home Auditorium 7 Is there a connection between intestinal dysbiosis and thrush? Intestinal dysbiosis. Causes, symptoms, modern diagnosis and effective treatment

Is there a connection between intestinal dysbiosis and thrush? Intestinal dysbiosis. Causes, symptoms, modern diagnosis and effective treatment

Symptoms of intestinal candidiasis are varied. Determining the disease is not difficult. Despite the fact that candidiasis is a disease caused by opportunistic flora, it cannot be avoided without proper treatment.

Intestinal candidiasis is a pathological condition gastrointestinal tract, caused by pathogenic mycoses of the genus Candida. Normally, microorganisms are found in the normal flora healthy person. The development of the disease occurs against the background of uncontrollable growth of fungi. The appearance of symptoms is due to the negative influence of candida waste products.

Symptoms of the disease

The main manifestation of thrush in the intestines will be pronounced pain syndrome, in addition to which you should pay attention to the following signs of invasion:

bloating occurs in the abdomen chronic course;
patients complain of heaviness in the epigastric region (stomach);
after eating, intestinal spasms are observed;
impaired intestinal motor function (diarrhea);
low-grade body temperature (from 37 to 37.5 0);
patients complain of lack of appetite;
V stool pus is also detected;
in the anal area and stool you can find a cheesy discharge with a foul odor;
after bowel movement there is no feeling of relief;
pain during defecation;
a rash appears on the skin.

Flatulence and abdominal pain can cause a lot of trouble for a baby and his parents with intestinal candidiasis

In addition to the primary signs of pathology, fatigue, insomnia and various forms of skin diseases (acne, dermatitis, urticaria) may appear.

Regardless of the severity of the clinical picture, intestinal candidiasis is easily determined an experienced doctor(gastroenterologist).

As the pathological spread of fungi progresses, all symptoms intensify. Lack of treatment allows the pathology to spread to various parts, most often the disease affects the genitourinary organs and the oral cavity. In addition to spreading, candidiasis provokes an exacerbation of existing diseases of the gastrointestinal tract.

The transition of thrush from the intestines to the genitals in a woman has the following symptoms:

cheesy discharge is detected on the genitals and underwear, having an unpleasant odor;
unbearable itching of the vagina, turning into a burning sensation, can be observed at rest, during urination or sexual intercourse;
in severe forms of the disease, menstrual function may be impaired; long-term infection can cause secondary infertility.

Symptoms in men are not very different:

itching and burning of the penis and scrotum;
discharge of a cheesy nature (outwardly reminiscent of cottage cheese);
disturbance of urination, pathogenic fungi are detected in the urine (visually the urine has a cloudy whitish sediment).

Intestinal infection with candida fungus has a pronounced clinical picture

When the oral cavity is affected, inflammation of the mucous membrane, a white coating that can be easily removed with a spatula or gauze swab, and pain during eating are determined.

Advice. When identifying the first signs of intestinal candidiasis (or simply long-lasting pain), you should contact a gastroenterologist in order to find out the cause of the negative sensations and timely treatment of the infection.

Possible complications

With absence adequate treatment possible occurrence serious complications. The most dangerous to the life and health of the patient is considered to be perforation and penetration of the ulcer (breakthrough of the ulcer into the surrounding tissues with the subsequent entry of its contents into the cavity of the damaged organ).

Reasons for the development of candidiasis

Intestinal fungus does not cause problems if the immune response is good. For the development of the disease, certain conditions are necessary that favor the development of mycosis:

decreased resistance of the body to the development of pathogenic flora under unfavorable environmental conditions (sudden time zone changes, temperature changes, high or low humidity);
chronic infections;
diseases of internal organs;
immunodeficiency (congenital or acquired);
uncontrolled treatment with antibiotics;
suppression of immunity during the treatment of oncological processes (chemotherapy or radiation);
imbalance in the hormonal background (the cause may be diseases of the endocrine system, hormone intake, menopause, pregnancy);
eating disorder ( favorable conditions for candidiasis is created by lovers of flour products with a rare and inconsistent diet).

Uncontrolled use of antibacterial drugs is the most common cause of candidiasis.

Important. Candidiasis develops only against the background of a weakened immune response of the body. Which indicates the need for an integrated approach to the treatment of pathology. In addition to application antifungal agents a necessary condition for recovery is the elimination of the root cause of the pathological growth of candida.

