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DOI: 10.1055/s-2006-950869
Biliary candida infections in primary sclerosing cholangitis
Aims: Primary sclerosing cholangitis (PSC) is characterized by progressive fibrotic inflammation of the bile ducts leading to their obstruction. Patients with PSC frequently develop dominant stenoses and bacterial infections represents a major problem in such patients. In the present study the role of fungal infections of the bile ducts has been evaluated.
Methods: In a prospective non-randomized trial 148 bile samples of 67 consecutive patients with PSC were microbiologically analysed. Of the patients studied, 49 had dominant stenoses which were treated by endoscopic dilatation. After selective cannulation of the common bile duct, bile samples were obtained during each procedure. All patients received ciprofloxacin for one week after endoscopic retrograde cholangiography.
Results: Candida species were found in 8/67 (12%) patients whereas Aspergillus was not detected. Of the eight patients with biliary Candida, seven had a dominant stenosis and one had a wide papillotomy with chronic ascending cholangitis. Altogether 7/49 (14%) of patients with dominant stenosis and 1/18 (5%) of patients without dominant stenosis had Candida in their bile. Two (25%) of the patients with Candida in addition had an infection with enterobacteria, and five (62%) with low grade pathogens. All patients with biliary Candida intermittently had received antibiotics and had advanced disease with cholestasis.
Conclusion: This is the first report on the identification of Candida species in the bile of patients with PSC. Apart from bacterial also fungal infection of the bile ducts should be considered in the treatment of such patients.