CANDIDIASIS

From Big Medical Encyclopedia

CANDIDIASIS (candidosis; synonym: candidiasis, superficial zymonematosis, soormikoz, candidiasis, moniliasis, oidiomycosis) — the infectious disease of skin, mucous membranes and internals caused by yeast-like fungi (mushrooms of the sort Candida).

The disease is for the first time described by B. Langenbek in 1839 though it was known since the time of Hippocrates under the name stomata aphtoides and aphta infantis (K. Galek). In 1848 F. Th. Berg for the first time established existence of yeast-like fungi in tissues of the sick person. Berkhnut (M. Berkhaut) in 1923 distinguished the sort Candida from yeast-like fungi. The term Candida was accepted in 1939 by the III International congress of microbiologists.

To. meets worldwide, it is especially frequent in a belt of tropical and subtropical climate. Number of patients various wedge, forms K., especially visceral, has a nek-ry tendency to growth.

Etiology

Fig. 1. Chlamydospores with a two-planimetric cover and granular contents on the ends of a pseudo-mycelium (are specified by shooters).

Activator K. most often Candida albicans is, S. is more rare than tropicalis, S. of krusei, S. of pseudotropicalis, S. stellatoidea and some other types. The sort Candida (class Fungi imperfecti) includes the St. 80 types which are characterized round, ovoidny, is more rare cylindrical, and sometimes than irregular shape cells. Young cells — in the diameter from 2 to 5 microns, mature — it is slightly more. Yeast-like fungi have no true mycelium; they form chains (pseudo-mycelium) of the extended cells which adjoin with each other the narrow basis (a so-called banner), length of a pseudo-mycelium to 12 — 16 microns. Cells breed germination and multipole budding (2 — 3 and more affiliated kidneys). The page of albicans and S. of stellatoidea form on the ends of a pseudo-mycelium disputes with dense, usually double cell wall — chlamydospores (fig. 1).

Candida — aerobes; they often are saprophytes of mucous membranes of a mouth, intestines, vagina, skin. Meet in the soil, on fruit and vegetables. For food they use from nitrogenous substances of a squirrel, peptones and amino acids. Candida are considered as conditionally pathogenic microorganisms; their pathogenicity for the person and animals substantially depends on a condition of a macroorganism (see below).

For cultivation Candida (optimum temperature 30 — 37 °) fluid medium of Saburo, a beer must, beef-extract glucose agar are the most widespread. Are most suitable for identification of chlamydospores Capek's circle — Doksa with addition of the twin-80, a potato agar with bile, a corn and rice agar.

Candida keep the viability in cultures (in the dried-up state) within several years, transfer repeated freezing and thawing in water and the soil. They sustain the competition to many microorganisms on duration of existence on various products, e.g.’ in acid milk, sauerkraut, fruit juice, etc. In cultures and patol, material fungi perish at boiling within several minutes. 2 — 5% solutions of phenol and formalin, chloroamine, lysol, iodides, borates, copper sulfate and zinc, potassium permanganate and other chemical substances have pernicious effect; fungitsidno solutions of aniline dyes work (a methylrosanilinum chloride, malachite green, methylene blue, etc.).

The epidemiology

Good adaptability of many types of the sort Candida to the environment provides them a wide spread occurance, and also a carriage with the person and animals. E.g., S. can be found by albicans on skin, mucous membranes and in excrements almost in 20% of healthy people. To. calfs, lambs, foals, poultry, etc. are ill; are noted diseases and wildings. Some representatives of the sort Candida associate with normal microflora of skin of the person (first of all S. albicans). As the source of an infection the greatest value is represented 'by patients with fresh forms of damage of skin and mucous membranes. Exogenous infection occurs at direct contact with the patient or the carrier of fungi (a kiss, sexual contact, etc.) and through the infected objects. Drain waters of baths, bathing pools and shower can under unfavorable conditions promote a disease superficial To. stop. Importance in emergence To. has a warm and humid climate, especially summertime of year. Unfavorable conditions of work (e.g., low level of hardware at the confectionery and fruktopererabatyvayushchy enterprises), violations of the rules of hygiene, both collective, and personal, can promote even to emergence of small flashes superficial To. in maternity homes, a day nursery, at the confectionery enterprises, etc. Cases of infection are known To. newborns during the passing of patrimonial ways; very exceptional cases inborn are described To. Endogenous infection is connected with activation of the yeast-like fungi which are already present at microbic associations of an organism therefore at serious illnesses (tuberculosis, pneumonia, diphtheria, malignant new growths, etc.) To. can arise as an associated disease.