Diagnosis of pathology

Determination of yeast fungi in the intestines is carried out by inoculating the contents of the secretions on a nutrient medium. After identifying fungi, differentiation of the type of mycosis is carried out.

In addition to sowing as diagnostic method You can use sigmoidoscopy, which allows you to identify plaque on the intestinal wall and confirm the preliminary diagnosis established on the basis of the patient’s sting.

Treatment

Only a doctor can determine how to treat intestinal candidiasis. Elimination of pathology should be comprehensive and carried out in two directions:

stopping the growth of mycoses and destroying the already expanded network;
treatment of a disease that causes a decrease in immunity.

When choosing treatment tactics for a condition, the doctor takes into account the form of the disease, severity, risk of complicated course, state of the immune system and background disease, which gave rise to thrush.

Antimycotic treatment

To stop the development of fungus in the intestines, antimycotic drugs are prescribed (impact on the growth of candida). When choosing a remedy, preference is given to the drug local action(the most commonly used form is rectal suppositories). The most commonly used:

Nystatin;
Levorin;
Pimafucin.

Pimafucin is a broad-spectrum antibiotic that acts in the intestinal lumen without affecting systemic blood flow.

For severe forms of infection, use systemic drugs: Fluconazole, Itraconazole, and others. These medications may be prescribed in the form of tablets (orally), solutions (intravenously), or suppositories (rectally). A combination of forms of local and systemic influence is possible.

Important. The choice of drug and treatment regimen is selected individually. Usage rectal suppositories should only be done after a thorough hygiene procedure(you should wash with baby soap without any additives).

Treatment of dysbiosis

In addition to destroying Candida fungi in the intestines, treatment of the disease is impossible without restoring healthy intestinal microflora.

When choosing prebiotics and prebiotics at the time of antifungal therapy, drug stability should be taken into account. This group helps eliminate intestinal dysbiosis, which leads to normalization of work digestive system. Drugs suitable for normalizing microflora after antimycotic therapy:

Bifidumbacterin;
Acylact;
Biosporin;
Linux.

Application of enzymes

To relieve symptoms during treatment of gastrointestinal thrush, a gastroenterologist may prescribe enzymes. The rapid breakdown of food under the influence of enzymatic action allows the patient to relieve flatulence and improve intestinal motor function.

Immunity restoration

When the body's immune response decreases, immunocorrective or immunomodulatory drugs are included in fungal therapy. Choice medicines carried out by an immunologist after determining the level of imbalance and identifying the cause of the pathology.

Traditional therapy methods

Treatment of intestinal candidiasis with folk remedies is auxiliary and is selected by a specialist.

Important. Self-medication of thrush with folk remedies can have irreversible consequences, especially during pregnancy and in the treatment of young children.

Sea buckthorn oil

Taking sea buckthorn oil helps against fungal infections of the intestines. In addition to the anti-inflammatory effect, this remedy stimulates the immune system (strengthens the body's resistance) and has a protective effect on the irritated walls of the digestive tract.

Sea buckthorn oil is considered one of the best traditional medicines that triggers the mechanism of tissue regeneration (healing and restoration). Take 1-2 teaspoons per day (depending on the patient’s build) for up to 10 days during meals.

Advice. To improve the absorption of sea buckthorn oil, include more raw vegetables in your diet.

Baking soda and iodine

For local treatment of thrush, baths in a soda solution with potassium permanganate are used. Washing the external genitalia when infected with fungus is also effective.

The course of treatment is at least 10 days. Even if symptoms disappear after the first procedures. This will prevent the recurrence of the disease.

Herbal decoctions

From plant materials, you can choose drugs that have anti-inflammatory, regenerating or immunocorrective properties.

The most common intake is white chamomile, sage, St. John's wort, oak bark, bird cherry, pomegranate peels, black currant leaves, etc.

Diet

In case of fungal infection of the digestive tract, normalization of nutrition will be a prerequisite for a favorable outcome of the disease in a short time.

What not to eat if you have intestinal candidiasis:

white bread and muffins (enhances the development of yeast);
sugar and sweets;
semi-finished products;
potato;
citrus fruits (oranges, lemons, grapefruit);
spices.

To improve digestion, you should forget about overeating and establish a diet in small portions and at least 4-5 times a day.

