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Candidal pneumonia, or invasive pulmonary candidiasis
Last reviewed: 23.04.2024
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Candidiasis pneumonia, or invasive candidiasis of the lungs - is usually a manifestation of acute disseminated candidiasis. Isolated candidiasis pneumonia develops very rarely, with aspiration of gastric contents or prolonged agranulocytosis.
Candidiasis pneumonia may be primary, for example the aspirated pathogen in the lungs, or secondary, resulting from the hematogenous dissemination of Candida spp from another source. Primary candidiasis pneumonia occurs very rarely, secondary lung involvement is revealed in 15-40% of patients with acute disseminated candidiasis.
It is of fundamental importance to distinguish candidal pneumonia with a characteristic high mortality and a much safer superficial candidiasis of the trachea and bronchial tubes, as well as the usually not requiring surface colonization of the respiratory tract. Along with this, superficial candidiasis and airway colonization are often detected in patients with invasive candidiasis.
[Symptoms of candidiasis of the lungs
The most frequent clinical symptoms of Candida pneumonia are the febrile body temperature refractory to antibiotics, cough, shortness of breath, chest pain and hemoptysis. Quite often candidiasis pneumonia occurs without significant clinical manifestations, as patients are in serious condition or they are being carried out by mechanical ventilation. On the other hand, these patients often reveal other signs of acute disseminated candidiasis, for example, peritonitis, specific damage to the skin and subcutaneous tissue, retinitis, renal damage, etc.
Mortality in candidiasis pneumonia in different categories of patients ranges from 30 to 70%.
Diagnosis of candidiasis of the lungs
Diagnosis of Candida pneumonia is complex. Clinical and roentgenological signs are not specific and do not allow distinguishing candidiasis pneumonia from bacterial or other mycotic. At CT of the lungs, foci with fuzzy contours are detected in 80-100% of patients, foci associated with blood vessels - 40-50%, alveolar infiltration - 60-80%, symptom of "air bronchogram" - 40-50%, infiltration by the type of "frosted glass "- 20-30%, the symptom of" halo "- 10%.
When radiographing lungs, alveolar infiltration is detected in 60-80% of patients, foci with fuzzy contours - in 30-40%, symptom of "air bronchogram" - in 5-10%. Despite this, CT of the lungs is a more effective method of diagnosis than radiography, CT is often difficult due to the severity of the patient's condition.
Detection of Candida spp during microscopy and sputum culture or BAL fluid is not considered a diagnostic criteria for candidiasis pneumonia, usually it indicates a superficial colonization of the bronchi or pharynx. Nevertheless, multifocal surface colonization is a risk factor for the development of invasive candidiasis. Diagnosis is established when Candida spp is detected in a biopsy from a lesion focus. However, lung biopsy may be difficult due to a high risk of bleeding. The second criterion for diagnosis is CT or X-ray signs of invasive lung mycosis in patients with candidemia or acute disseminated candidiasis. Serological diagnostic methods have not been developed.
Treatment of candidiasis of the lungs
The choice of the drug depends on the type of pathogen and the patient's condition. The main drugs for the treatment of Candida pneumonia are voriconazole, caspofungin and amphotericin B. The duration of therapy is at least 2 weeks after the disappearance of signs of infection. An important condition for successful treatment is the elimination or reduction of the severity of risk factors (cancellation or reduction of the dose of glucocorticoids, etc.).