Pathological anatomy

Fig. 2. Microdrug of the affected skin at superficial candidiasis: germination of a pseudo-mycelium (it is specified by shooters) in thickness of nekrotizirovanny epidermis is expressed. Coloring across Gram — to Veygert; X 280.
Fig. 3. Microdrug abscess granuloma (in the center of drug) in the depth of a derma at chronic granulematozny candidiasis a biopsy). Coloring PAS method and hematoxylin.

Candidiasis of skin is shown in the form of subacute dermatitis pleated of skin, occasionally with formation of abscesses and an ulceration. At gistol, a research intercellular hypostasis of epidermis, a parakeratosis, an acanthosis and germination of threads of a fungus in nekrotizirovanny epidermis (fig. 2) is noted. Inflammatory infiltration preferential from segmentoyaderny leukocytes is observed generally in a derma. Formation of limited abscesses with existence of the breaking-up segmentoyaderny leukocytes is sometimes observed. Afterwards the granulomas consisting of lymphocytes, epithelioid and huge lashes (fig. 3) are formed.

At To. mucous membranes of an oral cavity and a pharynx the top easily departing whitish-yellowish films are found. Microscopically they consist of a pseudo-mycelium of a fungus, a desquamated epithelium and a small amount of segmentoyaderny leukocytes. At more severe forms of defeat the fungus gets between layers of an epithelium and parasitizes in cells. Dystrophy and their hypostasis, perivascular inflammatory infiltrates in a derma are observed.

Visceral To. can be isolated (went. - kish. a path, a respiratory organs, urinogenital system) and generalized with single or multiple metastasises in internals, a nervous system, muscles, bones. The candidosis esophagitis is a consequence of distribution of process from a mucous membrane of an oral cavity and a pharynx more often; allocate three types of defeats: 1) the separate whitish plaques consisting of desquamated cells of an epithelium, leukocytes and threads of a fungus which are implemented between cells of a multilayer flat epithelium; 2) formation of the merging dense imposings and implementation of a fungus in a submucosal layer; 3) the pseudomembranous imposings developing on an ulcerated mucous membrane; threads of a fungus not only penetrate necrotic masses, but also get deeply into a muscular coat of a gullet and grow into vessels.

Damage of a stomach and intestines is observed less often that is explained by features of a structure of a ferruterous epithelium which produces sialomutsina, and, perhaps, bactericidal properties gastric juice (see). Usually To. a stomach and intestines develops against the background of the previous inflammatory, ulcer, atrophic changes. Than these changes are sharper were expressed, especially take a severe form To. At an easy form of thread of a fungus epithelial cells only partially burgeon and creep along a basal membrane, inflammatory reaction is expressed poorly, generally in a submucosal layer. At a severe form the necrosis of a mucous membrane is found, threads of a fungus diffuzno penetrate necrotic masses and get into thickness of a wall of a stomach, intestines; such form can be followed by formation of ulcers which sometimes are complicated by bleeding or perforation with the subsequent development of peritonitis.

To. mucous membranes of respiratory tracts it is shown by a catarral and desquamative and diphtheritic inflammation. Candidosis pneumonia (see. Pneumomycoses ) develops as a result of distribution of process on pulmonary fabric on an extent from respiratory tracts owing to aspiration of a fungus or a hematogenous way.

In lungs exudate from segmentoyaderny leukocytes with impurity of fibrin is characteristic of an early stage of the inflammation caused Candida. Further necrotic changes with the Passive fibrinous exudate in a gleam of alveoluses prevail. At hron, a form K. lungs there are multiple granulomas consisting of lymphocytes, histiocytes and colossal cells in which cytoplasm fagotsitirovanny elements of a pseudo-mycelium of a fungus quite often are found.