Products of choice:

It is better to choose low-fat and dairy products reduced content sugars;
boiled or steamed meat (preference is given to low-fat varieties);
zucchini and pumpkins;
cauliflower;
various greens (lettuce, spinach, dill, parsley);
garlic and onions promote the formation of bifidobacteria and lactobacilli in the intestines;
carrot juice (best taken with added oil);
seafood (squid, shrimp) and fish.

Green apples are an indispensable product in the fight against fungal infections of the intestines.

Intestinal candidiasis or candidomycosis is a fairly common, frequently occurring disease, which is triggered by the development of yeast-like fungi in the stomach and intestinal tract, which manifests itself in the form of severe dysbiosis.

Fungi of the genus candida are quite widespread in nature and enter the human body due to their contamination in food, water, and also in surrounding objects.

It should be noted that a person is constantly faced with the causative agent of intestinal candidiasis, but the disease manifests itself only in those who have a weaker immune system and cannot “cope” with the infection.

Forms of the disease "thrush"

As a rule, the owner of intestinal candidiasis is a transient carrier, and he does not have any obvious signs of this disease. If the immune system does not cope with the pathogen, active reproduction of yeast fungi occurs and their spread to other organs and tissues.

In this case, candidomycosis (thrush) of the intestines can develop in the oral cavity, on the tongue, throat, in the anus (in the anal area) and subsequently provoke perianal (anal) candidal dermatitis and dermatitis of the urinary organs, genital dermatitis, which can be not only in adults, but also in children.

Many experts argue that the main reason widespread intestinal candidiasis are the current achievements of scientists in the field of treatment of oncological diseases, including in the field of treatment of bacterial infections.

Candidiasis of the gastrointestinal tract can occur in several forms.

The rarest form of candidiasis is invasive or diffuse thrush of the gastrointestinal tract, which is characterized by the most severe course. This type of candidiasis is characteristic only of HIV-infected people, people with cancer, as well as people who take cytotoxic drugs, glucocorticosteroids or immunosuppressive therapy.

Such intestinal candidiasis is accompanied by the presence of erosive, pseudomembranous colitis (the main symptoms are the presence of bloody diarrhea) and infectious lesion other organs (anus, perianal dermatitis occurs).

Non-invasive intestinal candidiasis or candidal dysbiosis is the most common form of candidiasis of the gastrointestinal tract, which is accompanied by active, excessive growth of yeast fungi, and may also be a consequence of hypersensitivity of the body (more often in children) to the genus candida. The main symptoms and signs of non-invasive intestinal candidiasis are gastrointestinal discomfort, diarrhea, changes in stool consistency, and general health deteriorates.

The next form of candidiasis is intestinal focal candidiasis. This type of candidiasis is a secondary process if there is peptic ulcer tract (duodenum) or if there is ulcerative colitis, which causes a violation of the integrity of the epithelium and, as a result, invasive candidomycosis.

A separate form of candidiasis - perianal dermatitis or perianal candidomycosis - is candidiasis, which, in addition to damaging the tissues of the intestinal tract, involves the skin in the anus, that is, around the anus, in the pathological process.

This thrush is more common in HIV-infected people, as well as in infected homosexuals. Most often accompanied by the occurrence of a herpes infection. Also, candidal dermatitis can also occur in infants and has similar signs and symptoms to film dermatitis.

As a rule, dermatitis in a child is a consequence of violation of the rules for caring for the skin of infants. In adults, perianal dermatitis occurs due to the development of yeast fungi in the large intestine and rectum, which leads to disruption of the natural microflora in the anus.

Causes of intestinal candidiasis

Intestinal candidiasis (or thrush) does not develop in everyone, but only in the case of immunodeficiency, which is caused by any physiological changes, the presence of any immunodeficiency virus infections, or in the presence of cancer.

Most often, intestinal (non-invasive) candidiasis is caused by an unbalanced, poor-quality and unhealthy diet.

It is also known that certain foods can further promote yeast growth. These are usually products that are made with yeast or products causing fermentation. It could be beer, flour, sweets, carbonated sweet water, etc.

Also developing candidiasis of this type in the intestines may be a consequence of treatment with antibiotics, the result of prolonged use without timely consultation with a doctor.

Also, candidiasis developing in the intestines may be a consequence of the presence of other diseases. This can be an ulcer and ulcerative diseases, frequent colitis and dysbacteriosis.

Fungi do not develop on their own; they require special “conditions.” So, what provokes the proliferation of fungi and candidiasis (thrush) in the intestines? As a rule, this can be for some physiological reasons - stress, pregnancy, old age, and also early age in children.

