Fungal Bezoars Research Articles

Ansurethral Removal of Vesical Fungal Bezoar Using Ho:YAG LASER—A Case Report

Fungal bezoars are extremely rare in the urinary bladder, and there is limited literature regarding the modality of management. We report a case, where the piecemeal removal of a vesical fungal bezoar was performed using Ho:YAG LASER. A 60-year-old man presented with lower urinary tract symptoms and on evaluation was diagnosed with vesical calculus. On cystoscopy, a white-colored, smooth contoured ball was identified in the bladder. The effective endourological modalities for the removal of fungal bezoar require mention in the literature. This case report demonstrates the possibility and efficiency of Ho:YAG LASER in the endourological retrieval of fungal bezoar in the bladder. The rarity of the diagnosis results in difficulty in prompt management.

Bladder fungoma (fungal bezoar) by two Candida species in Medellín, Colombia: a case report and review of the literature

The presence of fungal infections in the urinary bladder is rare; there are no extensive reviews on this subject in current literature, even less with the presence of two different types of fungi in the same culture. We present a case of an 82-years-old male patient with a history of benign prostatic hyperplasia (BPH) and type 2 diabetes mellitus (DM2) who underwent a simple suprapubic prostatectomy. Shortly thereafter, he was readmitted to the emergency room with symptoms of fever and urinary distress, eventually diagnosed with a fungal infection caused by Candida tropicalis and Candida glabrata in the urinary bladder, secondary to prostatic hyperplasia. He was admitted for assessment and multidisciplinary management. Guided treatment with caspofungin 50mg every 12 hours for 14 days resulted in clinical improvement. Proper diagnostic approaches are crucial for effective management of bladder fungomas, ensuring optimal patient outcomes.

Obstructive Bilateral Renal Fungal Bezoars in an Extremely Premature Neonate Treated With Antifungals and Urokinase Irrigation: A Case Report and Review of the Literature.

An ex-27-week gestation female infant developed bilateral forearm nodules at 4 weeks of life during treatment for methicillin-sensitive Staphylococcus aureus bacteremia. A pure growth of Candida albicans was isolated on culture of both sterile aspiration of the forearm abscess and urine without evidence of methicillin-sensitive Staphylococcus aureus. The patient went on to develop bilateral obstructive renal fungal bezoars at 11 weeks of life. Bilateral nephrostomies were required to alleviate obstruction with the addition of local irrigation with amphotericin B deoxycholate. Two weeks later, urokinase via the nephrostomy tubes was added due to an unchanged appearance on ultrasound (US) and ongoing candiduria. A significant reduction in the size of bezoars was seen on US after 3 days. Sterilization of urine culture was achieved 7 weeks into treatment, and resolution of bezoars on US was seen 9 weeks after treatment began. No adverse events occurred from the use of local urokinase. Urokinase irrigation via nephrostomy is an effective and safe adjunctive treatment in refractory obstructive renal candidiasis in neonates.

Faecaloid like material in the urinary bladder: A radiological finding in a patient with urinary tract fungal bezoar infection

Fungal colonization or infection of the urinary tract system is caused by Candida species. Fungal intravesical bezoars, however, are extremely rare. Radiological features may mimic the appearance of emphysematous cystitis, which makes the radiological diagnosis challenging. We present an unusual case of urinary bladder fungal bezoar caused by Candida tropicalis.

Bipolar Transurethral Resection of Intravesical Fungal Bezoar Containing Multiple Multidrug Resistant Bacteria in a Chronic Catheter-Dependent Patient

Fungal bezoar is a very rare clinical entity that usually results from fungemia because of uncontrolled diabetes mellitus or immunosuppression. Most cases present in the upper urinary tract, but there have been less than 10 reported as presenting primarily in the bladder. Treatment is largely medical with antifungal therapies with no documented cases of concomitant bacterial colonization. Rarely, surgical intervention is warranted, but there are no documented surgical approaches with a bipolar cautery loop resectoscope. We present a case of a fungal bezoar of the bladder that was treated with transurethral resection. The presence of multidrug-resistant organisms resulted in postoperative sepsis controlled with intravesical and intravenous antibiotics and fluid resuscitation.

