Introduction: Under the recent progress in antifungal therapy, cases of systemic candidiasis were thought to be decreasing in number. We examined autopsies with systemic candidiasis, histopathologically, especially focusing on renal candidial lesions to elucidate effects of antifungal agents. Materials and Methods: Twenty-four patients autopsied in Ohashi Hospital, Toho University School of Medicine, were used in this study. Five of twenty-four had been treated with antifungals in their last few days. Histopathological study was performed using slides stained with HE and PAS reaction. Results: Four distinct histological patterns emerged from the study. The first was characterized by marked intratubular growth of Candida with peripheral extension of hyphae featuring radial pattern. No colliquative necrosis was accompanied. This was usually present the renal medulla. The second was foci with intratubular growth of Candida aggregated in the papillae. The third could be defined as abscess characterized by colliquation necrosis with prominent neutrophilic infiltrate. The fourth was characterized by restricted candidial proliferation with an encompassing of reacting macrophages with phagocytizing yeasts. In five cases treated with antifungal agents, all had received antibiotics, and three had been received surgery and adrenocorticosteroids. Two of three with adrenocorticosteroids showed the same histology of renal candidiasis as cases without antifungal therapy. These two patients had been treated with both adrenocorticosteroids and antifungals, using miconazole and fluconazole, respectively, for only a few days before death. However, in one of three cases with adrenocorticosteroids, candidial abscesses were seen in the renal cortex and medulla, and these abscesses were surrounded by macrophage infiltrates. This patient had been treated with fluconazole for 7 days. Conclusion: In patients with an administration of adrenocorticosteroids, antifungal agents did not seem to be effective, so it revealed therapeutic difficulty to reach an improvement of systemic candidiasis in these patients.
Full conference title:
The 15 th Congress of the International Society for Human and Animal Mycology
- ISHAM 15th (2003)