Also, candidiasis developing in the intestines can be a consequence of any internal chronic diseases or diabetes mellitus. Most often, in young girls, candidiasis (thrush) in the intestines, and as a result, dysbiosis, is a consequence of the use of drugs containing hormones.

Main symptoms of the disease

Deterioration of the condition is already a cause of panic, since this may be a signal of the presence of some disease or infection, including manifestations of thrush.

How does candidiasis actively developing in the intestines manifest? The symptoms of this disease depend on the type of candidiasis that develops.

Invasive candidiasis in the intestines has the following symptoms: as a rule, these are frequent flatulence, diarrhea, dysbacteriosis, bad stool with an admixture of whitish cheesy discharge (can also be in the form of white “flakes”), discomfort and pain in the abdominal area and sensations incomplete emptying intestines (heaviness in the anus).

Candidiasis of diffuse forms in the intestines has symptoms such as impurities in the stool, bloody and mucous discharge. Exacerbation of the disease leads to acute dysbiosis and diarrhea. As a rule, people do not pay attention to such manifestations of the disease, explaining everything by saying that they ate something wrong.

If candidiasis developing in the intestines is not treated in a timely manner, such manifestations can subsequently provoke disruption of the liver, kidneys and heart and cause more severe complications.

Candidiasis in children in the intestines is accompanied by increased stool frequency and dysbacteriosis occurs. The disease in a child can be determined by external signs during an examination by a pediatrician. As a rule, in infants (children) you can see small tubercles in the anal canal, which quickly merge with each other, forming spots resembling film dermatitis.

Treatment of candidiasis

It is quite difficult to eliminate candidiasis in the intestines, but it is still possible. If you (your child) have dermatitis or dysbiosis due to it, it can be eliminated by treating thrush, for which drugs are used that are not adsorbed from the intestines (its lumen).

It is possible to eliminate dysbacteriosis and dermatitis in adults and children that arise as a result of the disease if you take antifungal drugs. You should not use ketoconazole, itraconazole, fluconazole, amphotrecin B, since they are all adsorbed in upper sections, without reaching the localization of the fungus.

You can take medications such as nystatin, pimafucin, levorin. Also, it is important to restore the intestinal microflora and eliminate dysbiosis, for which drugs that contain bifidobacteria are used. Bifiform will help eliminate dysbacteriosis.

When treating both adults and children over 3 years old, it is necessary to adhere to a diet.

Eliminate sugar, sweets, alcohol, flour, crackers, chips, pork, bacon, crackers, and spices from your diet. It is better to eat as much fresh fruits and vegetables, eggs, and yoghurt as possible.

In infants, manifestations of perianal dermatitis can be eliminated if local treatment, for which the drugs dexpanthenol, ointments with zinc, and antiseptics are used. You can also make baths from string, chamomile and oak bark. But, such treatment is only effective if the infection is also treated in the intestines. Do not self-medicate your child; seek help from a pediatrician.

Thrush is a disease that gets its name from its main symptom - intense white cheesy discharge that occurs as a result of the inflammatory process of the vaginal mucosa. Provoke inflammatory process yeast-like fungi of the genus Candida.

The symptoms of the disease do not always manifest themselves, but if the intensity of yeast growth increases, candidiasis manifests itself quite clearly.

Establishing diagnosis
Release forms and indications for use
Taking medication when various ailments genital area
Preparations in the form of suppositories containing the substance

Establishing diagnosis

Diagnosis and treatment of the disease is carried out by a specialist in the field of gynecology, a gynecologist. The main unpleasant signs of vaginal candidiasis are:

If a woman is worried about only one of the listed signs, then we can talk about the erased course of vaginal candidiasis. And if a woman does not pay due attention to the treatment of thrush, then it can become chronic and return to the patient at least four times a year.

Thrush that has become chronic is more difficult to cure, and it often leads to secondary diseases of the genital area.

There are many reasons leading to the occurrence of the disease:

The disease is diagnosed and treated by a gynecologist, who must be contacted immediately when the first signs of a developing disease appear. The specialist will conduct all the necessary studies and prescribe adequate treatment tactics.

Therapeutic therapy for vaginal candidiasis is carried out according to the basic principles:

Identify and eliminate the causes of the disease.
Normalize metabolism in the body.
Restore protective functions body.
Eliminate intestinal dysbiosis.
Normalize the acidity of the vaginal environment and its microflora.