Male with urinary urgency, frequency, and dysuria.

A 55-year-old male with a past medical history of insulin-dependent diabetes mellitus presented to the emergency department for urinary urgency, frequency, and dysuria. He complained of passing white material intermittently with urination. He denied any systemic symptoms of infection. His blood glucose was in the 507 mg/dL without evidence of diabetic ketoacidosis. Urine analysis was positive for budding yeast and bacteria. Three months prior, the patient was found to have urinary retention requiring the temporary placement of a Foley catheter. An abdominal-pelvis computed tomography (CT) scan demonstrated fecaloid material throughout the urinary bladder and was concerning for chronic fungal cystitis with the presence of fungal bezoars (Figures 1-3). This very rare diagnosis has only been documented in the literature <20 times since first diagnosed in 1961.1 CT scans may also include a differential of colovesicular fistula, but differentiation can be established clinically. Diabetes mellitus appears to be a significant risk factor due to ample supply of glucose in the urine that helps foster fungal growth.2 Other risk factors include neurogenic bladder and indwelling Foley catheters.3 Urology performed a cystoscopy and obtained a sample for culture and pathology. Transurethral resection and evacuation of the bezoars was completed. The bladder was then irrigated with amphotericin B. Cultures grew Candida tropicalis along with mixed aerobic and anaerobic bacteria. The patient was additionally treated with systemic anti-fungals and antibiotics as well as continued daily bladder irrigation.

Unilateral colonization of fungal infection presenting as renal mass in young patient: A case report

Fungal ball or fungal bezoar is the saprophytic colonization of a preformed cavity by a conglomerate of fungal mycelia without invasion of the adjacent tissue. Fungal bezoar is seen commonly in immunocompromised individuals. We present a case of urinary tract infection, complicated by unliateral fungus balls in a 25-year old female whose imaging findings (USG and CT scan), laboratory investigation and histopathological findings are consistent with renal fungal ball. Keywords: fungal ball; urinary tract infection.

Urological Tract Infection with Candida Bezoars in a Woman with Diabetes Type 2

The aim of this report is to describe a case of fungal bezoar obstruction of the kidney and our experience in managing it endoscopically. A 61-year-old woman presented with flank pain. On CT scan, a proximal stone and secondary dilatation was seen. After placing a DJ stent and administering antibiotics, there was persistent pain, sickness, and kidney dilatation on CT scan. URS showed soft tissue bezoars surrounding the stent and the stone. We managed to remove all the fungal balls mechanically and endoscopically. This report showed that endoscopic removal of the bezoars is a good alternative for antifungal installation.

Urinary Tract Aspergillosis in a Patient With Diabetes Who Underwent Total Abdominal Hysterectomy

Urinary tract aspergillosis is uncommon even in the era of increased frequency of invasivemycoses. Experience is largely from isolated case reports and few case series or reviews.The majority of cases involve transplant recipients predominantly following renaltransplantation but is also reported in other immunocompromised states such as AIDS anduncontrolled diabetes mellitus. Most cases represent haematogenous spread to renalparenchyma, often in the absence of recognized focus of infection, presenting as small orlarge abscesses, infarcts, renal insufficiency or urinary drainage system fungal balls withobstructive uropathy. Diagnosis is usually made on the basis of renal tissue aspiration, urinecultures or by histopathology of the suspicious mass passed through urinary tract. Theeffective management of invasive aspergillosis includes strategies to optimize preventionand early antifungal treatment, immunomodulation, and, in some cases, surgery. Neweranti-Aspergillus drugs notably voriconazole offer less toxic therapeutic options and are quitesuccessful in combination with drainage measures to relieve urinary stasis. This reportdescribes a case of primary urinary tract aspergillosis with fungal bezoars formation in a 37years old female, diabetic, hypertensive, who presented with intermittent urinary tractobstruction and was successfully managed by oral voriconazole for six weeks as itraconazolewas found refractory.&#x0D; Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 74-77

