Fungal infections of the urinary tract primarily affect the bladder and kidneys.

Fungal infections of the urinary tract primarily affect the bladder and kidneys.

(See Introduction to urinary tract infections.) Fungal infections of the urinary tract primarily affect the bladder and kidneys. Various strains of Candida, as the most common cause, including in humans to the normal parasites. A Candida colonization differs from infection by that infection induces tissue reactions. All invasive fungi (eg. As Cryptococcus neoformans, Aspergillus sp., Mucoraceae sp., Histoplasma capsulatum, Blastomyces sp., Coccidioides immitis) can infect as part of a systemic or disseminated mycosis the kidney. Their presence alone already shows the infection. UTIs in the lower urinary tract with Candida usually caused by urinary catheters, typically after antibiotic therapy, although Candida – and bacterial infections often occur simultaneously. A C. albicans prostatitis occasionally occurs in patients with diabetes mellitus, typically after instrumentation. Renal candidiasis is usually hematogenous spread and typically from the gastrointestinal tract. An ascending infection is possible and occurs most often in patients with Nephrostomiekathetern or other permanently inserted tools or stents. Particularly at risk are patients with diabetes and immunocompromised patients (due to tumor, AIDS, chemotherapy or immunosuppressive drugs). A major cause of candidemia in hospitalized patients at high risk is a registered mounted vascular catheter. A kidney transplant increases the risk because of the combination of indwelling catheters, stents, antibiotics, Anastomosenleckage, obstruction and immunosuppressive therapy. Among the complications of Candida infection include emphysematous cystitis or pyelonephritis and fungal balls in the renal pelvis, ureter or bladder. Bezoars may form in the bladder. Obstructions in the lower or upper urinary tract can occur. A papillary necrosis and intrarenal and perinephritische abscesses can develop. Although renal function often decreases, a severe kidney failure without post-renal obstruction is rare. Symptoms and signs Most patients with candiduria are asymptomatic. Whether a Candida infection symptomatic urethritis can cause (weak urethral stinging, dysuria, watery discharge) in men, is controversial. Rarely dysuria in women by Candida urethritis is caused, but may arise from the fact that urine with the periurethral tissues come into contact, which is ignited by a Candida vaginitis. At UTI in the lower urinary tract cystitis leads by Candida in frequent urination, urgency, dysuria and suprapubic pain. Hematuria is common. In patients with poorly controlled diabetes mellitus may occur pneumaturia by emphysematous cystitis. Mycotic balls or bezoars can cause symptoms of urethral obstruction. Most Patienen with renal candidiasis caused hematogenous have not related to the kidney symptoms, but an antibiotic-resistant fever, candiduria and an unexplained renal impairment. Parts of fungal balls in the ureters and renal pelvis often cause hematuria and urinary obstruction. Occasionally cause papillary necrosis or intrarenal or perinephritische abscesses, fever, hypertension and hematuria. Patients may have manifestations of candidiasis in other places (eg. As CNS, skin, eyes, liver, spleen). Diagnostic urine culture detection of tissue reaction (for cystitis) or pyelonephritis A HWI by Candida should be considered in patients with predisposing factors and with symptoms suggestive of UTI and in all patients with Candidemie into consideration. Candida should be accepted only in men with symptoms of urethritis, when all other causes of urethritis can be excluded. The diagnosis of UTI by Candida is provided by culture, usually from the urine. The threshold at which a candiduria is a true Candida UTI and not merely colonization or contamination is not known. In order to differentiate between Candida colonization and Candida infection of the detection of a tissue reaction is required. Cystitis is usually diagnosed in high-risk patients with candiduria with existing bladder infection or -irritation, evidenced by a pyuria. Cystoscopy or ultrasound of the kidneys and the bladder can lead to the discovery of bezoars and obstruction. A Renal candidiasis is considered in patients with fever, candiduria or passage of mycotic balls into consideration. Severe renal impairment indicates a post-renal obstruction. The imaging of the urinary tract can help to determine the extent of infestation. Blood cultures to Candida often are negative. Unexplained candiduria should lead to an investigation on structural Harntraktanomalien. Only therapy in symptomatic patients or patients at high risk or fluconazole, for resistant organisms, amphotericin B; sometimes flucytosine is added to the fungal colonization of catheters not require treatment. Asymptomatic candiduria rarely requires therapy. Candiduria should be treated in the following cases: Symptomatic patients neutropenic patients patients with Allograftnierentransplantaten patients who undergo a urological procedure Harnstents and Foley catheter should (if possible) be removed. Symptomatic cystitis the treatment with 200 mg Fluconazole 1 time p.o./Tag. Pyelonephritis Fluconazole is 200-400 mg p.o. 1 time preferably daily. Therapy should be in both cases for 2 weeks. In fungi that are resistant to fluconazole, amphotericin B is at a dose of 0.3 to 0.6 mg / kg i.v. 1 time / day for 2 weeks at cystitis and 0.5 to 0.7 mg / kg i.v. 1 time / day 1 time / day for 2 weeks at pyelonephritis recommended. In resistant pyelonephritis flucytosine is p.o. 25 mg / kg 4 times, added daily to therapy when patients have adequate renal function; if not, the dose should be modified based on creatinine clearance (antifungal agents). Flucytosine can help to eliminate candiduria, which is caused by non-albicans Candida groups. However, a resistance may occur rapidly when this agent is used as monotherapy. A bladder irrigation with amphotericin B can lead to the temporary removal of candiduria, but is not indexed longer with cystitis or pyelonephritis. Even with apparently successful local or systemic antifungal therapy candiduria a relapse is common, and the likelihood increases with continued use of urinary catheters. Clinical experience with the use of voriconazole in the treatment of urinary tract infections is poor. Important points Fungal UTI affects v. a. Patients with urinary tract obstruction or instrumentation, immunodeficiency (including diabetes), or both. Go from fungal UTI from at-risk patients or patients with candidemia who have clinical or laboratory findings with UTI. Put an antifungal drug therapy only when patients undergo a urological procedure or have symptoms, neutropenia, or kidney transplants.

Health Life Media Team

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