After completing the course of treatment, the patient must be re-examined to rule out hidden current illness and establishing the fact of recovery.

Release forms and indications for use

In gynecology, Metronidazole is often prescribed to combat many diseases. The drug has wide range actions and is able to quickly improve the patient’s condition. Since Metronidazole is an antimicrobial and antibacterial drug, it is used in combination with antifungal agents to treat thrush.

And due to its helplessness against certain types of fungi, before prescribing it, it is necessary to carefully determine which pathogenic organism caused the disease.

Metronidazole is available in several forms:

Pills.
Cream.
Candles.
Solution.

The drug in tablet form is effective against the unpleasant manifestations of vaginal candidiasis. Tablets can also be taken by men against candidiasis, as well as the drug in gel form.

For women, it is more advisable to use the drug in the form of vaginal suppositories. The drug in the form of a solution in ampoules, used intravenously through droppers, is most often prescribed against pulmonary infections, gangrene and infections of the abdominal organs.

Metronidazole can be prescribed if a patient is diagnosed with:

Taking medication for various genital ailments

For bacterial vaginosis, the use of Metronidazole is the most optimal treatment method. The recommended dose is 0.5 g orally in tablet form, twice daily. The course of taking Metronidazole for bacterial vaginosis is at least a week.

Despite possible side effects from taking the drug and its absolute incompatibility with alcoholic beverages, bacterial vaginosis can be successfully treated and there is virtually no risk of transition bacterial vaginosis into more complex forms and stages.

In addition to the use of tablets, bacterial candidiasis is treated with gel. It is inserted into the vagina at least twice a day. The course of treatment is five days.

It is worth noting that for vaginosis, Metronidazole in tablet form is prescribed in the presence of related infectious diseases. In other cases, it is more advisable for women to undergo therapeutic therapy with vaginal suppositories.

In the case of acute form of trichomoniasis, a loading dose of the drug (2 g) is prescribed at a time. In some cases, for trichomoniasis, the following treatment regimen can be prescribed: 0.25 g twice a day, for a course of 10 days. Chronic trichomoniasis is treated according to the following regimen: 0.5 g of the drug, three times a day, for a course of 12 days.

If trichomoniasis is diagnosed in a woman during pregnancy, and the risk of complications of the disease is high, then starting from the second trimester of pregnancy, Metronidazole can be taken, 2 g once, before bedtime.

Complicated trichomoniasis, recurrent trichomoniasis, as well as in cases of carriage of trichomoniasis, the drug is prescribed according to the following regimen: 0.5 g three times a day, for at least 12 days. During the treatment of trichomoniasis with Metronidazole, you must completely stop drinking alcohol.

For therapeutic therapy against Giardia, the dosage of a single dose is from 0.5 to 1.5 g, for a course of up to 5 days.

For patients diagnosed with gardnerellosis, Metronidazole is prescribed both topical application of the drug in the form of gel and suppositories, and oral administration tablets. The drug is used for gardnerellosis in the form of a gel or suppositories, mainly at night, introducing suppositories or gel into the vagina, and in case of acute course gardnerellosis, the drug is administered into the vagina several times a day, morning and evening.

In the form of tablets, the remedy for gardnerellosis is prescribed twice a day. Due to Metronidazole's ability to destroy the DNA of anaerobic microorganisms, it is quite effective against this disease. The drug has a high permeability and accumulates not in the blood, but in the area where pathogens accumulate. The drug is eliminated through the kidneys.

Ureaplasmosis can also be treated with the drug Metronidazole. The drug against ureaplasma is used mainly in the form of tablets. The method of using Metronidazole against ureaplasma differs from the treatment of other diseases. Take the tablet exclusively during meals, with a glass of milk. Taking the medicine on an empty stomach with water is strictly prohibited. It is also prohibited to break or bite the tablets. Side effects when treating ureaplasma with Metronidazole:

During treatment, it is important to consider that simultaneous use of Metronidazole with alcoholic beverages leads to adverse consequences.

Treatment of chlamydia is also carried out with Metronidazole, but in this case, parallel administration of amoxicillin is often prescribed. The fact is that chlamydia quickly adapts to Metronidazole, and joint reception The use of two drugs ensures an enhanced effect of both drugs, eliminating the development of bacterial adaptation to metronidazole, making treatment against chlamydia more effective.