Результаты лечения ново-рожденных с постренальной анурией, обусловленной обструкцией грибковыми безоарами верхних мочевыводящих путей

To evaluate the results of different methods of urine derivation in patients with postrenal anuria due to upper urinary tract (UUT) obstruction, caused by fungal bezoar. The results of treatment of postrenal anuria in 8 patients without congenital obstructive anomalies of UUT in 5 clinics from 2004 to 2018 were analyzed. All patients from the birth received continuously two or more antibiotics for diseases not related to kidneys and the urinary tract. Median of gestational age was 32 weeks [31.5; 38.5]. There were 4 boys (50%), and 4 girls (50%). The duration of anuria at the time of hospitalization was 2 days [1.5; 5]. Creatinine level at admission was 218 mol/l [164.5; 392.5] and urea was 17.9 mmol/l [13.2; 24.95]. In all cases, candida albicans was revealed in urine. Postoperative complications were graded according to the Clavien-Dindo classification. All patients received systemic antifungal therapy; UUT drainage was performed in 7 (87.5%) cases. Ureteral catheter was placed bilaterally in 2 (28.6%) patients (4 renal units). There were 5 complications (Clavien-Dindo grade IIIb). Bilateral percutaneous nephrostomy was performed in 3 (42.8%) patients (6 renal units), and there were 2 complications (Clavien-Dindo grade IIIb and V). Open pyelostomy was performed in 2 (28.6%) patients (one bilateral, one on the right side; a total of 3 renal units). There was only one complication of Clavien-Dindo grade V. The average number of surgical procedures required to alleviate UUT obstruction per one renal unit was as following: 2.25 for ureteral catheterization; 1.17 for percutaneous nephrostomy; 1 for open pyelostomy. Regardless of the drainage method, diuresis tended to be normalized and azotemia decreased during the first postoperative day. In one case, the obstruction was eliminated by antifungal therapy without drainage of UUT. Mortality rate was 25% (n = 2). Ureteral catheterization is a minimally invasive, safe method for decompression of UUT obstruction, caused by fungal bezoar, which is non-inferior to nephrostomy tube or open pyelostomy. Ureteral catheterization can be used as a primary method of urine derivation in children with UUT obstruction caused by candida bezoar.

Renal salvage, an achievable goal in patients with emphysematous pyelonephritis: Outcomes of an algorithmic renal preserving strategy.

Introduction:Emergency nephrectomy has been the time-honored treatment of choice for emphysematous pyelonephritis (EPN), a fatal gas-forming necrotizing infection. Recent years have seen a shift toward nonextirpative approach aimed to achieve higher rates of renal salvage, limiting the indications for nephrectomy to severe grades of the disease. This study aimed at analyzing the role of initial renal preserving measures algorithmically applied across grades of EPN.Materials and Methods:We prospectively analyzed the clinical data and outcome of 36 consecutive patients of EPN in 5 years' study period, treated by renal preserving measures, which include aggressive resuscitation, parenteral antibiotics, effective drainage of infected fluid/gas, and relieving the urinary tract obstruction. Huang-Tseng computed tomography-based classification system was used to categorize the patients as well as to employ suitable treatment modality.Results:The mean age of the patients was 57.5 ± 12 years with female preponderance (2:1). Diabetes mellitus (97%) was the most common associated factor. Escherichia coli was (72%) the most frequent causative organism found. Urinary tract obstruction was seen in 27 patients (75%) attributable to ureteric calculi, renal papillary necrosis, ureteric stricture, and fungal bezoar in the descending order of frequency. Only 2 (6%) out of 36 patients managed according to our hospital renal salvage protocol required salvage nephrectomy. The overall survival rate was 94%.Conclusion:Our hospital-based algorithmic renal preserving strategy not only improved the survival but also decreased the need for nephrectomy.