Isolated To. uric ways results from the ascending infection more often; the urethritis and cystitis which sometimes lead to development of pyelonephritis are observed. In it is purulent - the necrotic centers of defeat growths of a pseudo-mycelium of a fungus and phagocytal reaction are found.

Generalized To. — the single or multiple metastatic centers as a result of hematogenous distribution of a fungus — can be various localization. At damage of a brain extensive growth a psevdomitsoliya around vessels is characteristic that connect with features of chemical composition of tissues of brain favorable for growth of a fungus. Candidosis meningitis has character of an acute limited or diffuse purulent or productive inflammation.

Fig. 4. Microdrug of metastatic abscess of a kidney: cells of a fungus (1) are surrounded with segmentoyaderny leukocytes (2). Coloring by strong green.
Fig. 5. Microdrug of metastatic abscess of a liver: in the center of inflammatory infiltrate accumulation of vegetans forms Candida (it is specified by an arrow), which are surrounded with the breaking-up leukocytes is visible. Coloring across Shabadash
Fig. 6. The Drozhzhepodobny cells of a fungus taken to macrophages and (it is specified by an arrow). Coloring by azur-eosine.

Gistol, a picture of changes in the metastatic centers of various bodies and fabrics has no strictly expressed peculiar features. In an initial stage of candidosis process it is observed necrotic - exudative inflammatory reaction, is more often than purulent character, is more rare with dominance in infiltrate of lymphocytes. Intensity of growth of a fungus depends on viability of fabric: where nekrozvyrazhen is sharper, threads of a fungus much more. At hron, the course of process around necrotic - the exudative center of an inflammation there is a growth of connecting fabric or formation is observed granulomas (see), reminding that at tuberculosis (fig. 3). Elimination of a fungus in an organism happens generally at the expense of lizosomalny enzymes of segmentoyaderny leukocytes (fig. 4), i.e. as a result of so-called extracellular phagocytosis therefore growth of a fungus in a suppurative focus it is usual is slowed down. Presence of a large number of segmentoyaderny leukocytes interferes with reproduction of a fungus, leukocytes as if stick around elements of a fungus and, being exposed to disintegration, delimit it from surrounding fabric (fig. 5). As show electronic microscopic examinations, in cells of a fungus integrity of a cytoplasmic membrane is broken and autofagichesky vacuoles in cytoplasm appear. Phagocytosis of fungi segmentoyaderny leukocytes meets seldom and concerns generally impractical cells of fungi; the fungus can be in cytoplasm of macrophages (fig. 6) and colossal cells a long time and to be viable - so-called endotsitobioz. As the fungus is capable to intracellular parasitizing, existence of its viable forms demonstrates that inflammatory process has long character.

At the weakened, exhausted patients inflammatory changes are expressed extremely poorly. Especially it is noticeable if To. accompanies diseases of the hemopoietic bodies, in particular an agranulocytosis and radial illness.

Detection Candida on the surface of skin, in an urethra, a vagina and other mucous membranes it is always not necessary to regard as a fungus disease. For To. existence of vegetans forms of a fungus, the phenomena of budding, filamentation, and also centers of a necrobiosis of fabrics with inflammatory reaction and phagocytosis of particles of a fungus is characteristic.

A pathogeny

As a rule, To. develops only during the weakening of protective forces of an organism. Pathogenetic factors such are diverse: hypofunction of parathyroid and thyroid glands, disturbances of carbohydrate metabolism, depletion of plasma potassium at its normal contents in erythrocytes, a disproteinemia, disturbance of belkovoobrazovatelny function of a liver, a hypnoadrenalism, a dysmenorrhea, a hypovitaminosis, maceration and small injuries of skin, the chronic exhausting diseases.

Very much importance in a pathogeny To. has dysbacteriosis (see), developing owing to use of antibiotics, corticosteroid hormones, tsitostatik and immuno-depressants, at Krom there is an increase in fungal microflora and strengthening of its pathogenic properties. Essential value has an immune condition of an organism and degree of its specific sensitization, and also massiveness of infection with fungi.