Side effects of Metronidazole in the treatment of chlamydia:

If you discover one of the above symptoms, it is recommended to immediately inform the specialist who prescribed the treatment.

Vaginal suppositories Metronidazole for thrush are prescribed only in combination with antifungal drugs, because they are not effective against some fungi that cause candidiasis. Suppositories have many contraindications for use, and, in case of hypersensitivity to the drug, the suppositories are replaced with a gel, which is used topically on the external genital organs to relieve the unpleasant symptoms of candidiasis.

Important! The drug Metronidazole is contraindicated for the treatment of women during pregnancy and breastfeeding!

Preparations in the form of suppositories containing the substance

Treatment of diseases genitourinary system It is more advisable to carry out locally, using vaginal suppositories.

The most popular drugs in the form vaginal suppositories containing the antiseptic metronidazole are:

Metronidazole suppositories;
Metrovit;
Metrovagin.

The drugs are used in the form of vaginal suppositories once a day, mainly at night. The course of treatment is, on average, ten days. A specialist, a gynecologist, can re-prescribe the course of treatment no earlier than a month later.

Despite the local use of drugs, they are contraindicated during pregnancy and breastfeeding. Their use is also not recommended in cases of blood and central nervous system diseases. An important condition when treating with these drugs is complete failure from drinking even the weakest alcoholic beverages.

Side effects during treatment with drugs in the form of vaginal suppositories can occur from the genitourinary, digestive and nervous systems.

The effectiveness of treatment with drugs containing metronidazole increases when they sharing with vaginal suppositories containing nystatin. These medications are prescribed in the first half of a woman’s menstrual cycle, after her menstrual period. During treatment, it is necessary to limit visiting pools, ponds and taking baths. It is also worth refusing to douching.

When carrying out therapeutic therapy for diseases of the genital area, it is necessary to jointly examine and treat the patient’s sexual partner.

How are iodine and thrush related: the drug Betadine for thrush

Thrush is one of the most common diseases in the world. Every second woman encounters it in her life.

Uncontrollably reproducing fungi of the genus Candida albicans - this is the definition given to us by the scientific community. And they multiply uncontrollably because the normal microflora is disrupted, where this fungal growth depends on the activity of other microorganisms. There are many theories as to why this happens. Here are the main ones:

The theory of reduced immunity

The fact is that when immunity decreases, an imbalance of microorganisms in the body occurs, which causes the growth of those infections that in large quantities cause harm to the body - these microorganisms are classified as opportunistic flora.

One of the components of such flora is a fungus. Diseases that reduce immunity are all chronic diseases of organs and systems (chronic pyelonephritis, gastritis, pancreatitis, blood disease, HIV, chronic untreated infections (chlamydia, gonorrhea, trichomoniasis).

Taking antibiotics also disrupts the functioning of the immune system, as it kills beneficial flora in the intestines. Next, dysbiosis develops and the production of protective cells of the immune system stops.

Theory of hormonal disorders

When the functioning of one organ of the endocrine system is disrupted, the vaginal microflora becomes acidified or alkalized, which also affects the ability of some microorganisms to survive. This is how Candida fungus develops in an acidic environment.

It has also been proven that progesterone and its increased level can acidify the flora in the vagina, which is what happens during pregnancy.

Allergy theory

With allergies, there is also a violation immune status, besides this in acute period allergies, the body directs all its forces to respond to the allergen, probably due to this, the environment in the vagina changes.

In mind different mechanisms allergies and thrush occurs. Scientists have confirmed that women who suffer from allergies are also susceptible to frequent attacks of candidiasis.

The symptoms of thrush are quite specific:

At first glance, thrush cannot cause much trouble other than discomfort, which sometimes goes away on its own (in the case of premenstrual candidiasis). But the whole problem lies deeper.

It often happens that when improper treatment, thrush turns into recurrent candidiasis, that is, into its chronic form, which becomes much more difficult to cure. Chronic thrush is dangerous because it can progress to neighboring organs and cause a kind of inflammation there. And this is one of the common causes of infertility.

To clarify the diagnosis, he will take a smear on the microflora, where Candida fungi should be sown. Next, he will prescribe a treatment that is right for you.

During treatment, the following recommendations should be strictly followed:

There are a huge variety of drugs that treat thrush, but, as a rule, they contain one of the following active ingredients: Clotrimazole, Isoconazole, Nystatin, Natamycin, Miconazole.

