Colon non tumor
Infectious colitis (specific microorganisms)
Candida

Author: Nalini Bansal, M.D. (see Authors page)
Editorial Board Member Review: Raul S. Gonzalez, M.D.

Revised: 21 April 2017, last major update March 2017

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: colon candida

Cite this page: Candida. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/coloncandida.html. Accessed August 18th, 2017.
Definition / general
  • Candida colonies are normal commensals of the gastrointestinal tracts and rarely pathogenic in gut
  • Candida infections are usually seen in immunocompromised and debilitated patients due to concurrent chronic diseases, malnutrition, use of immunosuppressive drugs or old age (Int J Contemporary Medical Research 2017;4:76)
  • In immunocompetent patients, low pH, regular use of antacids as well as hyperglycemia can cause the yeast to break through the intestinal mucosal barrier and lead to invasive candidiasis and candidemia (Dtsch Arztebl Int 2009;106:837)
Essential features
  • Candida colonies are normal commensals of gastrointestinal tracts
  • Infections are usually seen in immunocompromised and debilitated patients
  • Factors favoring fungal proliferation include: regular antacid use, which lowers pH; use of antibiotics, which diminish useful bacteria; and hyperglycemia, as seen with diabetes
  • Candida usually causes mucosal lesions; rarely perforations
  • Esophagus is the most commonly affected site in GI
  • Gold standard test for diagnosis is culture
  • Antifungals are treatment of choice
ICD-10 coding
  • B37.8 - Candidiasis of other sites
Epidemiology
  • Patients usually middle aged to elderly, with an average age of 65 years
Sites
Pathophysiology
  • Under normal conditions, there is homeostasis between C. albicans and the host; however, if the balance is disrupted by low pH, regular use of antacids or hyperglycemia, the yeast can break through the intestinal mucosal barrier and cause invasive candidiasis and candidemia (Dtsch Arztebl Int 2009;106:837)
Etiology
Diagrams / tables

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Fungal colonization in patients
with GI tract disease

Clinical features
  • Invasive Candida infections are characterized by fever and shock along with low blood pressure, abdominal pain, rigors, an elevated heart rate, respiratory distress and multiorgan failure (Emerg Med (Los Angel) 2015;5:264)
Diagnosis
  • Histopathology showing fungal hyphae and spores
  • Gold standard is culture for fungi
Laboratory
Radiology description
  • With intestinal perforation, chest Xray and Xray abdomen in erect view demonstrate gas under right hemidiaphragm
Prognostic factors
  • Prognosis of Candida peritonitis is very poor in critically ill surgical patients, with a mortality rate between 52% and 75% (Curr Opin Crit Care 2007;13:195)
  • Risk factors associated with increased mortality in Candida peritonitis include: extremes of age, upper GI tract infection as well as patient comorbidities, such as cardiac insufficiency, cirrhosis, diabetes mellitus, renal failure and multiorgan failure (Medicine (Baltimore) 2011:90:69)
Case reports
Treatment
  • The antifungal agents for Candida peritonitis include polyenes, azoles, echinocandins and flucytosine
  • Azoles are fungistatic against most Candida species, whereas the polyenes and echinocandins are fungicidal
  • Fluconazole is recommended for patients without prior azole exposure and not at high risk, such as elderly, diabetic and cancer patients (Clin Infect Dis 2009;48:503, Perit Dial Int 2009;29 Suppl 2:S161)
Gross description
  • Candida tends to cause mucosal lesions and produce ulcers of varying configuration, mucosal flecks, sloughed mucous membranes, polypoid masses and segmental lesions (J Clin Pathol 1992;45:806)
  • With perforation, bowel may be covered by a thick, black, serosal exudate (Acta Paediatr 2003;92:258)
Microscopic (histologic) description
  • Ulcer slough with eosinophils and neutrophils
  • Classical budding hyphae and spores of Candida admixed with ulcer slough
Microscopic (histologic) images

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Contributed by Nalini Bansal, M.D.

PAS positive fungal hyphae in a case of gastric adenocarcinoma with fungal infection



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Fungal hyphae with gastric performation

Virtual slides

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Oral candidiasis

Cytology description
  • Fungal spores and hyphae
Positive stains
Negative stains
Differential diagnosis