On laboratory animals models focal and widespread, acute and hron, forms K are developed. various localization. Detection of fungi in the small small knots of whitish color which are localized in lungs, kidneys and a spleen of the dead from To. or the mice killed on the 5th days (rabbits on the 10th days), it is used for definition of degree of pathogenicity of the studied cultures. The extracts received from cells of svezhevydelenny fungi which were the most pathogenic for animals have the expressed immunogene properties. The Polisakharidny drugs received by processing of yeast cells pepsin, betanaftolny and etanolny were the most suitable for serol, diagnoses To., reactions of immunodiffusion in gel, reaction of binding complement, indirect hemagglutination and an agglutination test of particles of latex. In the course of an infection and immunization live and inactivated vaccines form the agglutinins, pretsipitina, antibodies connecting a complement. Also processes of phagocytosis amplify, there is an allergic reorganization of an organism.

Immunity

the Congenital immunity to To. is not present; acquired is expressed poorly. Healthy people very seldom are ill To., especially its visceral form though Candida have allergenic properties, and their hit in an organism happens at chest age. At healthy people the caption of agglutinins fluctuates within 1:20 — 1:160.

Classification

Due to a big variety of manifestations To. many classifications are offered. However on a wedge, to manifestations To. it is possible to subdivide into four basic groups.

A. Superficial Candidiasis:

1. Candidiasis of mucous membranes: a) barmy stomatitis (milkwoman); b) barmy glossitis; c) candidosis quinsy; d) candidosis vulvovaginitis; e) candidosis balanitis and balanoposthitis.

2. Candidiasis of skin: a) candidosis perleche; b) candidosis cheilitis; c) Candidiasis of large folds of skin (Candidiasis intertriginozny, mycosis intertrigi-nozny barmy); d) interdigital candidosis erosion of brushes; e) Candidiasis of small folds of skin; e) other displays of candidiasis of smooth skin. 3. Candidiasis of nail rollers and nails.

B. Chronic generalized (granulematozny) Candidiasis.

B. Visceral Candidiasis.

1. Candidiasis of respiratory tracts. 2. Candidiasis of bodies of a digestive tract. 3. Candidiasis of an urinary system.

G. Secondary (allergic) forms of candidiasis.

Clinical symptomatology

Candidiasis of mucous membranes

Barmy stomatitis (see), or the so-called milkwoman, occurs preferential at the weakened chest and small children or at elderly people against the background of hron, diseases. In the beginning on not changed mucous membrane of cheeks, a hard and soft palate, language and gingivas dot plaques of white color which, merging, form the white films reminding the turned milk are formed. If to remove films, then under them the bleeding mucous membrane is found. At the milkwoman at the child can arise To. nipples at the feeding woman: skin reddens, bubbles and cracks on a nipple, sharp morbidity appear during the feeding.

Barmy glossitis (see) — in addition to the milkwoman, on some sites of a back of the tongue it is possible to observe an atrophy of threadlike nipples; at some patients deep furrows of language are considerably expressed (tsvetn. fig. 1) in which plaques are visible whitish color; all language increases due to puffiness a little. To. mucous membranes not serious illness, however it is the symptom indicating the general weakening of an organism; the barmy glossitis is often observed at the elderly people carrying dentures.

Candidosis quinsy (see) usually proceeds chronically at a standard temperature of a body and lack of morbidity during the swallowing. On almonds whitish traffic jams are formed, but there can be also plaques in the form of films of white color. Regional limf, nodes are not involved in process.

Candidosis vulvovaginitis (see) it is found emergence of the allocations of whitish color having kroshkovidny character. On a mucous membrane of a vagina, edge it is usually hyperemic, plaques, surface erosions are found whitish or gray color. Patients note an itch, burning in external genitals. Quite often To. it is combined with mecotic a colpitis.

Candidosis balanitis and balanoposthitis (see. Balanitis, balanoposthitis ) — on a balanus, on an internal leaf of a prepuce less often on an outside leaf plaques of white color are formed, under to-rymi surface erosions are found; rashes are followed by burning, morbidity.

Candidiasis of skin

Candidosis perleche can arise as an independent disease or to be manifestation, e.g., of the milkwoman. The barmy infection differs in dominance of maceration and peeling of upper sites of a corneous layer in the form of a border around cracks in corners of a mouth and considerable infiltration in their basis (see. Perleche ).