Fungaemia caused by obstructive renal candida bezoars leads to bilateral chorioretinitis: a case report

BackgroundRenal fungal bezoars are remarkably rare and mostly occur in immunodeficient patients. Only a small number of cases with immunocompetent patients have been published so far. The published treatment approaches comprised systemic antimycotic therapy and surgical or minimal invasive removal of the fungal balls. In some cases irrigation of the renal duct system with amphotericin B was performed.By obstruction of the urinary tract bezoars can lead to infected hydronephrosis and severe urosepsis with high lethality. Fungaemia can cause fungal colonization in different distant organs. Fulminant chorioretinitis and irreversible visual impairment can be the consequence of ocular fundus colonization. The following report highlights that a co-operation between urologists and ophthalmologists is absolutely indispensible in case of fungaemia.Case presentationHereinafter we describe a case of an immunocompetent 56 years old woman, presenting with flank pain and shivering. The diagnosis turned out to be difficult due to initially negative urine culture. The fungaemia caused by obstructive nephropathy led to bilateral candida chorioretinitis. The patient was treated with intravenous amphotericin b and the bezoar was removed by percutaneous “nephrolitholapaxy”.After two months, a follow up revealed the patient felt well, chorioretinal lesions regressed and urine culture did not show any fungal growth.ConclusionTo the best of our knowledge, this is the first case reporting on obstructive renal bezoars, which lead to haematogenous fungus spread and bilateral chorioretinitis.It points out that extensive ophthalmologic examination should be performed in case of fungaemia even if the patient is not suffering from any visual impairment.

Rare cases of bezoars in the urinary tract of diabetic patients — a review of case reports

Bezoars are spherical conglomerates of foreign bodies or food debris, typically occurring in the gastrointestinal tract, primarily in the stomach. In exceptionally rare cases bezoars may also form within the urinary tract. In such cases, their formation is a result of an ongoing fungal infection in the urinary tract or a systemic infection, and the bezoar is most often composed primarily of hyphae, mostly of species Candida albicans , and fragments of necrotic tissue. Chronic hyperglycaemia impairs natural defence mechanisms of the immune system, both cellular as well as humoral, and thus predisposes towards fungal infections. This paper discusses selected examples of cases of fungal bezoars in the urinary tract in diabetic patients described to date, with an emphasis on risk factors for their formation and treatment methods.

Management of a Renal Fungal Bezoar Caused by Multidrug-Resistant Candida Glabrata

We describe our management of an immunocompetent individual who developed obstructive uropathy and candidemia as a result of a fungal bezoar in the kidney. These sequelae arose from candiduria, provoked after several courses of antibiotics. Successful treatment included therapy with both culture-appropriate intravenous antifungals and operative intervention, including direct irrigation of the affected kidney with amphotericin B, relief of renal obstruction with a ureteral stent, a percutaneous nephrostomy tube, and ultimately endoscopic removal of the fungal bezoar. Our patient was successfully treated as evidenced by negative urine culture and lack of ongoing symptomatology.

Un cas de bézoard candidosique rénal

Candida infection is a relatively common hematogenous nosocomial infection in immunocompromised patients. However, renal disease remains unusual. The mode of presentation in the case reported herein was lumbar pain with fever and hydronephrosis of the left kidney due to a fungal bezoar in the renal pelvis. Clinical and biological suspicion of this disease must quickly lead to ultrasound examination to confirm the diagnosis.