Often women also resort to alternative medicine, using: douching with hydrogen peroxide, douching with decoctions medicinal herbs, honey and other means. So, someone treats the vagina sea buckthorn oil, someone buys Malavit drops, for some the doctor prescribes a drug based on iodine.

Betadine is a drug that is active active substance which is povidone-iodine, which gives the drug the right to be listed as an antiseptic. Betadine has a wide spectrum of action against pathogens, fungi and viruses.

The fact is that when it enters the vaginal mucosa, it binds to yeast cells and kills them.

The drug Betadine is available in the form of suppositories for vaginal administration and an aerosol for topical treatment.

Betadine suppositories are also prescribed for colpitis caused by infections such as staphylococci, streptococci, shigella, E. coli and others.

Betadine also has bactericidal properties, destroying bacterial proteins and thereby inactivating the enzymes of harmful microorganisms.

This allows doctors to prescribe these suppositories not only for thrush, but also for vulvovaginitis of various etiologies.

Indications:

Candidiasis
Bacterial vaginosis
Trichomoniasis
Vaginitis of mixed and specific type
Genital herpes
Betadine suppositories are often prescribed as a prophylaxis against infectious diseases before surgery.

Method of using Betadine suppositories for thrush

As a rule, these suppositories are prescribed in a course of 7 days, 1 tablet 2 times a day. And in some cases, all 14 days, depending on the symptoms and the body’s reaction to this drug.

During pregnancy, Betadine for thrush is prescribed in the first trimester; after 12 weeks, taking the drug is unsafe for the fetus.

Often, to improve the effect, in combination with local treatment, antifungal drugs are prescribed orally.

When taking suppositories, it is necessary to place material in the form of a thick pad, since suppositories become liquid at temperature and flow out of the vagina. Iodine is practically not absorbed through the vagina and does not enter the general bloodstream.

Contraindications:

Disorders associated with the thyroid gland;
Allergy to iodine;
Pregnancy 2nd and 3rd trimester and lactation;
Age up to 8 years;
Dühring's dermatitis;
Kidney failure.

If dryness, increasing swelling of the mucous membrane, or increased discharge occurs, you should immediately stop taking the suppositories and consult a doctor.

How to get rid of thrush forever?

it is necessary to pay attention to the status of your immunity while treating all diseases before they become chronic;
monitor your diet, do not break your diet (consume sweets, fatty foods in moderation, salty foods, canned food, give preference fresh fruit and vegetables);
reduce the use of synthetic pads to a minimum, as they create a greenhouse effect, and this is a favorable environment for the growth of fungus;
during the reception antibacterial therapy, in parallel, you should start taking probiotics for proper operation intestines and, accordingly, vaginal flora;
strictly follow the instructions of the doctor who prescribed treatment for thrush.

This place is their main and usual habitat, however, its increased reproduction can lead to disruption of the normal state of the microflora and the manifestation of typical symptoms in the gastrointestinal tract.

Thrush and dysbacteriosis can develop with:

Immunodeficiency.
Oncological diseases.
Unbalanced, poor-quality and unhealthy diet.
Antibiotic therapy.

Thrush or intestinal dysbiosis manifests itself without severe depression of the body. Light form thrush can occur in cases of severe immune dysfunction. Symptoms of a mild form of dysbiosis include:

Diarrhea.
Flatulence.
Often and poorly formed stools in the presence of whitish cheesy flakes.
Discomfort and pain in the abdomen, and constant feeling incomplete emptying.

In the case of a severe form of candidal dysbiosis, damage to parts of the intestine begins, which provokes the appearance of ulcerative pathological processes. In some cases, there may be blood and mucus impurities in the stool.

During the period of exacerbation of candidal dysbiosis, patients begin to experience manifestations that are similar to indigestion, accompanied by diarrhea. Mostly thrush can be confused with indigestion.

In general, the intestinal form of candidiasis can be characterized by lesions outer surface, and if there is no treatment, Candida will cause a chronic course with functional changes in the activity of the liver, kidneys and heart.

In the process of treating thrush and dysbiosis, drugs are prescribed that are not adsorbed in the intestinal lumen.

Various types of antimycotic agents have a systemic effect and are used orally and intravenously for candidiasis. However, they can be almost completely adsorbed from the upper gastrointestinal tract, which is why they cannot reach the ileum, where the greatest development of Candida occurs. In addition, such remedies for thrush and dysbiosis have some side effects.