Fig. 1. A candidosis cheilitis (grayish scales on an edematous red border of lips) and a glossitis (a whitish plaque, deep furrows in language).

Candidosis cheilitis (see) it is characterized by reddening of a red border of lips, dryness, feeling of tightening and burning. Grayish color of a scale are as if pasted on a red border of lips, and their free edge slightly rises (tsvetn. fig. 1); diagnosis of a candidosis cheilitis requires repeated detection of elements of a fungus.

Fig. 2. Candidiasis of large folds of skin — defeat of folds of an anus and mezhjyagodichny fold with a characteristic border from matserirovanny epidermis.

Intertriginozny K. (large folds) meets quite often. Axillary poles, folds of skin under mammary glands, especially at corpulent women, mezhjyagodichny and inguinofemoral folds can be surprised (tsvetn. fig. 2). At such localization the large centers with a clear boundary are formed, it is frequent with erosion and moknutiy. The periphery of the centers is surrounded with a border from whitish matserirovanny epidermis. Around the main center, especially under mammary glands, small ochazhka of the same character (so-called affiliated elements) often are found.

Interdigital candidosis erosion brushes meets very often, sometimes as manifestation of an occupational disease (professional To.). Usually process develops in the third interdigital fold, is more rare in others. The corneous layer in a fold bulked up, matserirovan, has a nacreous shade. In the center of the center the erozirovanny surface of red color, wet and brilliant owing to moderately expressed a moknutiya is found. Further side surfaces of the main phalanxes process does not extend. Erosion proceed quite persistently and without elimination of pathogenetic factors are inclined to a recurrence. Patients note an itch and burning.

Candidiasis of small folds of skin (behind auricles, in a navel, interdigital folds of feet) meets quite often. Process is characterized by the same a wedge, signs, as at localization in large folds, and can be or primary manifestation To. or to develop along with symptoms of other disease.

Other displays of candidiasis of smooth skin can be found in the form of eritematoskvamozny, vezikulobullezny, scarlatiniform and psoriasiform rashes. Also candidosis erythrosis is seldom observed.

Candidiasis of nail rollers and nails (an onychia and a paronychia) it is usually observed only on hands as an occupational disease at the working fruktopererabatyvayushchy enterprises.

Fig. 3. A candidosis onychia (a thickening and opacification of nail plates) and a paronychia (the inflamed nail rollers, an eponychium is absent).

Process begins more often with the nail roller which becomes hyperemic, «subauriculate», the cuticle disappears, during the pressing the small drop of pus is allocated; the acute stage gradually passes in subacute and chronic. Later the nail plate is involved in process, edges gradually becomes hilly with cross strips and impressions or becomes thinner, sometimes easily exfoliates. Color of the struck nail plates brownish, is more rare with a greenish shade. Barmy paronychias and onychias (tsvetn. fig. 3) can be the only manifestation To. or to be combined with other forms superficial or even visceral To.

Visceral Candidiasis

Fig. 4. Chronic generalized (granulematozny) Candidiasis - on head skin and trunks of the child the shelled infiltrirovanny spots and hillocks with horn deposits.
Chronic generalized (granulematozny) Candidiasis — independent a wedge, a version To. As a rule, the disease begins in the early childhood with the milkwoman of a mucous membrane of an oral cavity. Then gradually nail rollers and nail plates of brushes and feet, pilar head skin, face skin, trunks and extremities are involved in process. Often observed barmy cheilitis, especially defeat of an under lip, leads to development of a makrokheyliya. Emergence further on skin of a pilar part of the head, the person, a trunk and extremities of the hyperemic and shelled spots with infiltration in the basis, papules, hillocks and horn deposits is characteristic (tsvetn. fig. 4). At many patients are noted recurrent pneumonia: (see. Pneumomycoses ) and epileptiform attacks; damage of a liver and kidneys is possible. The course of a disease chronic with aggravations. Most of patients are exhausted, children lag behind in physical. development.

Candidosis panophthalmia, an iritis, an endocarditis, etc. are observed.