Successful treatment of bilateral paecilomyces pyelonephritis in a German shepherd dog

A six-year-old female entire German shepherd dog was investigated for polyuria, polydipsia and lethargy. Investigations revealed a mild azotaemia and abdominal ultrasound revealed marked bilateral dilation of the renal pelves with echogenic material and proximal left hydroureter. Urine cytological examination and aspirates from the right renal pelvis revealed mats of fungal hyphae consistent with fungal bezoar formation. Fungal cultures revealed a profuse growth of Paecilomyces variotii. Initial treatment with oral itraconazole was unsuccessful, leading to bilateral nephrotomies to remove the fungal material. Postoperatively the Paecilomyces infection persisted despite continued itraconazole therapy. Treatment was commenced with amphotericin B, leading to resolution of the dog's clinical signs. To the authors' knowledge this is the first report of canine Paecilomyces pyelonephritis, without disseminated systemic disease, which documents its successful treatment.

Renal fungal bezoar owing to Geotrichum candidum

Geotrichum candidum is yeast like fungi that cause infections in immunocompromised patients. We report a case of renal fungal ball with Geotrichum candidum in a 27yr. old women post-partum. This case to our knowledge is the first case of renal fungal bezoar due to Geotrichum candidum reported in India.

Invasive Fungal Bezoar Requiring Partial Cystectomy

A 67-year-old man developed dysuria and position-dependent obstructive voiding symptoms after undergoing holmium laser ablation of the prostate (HOLAP) for benign prostatic hypertrophy. A large fungal (candidal) ball adherent to the bladder wall was removed by loop excision, but the bezoar recurred in 2 weeks despite systemic fluconazole and intravesical amphotericin B. A second attempt at endoscopic removal with ultrasonic lithotripsy, endoscopic graspers, and fulguration was also unsuccessful. The patient underwent open partial cystectomy to remove his invasive fungal bezoar. Convalescence was unremarkable. Urinalysis, culture, and follow-up cystoscopy after partial cystectomy demonstrated successful definitive treatment of the fungal ball.

Intermittent renal graft obstruction by fungal ball--case report

Sir, The saprophytic colonization of a cavity by fungal hyphae, without the invasion of the adjacent tissue, is referred to as ‘fungal ball’ [1]. Fungal balls causing intermittent graft obstruction have not been previously reported. We managed a renal graft case that was characterized by intermittent graft obstruction. The patient was a recipient of a live unrelated renal graft. At 4 months after transplantation, he presented with a history of fever for 7 days and did not pass urine for 1 day. He had diabetes and had been treated for right psoas hematoma 2 months previously. Upon presentation, he was in shock (blood pressure 90/60mmHg) and the graft was tender. His clinical evaluation showed many pus cells in the urine, a dilated pelvicalyceal system (PCS) with nonshadowing echogenic strands in the graft, suggesting fungal ball or clots on ultrasound, (Figure 1) and deranged renal function (serum creatinine: 5.3 mg/dL). He was stabilized with vasopressors and given one session of hemodialysis. From the next day onwards, his urine output increased without surgical intervention and renal function returned to normal by the fourth day; however, he developed anuria again on Day 5. Because repeat ultrasound revealed again the same findings, we performed percutaneous nephrostomy, and a white cheesy material was removed through the nephroscope. Histopathology confirmed it as a Candida species and urine culture grew Candida non-albicans. Due to the partial success of the procedure (nephroscopic removal of fungal ball), local irrigation with amphotericin-B was started. This treatment resulted in complete disappearance of the fungal ball, a return of renal function and a disappearance of graft PCS dilatation by Day 14. Fig. 1. Ultrasound picture of renal allograft showing nonshadowing echogenic foci in pelvis—fungal bezoars.

An Aspergilloma Mistaken for a Pelviureteral Stone on Nonenhanced CT: A Fungal Bezoar Causing Ureteral Obstruction

Fungus balls rarely cause upper urinary tract obstruction, and they are most often found in patients with diabetes mellitus or impaired immunity. The computed tomography (CT) findings of fungal bezoars of the urinary tract are nonspecific and have rarely been described, while in most cases, radiolucent filling defects are observed on excretory or retrograde urography. Here, an unusual case of an aspergilloma causing ureteral obstruction is presented; it was initially mistaken for a pelviureteral stone on nonenhanced CT.