During the last 10-15 years there has been a clear tendency to increase the number of mycotic infections. Thus, yeast and fungi are among the most frequently detected nosocomial pathogens in ICUs, they are defined in the fifth place, reaching 17%, bloodstream infections among Candida spp. occupy 4 th place, accounting for 7.6%, approximately 7% of fevers of unknown etiology in patients receiving treatment in hospital are caused by fungi [1,2]. Moreover, these microorganisms are of concern not only patients with hematological malignancies. Thus, in analyzing 837 cases of candidemia showed that the more often they occurred in patients with malignant tumors (26%) and after surgical treatment (18,5%). Moreover, among surgical patients, the highest rate was registered in abdominal surgery, accounting for 13.5% (number of patients 113) [3]. The frequency of candidemia in cardiothoracic surgery was 4.3% in the departments of general surgery - 1,7% [3]. Fungal infections are not rare complications in patients with burns and after injury.
Most often mycotic process is due to fungi Candida spp., Which accounted for 80% of all nosocomial fungal infections.
Epidemiology of invasive candidiasis. Of the yeasts most frequent pathogens are Candida albicans. However, there is a tendency to decrease the frequency of their isolation from 80-90% (70-80 years) to 40-60% (90 years). Starting with the 90-ies increases the allocation of Candida non-albicans: C. tropicalis, C. krusei, C. glabrata, C. kefyr, C. parapsilosis and others [1]. The share of infections caused by C. glabrata, has from 5 to 35%, C. tropicalis - from 8 to 43%. C. lusitaniae, C. dubliniensis, C. guilliermondii are rare pathogens.
Risk factors in the development of invasive candidiasis. Factors determining the occurrence of invasive candidiasis in surgical patients are different from the factors that induce fungal infections in patients that category. The main factors include abdominal surgery, especially repeated, which accounted for 75% of all cases of fungal infections. Another no less important a factor is age (approximately 50% of fungal infections in surgical practice recorded in patients over 60 years). The likelihood of developing candidemia was significantly higher if the treatment of infectious complications using three or more antibiotics [4]. In the multivariate analysis showed that colonization of Candida spp. many loci (eg, oral cavity, intestines, vagina), prior hemodialysis, parenteral nutrition, presence of central venous catheters, especially the three-way, are also significant factors influencing the occurrence of invasive candidiasis [5]. Invasive candidiasis is most often detected in patients with extensive burns, with urinary catheter receiving antacids, H2-blockers or other means to suppress gastric acidity, glucocorticoid drugs for a long time applying antimicrobials.
Pathogenesis. Candidiasis is primarily an endogenous infection. Candida brand viagra may colonize the skin, mucous oropharynx, intestine, and their translocation occurs through the intestinal epithelium [6]. In such an embodiment, dissemination, through the bowel, Candida infestation occurs, primarily the liver, spleen, and lungs. Other entrance gate for Candida - venous catheters [6]. Injection catheters happens to the skin or the patient through the hands of medical staff. In this way dissemination of mushroom bodies, are particular targets, usually the kidneys, heart and lungs. Candida in the blood circulation is a short time, then, damaging the endothelium, they are introduced to the bodies, leading to the formation of small abscesses.
Invasive candidiasis
Candidemia - a selection of fungi Candida spp. at least one blood culture is always taken into consideration and is the basis (if any symptoms of infection) to conduct an adequate antimycotic therapy. It should be noted that some patients detect Candida spp. in the blood can not clinically manifested. A similar course of infection occurs in patients with uremia, in the treatment of glucocorticoid agents.
Acute disseminated candidiasis - Candida infestation is one or more bodies hematogenous route. The defeat of the yeast may be any organ, but most often involved in the process of liver, kidney, spleen, heart, the eyes, lungs, brain, skin and subcutaneous tissue. In these cases, the fungi can be detected only by culturing and / or histological examination of biopsy specimens organs.
multivitamin
Review CNS
long time
microadenomas
once a day
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