Candidiasis of respiratory tracts can be primary or secondary. Damage of a throat and throat is followed by attacks of dry cough, change of a timbre of a voice, a laryngostenosis and expectoration. Candidosis bronchitis is shown by persistent cough, a mucopurulent phlegm, large-bubbling rattles. Primary barmy pneumonia arises at treatment of any other disease of antibiotics more often, and secondary can arise at TB patients and proceed as a complication of pneumonia of other etiology. Sometimes owing to cavitation mycotic pneumonia reminds tubercular damages of lungs that needs to be considered always during the carrying out the differential diagnosis (see. Pneumomycoses ). Sometimes she reminds a sarcoidosis of lungs.

Candidiasis of bodies of a digestive tract is shown by various symptomatology: a loss of appetite, difficulty during the swallowing, vomiting with allocation of curdled films, a liquid stake with impurity of slime, etc. During the progressing To. intestines there is dehydration of an organism, the phenomena of intoxication, an adynamia are expressed, the feverish state can be observed.

Candidiasis of an urinary system is followed by emergence in urine of protein, blood and cylinders, abundance of elements of a fungus; filtrational ability of kidneys is broken.

Secondary forms of candidiasis

Secondary forms of candidiasis (a levurida, or a mikida) arise in the presence of primary center in internals, on skin or mucous membranes, sensibilizing an organism. Clinically levurida are shown in the form of eritematoskvamozny, vesicular, parapsoriasiform or other elements. Secondary allergic rashes are usually symmetric, can be followed by a headache, an indisposition, disturbance of cordial activity, change of a formula of peripheral blood. In emergence of levurid disturbances of the medical mode, irrational therapy, traumatizing the centers have essential value To. or irritation chemical substances.

Complications are various, but the heaviest — a septicopyemia and a septicaemia (see. Sepsis ).

Diagnosis

the Diagnosis To. visible mucous membranes, skin, nail rollers and nail plates the wedge, manifestations and finding of fungi is put on the basis at a research of material from a surface of the centers. At visceral To. additional researches, and also infection of laboratory animals are necessary.

Laboratory researches. As material for a research serve skin and nail scales, a discharge of ulcers, pus, cerebrospinal liquid, blood, urine, bile, excrements, pieces of biopsirovanny fabric and cadaveric material. Patol, material mikroskopirut in 10% solution of caustic alkali, or in solution of Lugol of double fortress, or in mix of alcohol and glycerin (2 h alcohol, 4 h glycerin, 4 h water).

Fig. 7. Candida in cuts of tissue of kidney at a research by method of a luminescence (shooters specified pseudo-myceliums). Schiff Rivanolum reactant of SO 2 .
Fig. 8. Germination of threads of a pseudo-mycelium (it is specified by shooters) from drozhzhepodobny cells Candida. Coloring by PAS method.

Candida can be found at gistol. a research — coloring of cuts of the centers of defeat across Gram — to Veygert in various modifications (see. Veygerta methods of coloring , Grama method ). Best of all they come to light during the coloring on neutral mucopolysaccharides on Hochkissu-Mack-Manus or across Shabadash (see. IAC Manus method , Shabadasha ways ): uniform coloring of drozhzhepodobny cells and a pseudo-mycelium of a fungus is observed, fagotsitirovanny elements of fungi, and also the dying-off particles of a fungus well are defined. In the earliest terms of parasitizing apply a direct method of a luminescence (fluorescent antibodies) by means of which are found Candida (fig. 7). In process of development of inflammatory process intensity of a luminescence of fungi weakens that is connected with synthesis of antibodies against antigens of a fungus. In cuts of fabrics fungi are found in the form of the round or oval drozhzhepodobny cells sometimes budding of a pear-shaped form. Side budding in places of a joint of cells (verticil) is quite often visible. As a result of filamentation (filamentation) fine, short, curved and long ends of a pseudo-mycelium, sometimes with thickenings on the ends up to 7 microns thick (fig. 8) are observed.

Cultural diagnosis is reached by crops patol, material on Saburo's circles and a must with streptomycin, penicillin, levomycetinum for suppression of growth of the accompanying microbes. For identification of a pseudo-mycelium and formation of chlamydospores the most suitable are shaped 4 — 5-day cultures on slanted morkovnokartofelny, corn or rice agar mediums. Growth of a large number of barmy colonies (over one thousand on gram of the studied material in crops on dense environments) says that this organism can be etiol, the agent of a disease; however repeated crops of the same studied material are necessary.

