Urogenital mycosis
Introduction
Introduction to genitourinary mycosis Genitourinary fungal diseases are rare, mainly due to factors such as the broad-spectrum application of broad-spectrum antibiotics or adrenal glucocorticoids, causing the normal presence of non-pathogenic fungi in human skin, mouth, intestines, and anus. Disease effect. The main pathogens are Candida, including Candida albicans, Candida albicans, Candida globosa, and Candida glabrata. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of transmission: contact, sexual transmission Complications: abscess renal failure
Cause
Causes of genitourinary fungal diseases
Causes:
Normal people with Candida are not necessarily ill, and they are not necessarily infected when exposed to the bacteria. People are susceptible to the following conditions: 1 The body's resistance is reduced: suffering from long-term, chronic wasting diseases such as leukemia, diabetes , tuberculosis, cachexia; 2 a large number of broad-spectrum antibiotics; 3 long-term use of corticosteroids or long-term application of immunosuppressive drugs and chemotherapy, radiotherapy, etc.; 4 vitamin B deficiency; 5 long-term application of various drainage tubes: tracheotomy, pubic Ostomy tube, indwelling catheter, intravenous high-nutrition catheter, abdominal dialysis tube, etc.; more than 6 chest, abdominal surgery, severe burns or immunodeficiency: such as AIDS.
Pathogenesis:
Whether the incidence of Candida after invading the body depends on many factors, in addition to the immune function of the body, but also related to the number of Candida, virulence, local environmental changes, etc., generally, determine the pathogenicity of Candida albicans Including the following five types: 1 adhesion: adhesion is proportional to virulence, Candida albicans adhesion is the strongest, the current research on the pathogenesis of Candida is the adhesion mechanism of Candida albicans; 2 two forms : yeast cell type or hyphae type; 3 toxin: bacterial cell surface has bacteriosaccharide toxin and candida toxin, may be the cause of disease; 4 cell surface components; 5 extracellular enzyme: Candida albicans can secrete some enzymes, such as phospholipids Enzymes, lysophospholipases and acid hydrolases can hydrolyze keratin and collagen to promote the adhesion of Candida albicans.
Prevention
Urogenital fungal disease prevention
1. Keep your own cleanliness on weekdays.
2, before and after sex, urinate as much as possible, do not have urine.
3, try to drink cranberry juice, because it has the effect of reducing bacteria adhesion to the urinary tract.
4, you can also drink plenty of water to effectively avoid the possibility of bacterial invasion.
5, during the usual activities due to maintaining urination habits once every 2-3 hours, in addition to pay attention to the addition of vitamin B group and lactic acid bacteria and so on.
Complication
Urogenital mycosis complications Complications, abscess, renal failure
Kidney infections often lead to the formation of abscesses, and in rare cases, hyphal masses can form a blockage of the renal pelvis or ureter leading to hydronephrosis or anuria. As the intracapsular pressure increases, the glomerular rate is reduced, so the clearance of creatinine and urea nitrogen is reduced, which can cause renal insufficiency. Severe cases may lead to renal failure. When patients have symptoms such as oliguria and no urine, Pay attention to monitoring kidney function.
Symptom
Symptoms of genitourinary fungal disease Common symptoms Urinary pain Urinary frequency Abdominal pain No urinary cold Pustular bacteria Infection Papillaria Candida infection Lack of urine
1. Candida glans dermatitis is easy to occur in the foreskin is too long without circumcision, often the symptoms are the foreskin and glans mild flushing, dry and smooth, with white cheese inside the foreskin and coronal groove Some plaques, some of which are light red smashed and thin-walled pustules, itching is obvious, and the foreskin and glans flushing are also visible. Visible small papules can be seen. When the scrotum is invaded, scaly erythema can be seen on the contact surface with the penis. When the urethral opening of the urethral socket is involved, it can produce frequent urination and dysuria.
2. Lower urinary tract candidiasis includes ureter, bladder and urethra and other candidiasis. Most of the disease is caused by stagnant urethral intubation or local genital tract and gastrointestinal tract. It is more common in diabetes and associated with it. Patients with abnormal or damaged urinary tract, clinical manifestations of ureter, bladder or urethra, but different from bacterial infection, many patients can only have candidiasis without any symptoms, Candida albicans is still the main disease of this disease Pathogens, but resistant to fungal treatments, can also be as much as 30% of Candida glabrata infections.
3. Renal candidiasis This disease is caused by bloodstream dissemination, which is more common than ascending infection. At least 80% of patients with disseminated candidiasis develop renal candidiasis. Therefore, it is accompanied by Candida. Patients with neutropenia who have urinary symptoms and have fever symptoms should be suspected of disseminated candidiasis. The main symptoms are fever, chills, low back pain and abdominal pain. Oliguria or anuria is a common sign of infant infection, except for renal pelvis and The fungal ball of the ureter can be characterized by irregular filling defects of radiation transparency and no specific imaging features.
Examine
Examination of genitourinary fungal diseases
1. Microscopic examination of urine sediment or secretions can be found in pseudohyphae or spores; Gram-stained hyphae, spores are blue, unevenly colored; periodic acid-stained hyphae, spores are red; 1/1000 acridine The orange-stained cells are bright green under a fluorescence microscope.
2. Urine culture Candida is blastocyst in the culture medium, and acute urinary tract infection can be diagnosed when the urine culture colony is >1000/ml.
3. Serological test can be used for Candida antibody detection, but it has no diagnostic significance for a positive result. It should be diagnosed by high-standard antibody titer or titer gradually in response to serum samples obtained periodically for a period of time. In recent years, Some Candida antigens (such as an enolase 48-KDa antigen and a 90-KDa heat shock protein product 47-KDa antigen) can be detected by immunoblotting in some specialized laboratories.
X-ray examination: Kidney fungal infection, fungal mass in the renal pelvis, IVU and retrograde pyelography can be seen in the renal pelvis filling defect changes, biopsy and fungal ball pathological examination can find pseudohyphae or spores.
Diagnosis
Diagnosis and identification of genitourinary fungal diseases
diagnosis
According to the medical history, typical clinical manifestations and laboratory tests are not difficult.
Differential diagnosis
1. Renal sputum cancer may have hydronephrosis, urography shows that the renal pelvic filling defect has similarities with renal fungal infection, but patients with renal pelvic cancer have a full-course, painless gross hematuria, easy to pass B-ultrasound, CT examination found In the renal pelvis, ureteroscopy, cystoscopy can be seen in renal pelvis tumors and tumors implanted in the bladder.
2. Acute pyelonephritis also has fever, low back pain, hematuria and other clinical manifestations, but no history of wasting disease, no history of urinary "fungal ball", urinary sediment smear and urine culture can find pathogenic bacteria, but no fungal silk and Fungal growth.
3. When the urinary negative stone fungus is infected, the acute ureteral obstruction is caused by the discharge of white fungal block in the urine, which leads to the occurrence of renal colic, sometimes it is easy to mistake the urinary negative stone, but the pseudohyphae and spore can not be found in the urine sediment. Sometimes, urine salt crystals can be found. B-ultrasound can be seen with glare glare with sound and shadow. If fungal ball can be collected, pathological examination can confirm the diagnosis.
4. Chronic cystitis has recurrent bladder irritation, similar to fungal cystitis, but there is generally no white mass floating or sediment in urine. Microscopic examination of urinary sediment only sees white blood cells, pus cells or red blood cells. There are no fungal spores and hyphae, and the mid-stage urine culture has non-specific bacterial growth, which can be identified accordingly.
