or resection of obstructions. In clinical practice, these methods often need to be used in combination. Amphotericin B [1.0mg/(kg·d)], with or without fluoro-cytosine (5-fluorocytosine) [100-150mg/(kg·d)], is still the best treatment plan for candidiasis of the kidney. Fluconazole is excreted from urine in its prototype and at high concentrations, and its efficacy is currently being observed. It is an effective substitute for amphotericin B (if the pathogen is sensitive to it), and the recommended dose of fluconazole is 200-400mg/d, but the dose should be adjusted accordingly in patients with impaired renal function.