Biliary candida infections in primary sclerosing cholangitis.
OBJECTIVE
Patients with Primary Sclerosing Cholangitis (PSC) frequently develop dominant stenoses of the bile ducts and bacterial infections represent a major problem in such patients. In the present study, the role of fungal infections of the bile ducts has been evaluated.


METHODS
In a prospective non-randomized trial, in 67 consecutive patients with PSC, 148 bile samples, each taken at one endoscopic examination, were microbiologically analysed.


RESULTS
Candida species were found in 8/67 patients whereas Aspergillus was not detected. Seven patients with biliary Candida had a dominant stenosis and one had a wide papillotomy with chronic ascending cholangitis. Altogether 7/49 of patients with dominant stenosis and 1/18 of patients without dominant stenosis had Candida in their bile. All patients with biliary Candida intermittently had received antibiotics and had advanced disease with cholestasis. Candida disappeared spontaneously in 2/7 patients, cleared after antifungal treatment in 2, and persisted in 3 patients. Patients with biliary Candida had more severe cholangitis with higher CRP and serum bilirubin compared to those without Candida infection.


CONCLUSIONS
This is the first report on the identification of Candida species in the bile of patients with PSC. Apart from bacterial also fungal infection of the bile ducts should be considered in the treatment of such patients.
Kulaksiz
Hasan
H
Department of Medicine, University of Heidelberg, Medizinische Universitätsklink, Im Neuenheimer Feld 410, D-69120 Heidelberg, FRG, Germany.
Rudolph
Gerda
G
Kloeters-Plachky
Petra
P
Sauer
Peter
P
Geiss
Heinrich
H
Stiehl
Adolf
A
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001646:Bile / Q000382:microbiology; D001652:Bile Ducts / Q000382:microbiology*; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy*; D002758:Cholangiography / Q000009:adverse effects; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000382:microbiology*; D003251:Constriction, Pathologic / Q000150:complications / Q000382:microbiology*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012075:Remission, Spontaneous
D000935:Antifungal Agents