Domagk Dirk, Fegeler Wolfgang, Conrad Beate, Menzel Josef, Domschke Wolfram, Kucharzik Torsten
Department of Medicine B, University of Muenster, Muenster, Germany.
Am J Gastroenterol. 2006 Nov;101(11):2530-6. doi: 10.1111/j.1572-0241.2006.00663.x. Epub 2006 Oct 4.
Biliary obstruction with its wide range of potential causes is a common disorder in gastroenterology. Infections of the biliary tract with Candida and other fungal species leading to obstructive jaundice have increasingly been recognized in the last few years. Besides a few case reports, there are few data in the literature giving us an idea how to diagnose and treat these patients.
We report on a series of seven patients suffering from biliary tract candidiasis who were diagnosed and treated at our institution. Predisposition factors, reliability of various diagnostic modalities, and treatment options based on our own experience are presented and discussed.
Besides the general diagnostic modalities such as laboratory findings or ultrasonography, we often observed mycelia in the bile duct system endoscopically. Typical morphological changes in peripheral bile ducts could be detected during endoscopic retrograde cholangiopancreatography (ERCP). Aspiration of bile and subsequent microbiological analysis in combination with ERCP findings revealed diagnosis of bile duct candidiasis in all cases. Treatment included both antiinfectious drugs and endoscopic therapy such as bile duct drainage, lavage, or débridement. With respect to fungal eradication, therapy was successful in 71% of cases as proven by microbiological analysis of bile aspirates. Since many of these patients suffer not only from biliary mycosis but also from disease necessitating immunosuppression, the prognosis was poor in some cases.
Biliary tract candidiasis because of immunosuppression is an increasingly recognized disease and remains a major clinical challenge. Besides laboratory analysis and ultrasonography, diagnostic modalities should include aspiration of bile during ERCP and microbiological analysis. Antiinfectious drug treatment as the main therapeutic column for biliary candidiasis should be complemented by endoscopic intervention.
胆道梗阻病因广泛，是胃肠病学中的常见病症。过去几年，念珠菌及其他真菌引起的胆道感染导致梗阻性黄疸日益受到关注。除了少数病例报告外，文献中几乎没有数据能让我们了解如何诊断和治疗这些患者。
我们报告了在本院诊断和治疗的7例胆道念珠菌病患者。介绍并讨论了易感因素、各种诊断方法的可靠性以及基于我们自身经验的治疗选择。
除了实验室检查结果或超声检查等常规诊断方法外，我们在内镜检查中经常观察到胆管系统中的菌丝体。在内镜逆行胰胆管造影（ERCP）过程中，可以检测到外周胆管的典型形态变化。胆汁抽吸及随后的微生物学分析结合ERCP结果，在所有病例中均确诊为胆管念珠菌病。治疗包括抗感染药物和内镜治疗，如胆管引流、灌洗或清创。就真菌清除而言，胆汁抽吸物的微生物学分析证明，71%的病例治疗成功。由于这些患者中的许多人不仅患有胆道真菌病，还患有需要免疫抑制的疾病，因此某些病例的预后较差。
免疫抑制引起的胆道念珠菌病是一种日益受到关注的疾病，仍然是一项重大的临床挑战。除了实验室分析和超声检查外，诊断方法应包括ERCP期间的胆汁抽吸和微生物学分析。作为胆道念珠菌病主要治疗手段的抗感染药物治疗应辅以内镜干预。
