Patients with primary sclerosing cholangitis frequently develop dominant stenoses of the bile ducts and bacterial infections represent a major problem.
Dr Stiehl and colleagues from Germany evaluated the role of fungal infections of the bile ducts.
The team of doctors conducted a prospective non-randomized trial, in 67 consecutive patients with primary sclerosing cholangitis.
Of these, 49 had dominant stenosis, and 18 were without dominant stenosis.
The team microbiologically analyzed 148 bile samples, each taken at one endoscopic examination.
The doctors found candida species in 12% of patients whereas Aspergillus was not detected.
|14% of patients with dominant stenosis had Candida|
|Journal of Hepatology|
The team noted that 10% of patients with biliary Candida had a dominant stenosis.
Less than 1% of patients had a wide papillotomy with chronic ascending cholangitis.
Altogether 14% of patients with dominant stenosis and less than 1% of patients without dominant stenosis had Candida in their bile.
The doctors observed that all patients with biliary Candida intermittently had received antibiotics and had advanced disease with cholestasis.
Of 7 patients, Candida disappeared spontaneously in 29%, cleared after antifungal treatment in a further 29%, and persisted in 30%.
Patients with biliary Candida had more severe cholangitis with higher C-reactive protein and serum bilirubin compared to those without Candida infection.
Dr Stiehl's team concludes, “This is the first report on the identification of Candida species in the bile of patients with primary sclerosing cholangitis.”
“Apart from bacterial also fungal infection of the bile ducts should be considered in the treatment of such patients.”