Serol, diagnosis To. it is reached by means of reaction agglutinations (see) and reactions of binding complement (see). Sharply positive agglutination test in cultivation of serum not lower than 1 is considered reliable: 200, and reaction yields more accurate results with autoantigen — the culture received from the patient. Reaction of binding complement is more specific; the most accurate results turn out at generalized and visceral forms.

Specific immunofluorescence (see) there was useful and for definition of serotypes, identification Candida.

Fig. 5. Sharply positive skin reaction to candidosis antigen on skin of a shoulder.

The most important for diagnosis To. increase of antiserum capacities in the course of a disease is; increase in quantity of yeast-like fungi at repeated researches patol, material. Positive allergic skin reactions (tsvetn. fig. 5) matter in combination with other data.

It is necessary to carry out differential diagnosis between Candida, aspergillam (see. Aspergillosis ) and a nokardia (see. Nocardiosis ).

Treatment

Therapy is carried out with the obligatory accounting of pathogenetic factors. So, e.g., normalization of carbohydrate metabolism or functions of a thyroid gland, improvement of the general condition of an organism can lead to elimination a wedge, manifestations To. Means etiol, influences accelerate treatment. Fortifying means and healthy nutrition of patients are important: food shall be protein-rich, vitamins, but the amount of carbohydrates should be limited. Purpose of repeated rates of nystatin, levorinum or their salts is shown (both antibiotics are most effective at To. digestive tract). Nystatin is appointed inside the adult on 6 000 000 — 8 000 000 PIECES a day (between courses do breaks). Amphotericinum In is shown at hard proceeding form visceral To. and generalized hron. To.; it is appointed intravenously in 5% solution of glucose in the form of drop injections from calculation for adult 250 PIECES to 1 kg of body weight of the patient with the general course dose of 1 500 000 — 2 000 000 PIECES. An immunotherapy of patients To. it is applied quite widely; appoint a polyvalent vaccine (or an autovaccine). Use also the drugs from S.'s fungus of albicans containing a complex of proteins, polysaccharides and lipids.

Means of outside therapy are various. With success 1 — 2% spirit or water solutions of aniline dyes, Castellani's liquid, benutsid, mikoseptin, Zincundanum and other fungicidal liquids are applied. From ointments amfoteritsinovy, levorin and nystatin, 10% of sulfuric and 3% salicylic, etc. are applied. At To. a mucous membrane of an oral cavity greasings (2 — 3 times a day) by water solutions of aniline dyes, 10 — 20% solution of borax in glycerin, rinsings of 1 — 2% water solution of a tannin or 1% water solution of Iodinolum, and also tablet with Dekaminum in the form of caramel are recommended.

Solutions (water) of aniline dyes, 5 — 10% solutions of borax in glycerin — greasing of the centers 3 — 4 times a day apply 1 — 2% to treatment of children; rinsing of an oral cavity of 5 — 10% solution of a tannin, caramel with Dekaminum.

At a vulvovaginitis apply tampons from 20% solution of borax in glycerin, the foaming tablets of levorinum, greasing of 1 — 2% water solution of aniline dye.

The forecast

At superficial forms the forecast is favorable; e.g., the milkwoman of a mucous membrane of a mouth at babies at the correct treatment and food of the child recovers quickly. The forecast is more serious at hron, a generalized and visceral form, especially at complications of allergic character. To a large extent the forecast depends on the course of a disease, against the background of to-rogo developed To.

Prevention

On production on processing of fruit and vegetables, juice and syrups it is necessary to implement the mechanization and automation excluding use of manual processing. At infectious and other diseases prolonged use of antibacterial antibiotics it is necessary to combine with nystatin (to 400 000 — 600 000 PIECES a day) and a complex of vitamins, especially groups B. In baths and shower it is recommended to use rubber slippers. Prevention concerning newborns and babies is especially important; in maternity homes and a day nursery it is impossible to allow people who have K. V signs house conditions patients To to work with children. shall avoid communication with children; ware, linen and towels need to be disinfected.



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A. H. Arabian, P.N. Kashkin, N. Ts. Sheklakov; O.K. Khmelnytsky (stalemate. An.).

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