[Complicated course of oesophageal perforations because of fungal infections].
Perforations of the oesophagus are characterized by a high mortality rate, varying between 7 and 49%. In the analyzed group of patients between the years 1986 and 2003, the mortality rate of 28% was caused by septic complications such as mediastinitis and pneumonia. Microbiological examinations of samples from different locations and various secretions, detected mycoses in 28% of the patients (n = 16). Compared with the total of mycoses, a higher mortality of 50% was calculated. The invasive Candida infection of the oesophagus itself can cause a perforation. In perforations of the oesophagus, simultaneous mycoses arise by fungi invading sterile compartments or by haematogenous and lymphogenous dissemination up to sepsis. Uncomplicated courses do not need antimycotic therapy. At the beginning of the treatment, a microbiological monitoring should be provided, particularly with regard to the intraoperative facts. In relation to the course and the risk factors of the patients, an antimycotic therapy is initiated. Surgical clearing and sufficient drainage of the collateral compartments such as pleural and mediastinal compartments is highly significant.
Jungbluth
T
T
Klinik für Chirurgie des Universitätsklinikums Schleswig-Holstein, Campus Lübeck, D-23538 Lübeck, Germany. jungbluth-th@gmx.de
Bouchard
R
R
Kujath
P
P
Bruch
H-P
HP
D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000382:microbiology / Q000401:mortality*; D004939:Esophageal Perforation / Q000150:complications* / Q000382:microbiology / Q000401:mortality* / Q000601:surgery; D005658:Fungi / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D008480:Mediastinitis / Q000382:microbiology / Q000401:mortality*; D011014:Pneumonia / Q000382:microbiology / Q000401:mortality*; D012307:Risk Factors
D000935:Antifungal Agents