Abstract
Background: The clinical significance of the detection of Candida albicans on mucous membranes of the respiratory or intestinal tract from patients in intensive care units is still not finally clarified. Many patients reveal colonization, although, despite increased risk, there are only a few invasive infections detectable. Therefore, antimycotic therapy in this setting is strongly discouraged. In reality, however, many patients receive antimycotics as a pre-emptive therapy. To elucidate this point, a literature research was performed. Results: In the light of new results on the pathogenicity of C.albicans, the recommendation not to treat should be discussed anew. Without becoming invasive, C.albicans influences the immune system negatively in an anti-inflammatory sense (Th2) by means of at least two distinct mechanisms [action on toll like receptors (TLR), production of farnesol], which will be discussed. Conclusion: It is believed that patients in the phase of CARS or MARS can be further endangered by concomitant colonization of mucous membranes by C.albicans, i.e., in the sense of an anti-inflammatory immune response. Treatment with azole preparations, like fluconazole, which interacts with ergosterol synthesis in this phase of the disease, may trigger an additional effect on the patient, through increase of farnesol concentration by way of a negative feedback. Results of animal experiments on the immune system and concomitant therapeutic consequences indicate the need for verification through clinical trials.
Highlights
The clinical significance of the detection of Candida albicans on mucous membranes of the respiratory or intestinal tract from patients in intensive care units is still not clarified
It is believed that patients in the phase of CARS or MARS can be further endangered by concomitant colonization of mucous membranes by C. albicans, i.e., in the sense of an anti-inflammatory immune response
Mucous Membranes Intersection— C. albicans and the Local Immune System. As they exist in biofilms on mucous membranes, lead to a growth of C. albicans in hyphal form, the growth form that controls the anti-inflammatory shift of T-cells via TLR2
Summary
“The diagnosis of pulmonary moniliasis (C. albicansInfection) is fraught with difficulties. There are no indisputable criteria for establishing the diagnosis...” [1]. Even after 50 years the clinical significance of a detection of Candida in the respiratory or intestinal tract is greatly disputed. Based on the results of studies performed on non-neutropenic patients, the detection of Candida species in specimen of the deep respiratory tract, even in high concentrations, is regarded as colonization of mucous membranes rather than invasive infection [2], in many cases, administration of anti-fungal drugs is regarded as unwarranted and expensive [3]. The conclusion seems obvious: detection of Candida from the deep respiratory or intestinal tract has no further significance for affected patients, unless they have additional risk factors for an invasive infection e.g. colonization in multiple body sites. The question arises as to whether a pathogenic correlation does exist that justifies the “empirical therapy” (better: prophylaxis or “pre-emptive therapy”)
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