Early diagnosis and treatment of a case of gastrointestinal perforation and candidemia caused by gastrointestinal mycosis
10.3969/j.issn.1008-9691.2025.01.019
- VernacularTitle:胃肠道真菌病致消化道穿孔及念珠菌血症的早期诊治体会
- Author:
Mingying DAI
1
;
Jia LIU
;
Huimin WANG
;
Shixia CAI
;
Kun LI
Author Information
1. 青岛大学附属医院重症医学科,山东 青岛 266061
- Publication Type:Journal Article
- Keywords:
Fungus infection;
Gastrointestinal tract;
Candida;
Candidemia;
Mucor
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2025;32(1):100-103
- CountryChina
- Language:Chinese
-
Abstract:
Fungi are widely present in the human environment and generally non-pathogenic.However,they may invade tissues and cause disease when host immunity is compromised or conditions conducive to fungal proliferation arise.A case of a 70-year-old woman with acute gastrointestinal perforation and secondary abdominal infection,admitted to the department of intensive care medicine(ICU)of the Affiliated Hospital of Qingdao University on August 17,2021 was enrolled.Following emergency exploratory laparotomy with gastric perforation repair,partial small bowel resection,peritoneal lavage drainage,and jejunal feeding jejunostomy,the patient received imipenem and cilastatin sodium antimicrobial therapy.Despite these interventions,clinical deterioration ensued with septic shock and multiple organ dysfunction syndrome.Prompt initiation of antifungal therapy alongside existing anti-infective treatment,anti-shock management,continuous renal replacement therapy(CRRT),and invasive mechanical ventilation led to rapid clinical improvement.Notably,blood cultures obtained at admission revealed Candida albicans after 5 days in ICU,while pathological examination of gastric pyloric perforation margins(8 days post-admission)demonstrated abundant Candida and small bowel ulcer sections showed extensive Mucor infiltration.This case highlights critical lessons in ICU management:Invasive fungal infection should be strongly suspected when gastrointestinal perforation patients deteriorate despite adequate surgical intervention and empirical antibacterial therapy;Timely fungal diagnostic workup should be initiated,utilizing validated fungal infection risk assessment tools to guide rapid diagnosis;Early empirical antifungal therapy proves crucial for improving outcomes in such critical scenarios.