Nystatin, Levorin, Pimafucin can act as non-absorbing agents for the treatment of candidiasis and dysbiosis. Although they often give side effects for thrush, they are not absorbed from the gastrointestinal tract. It is worth noting that the use of such medications can cause an allergic reaction and toxic liver damage.

Therapy in the event of the appearance of candidal dysbiosis is aimed at eliminating risk factors and restoring the main microflora. Products are prescribed that contain bifidobacteria and reduce the growth of pathogenic fungi in stool. In addition, in case of thrush and dysbacteriosis, they can create conditions to ensure natural reproduction and biological restoration of the balance of microflora, providing replenishment of the epithelial layer of the mucosa.

In the process of choosing a treatment method for thrush, you need to remember about the treatment of the underlying disease, as well as correction during the individual selection of antifungal agents.

Fungal dysbiosis

Such a violation of the intestinal microflora can be provoked by:

Treatment with immunodeficiency, immunosuppressive, antimetabolic and antibiotic drugs.
Immunodeficiency state.
Serious metabolic disorders.
Oncological neoplasms.
Candida fungi.

Signs that indicate the onset of thrush in the gastrointestinal tract include changes in stool structure, watery diarrhea alternating with constipation, bloating, excessive gas, a feeling of fullness, itching or eczema around the anus. Manifestations of fungal dysbiosis in the form of weakness, apathy, fatigue, metallic taste in the mouth and unbridled desire and appetite for sweets.

Impact medications When treating fungal dysbiosis, it should be supported by proper nutrition. Its purpose is to prevent further development of infection and supplement the deficiency of vitamins and minerals.

From medications for thrush and dysbiosis, pro- and prebiotics are prescribed, which help restore the normal state of intestinal microflora, as well as antibacterial agents to get rid of fungus. In addition, therapeutic and cleansing enemas with solutions of medicinal herbs can be prescribed.

In the diet for fungal dysbiosis, the consumption of alcoholic beverages, coffee, and black tea is prohibited. Preference should be given to mineral waters, which will help the body eliminate toxins released in fairly large quantities during thrush.

In addition, you should refuse all flour products, monosaccharides, disaccharides, which are obtained from fruits and dairy products. The basis of the diet for fungal intestinal dysbiosis should be fresh vegetables and foods containing oligosaccharides. Eating meat is allowed low-fat variety, fish and seafood. Of the legume products that can be included in the diet, only dietary varieties, for example, chickpeas, soybeans, lentils, etc.

In some cases, depending on the course of fungal dysbiosis, repeated courses may be prescribed. Maintenance therapy may also be prescribed.

Dysbacteriosis and thrush

Dysbacteriosis, or dysbiosis, is a pathology that is controversial. Many experts claim that detailed illness does not exist, but dysbiosis in the intestines or vagina is accompanied unpleasant symptoms, significantly worsening the quality of life. Dysbiosis can provoke the development of other ailments, which include thrush or candidiasis.

What will the article tell you?

The concept of dysbiosis, types and causes of occurrence

The scientific name of dysbiosis is bacterial overgrowth syndrome. The essence of the pathology is that when unfavorable factors there is a violation of the optimal balance between beneficial microflora and opportunistic microflora.

Conditionally pathogenic flora (fungi, E. coli) is present in the intestines and vagina of women, but its quantity is negligible, and there is no negative effect on the body. When the body is weakened, poor nutrition, or taking potent medications, the balance is disrupted, opportunistic microorganisms begin to actively displace and replace the beneficial flora, causing a number of unpleasant symptoms:

indigestion - bloating, heaviness in the abdomen, flatulence;
bowel dysfunction - constipation and diarrhea, replacing each other;
pain syndrome - pain of a spastic or pulling nature, localized in the navel area and below;
from the reproductive system - discharge, itching, burning, development of concomitant diseases;
general weakness and malaise.

Depending on the location of dysbiosis, it can be:

intestinal - activation of pathogenic flora in the small intestine;
vaginal - bacterial vaginosis.

Thrush as a consequence of vaginal dysbiosis

Many gynecologists claim that genital candidiasis in women is the same as dysbiosis. This opinion is incorrect: with thrush, the causative agent is a fungus of the genus candida, and with dysbacteriosis, there may be several pathogens (staphylococcus, E. coli, Protea).

With candidiasis, a rapid spread of fungal flora occurs, displacing beneficial lacto- and bifidobacteria. Depending on the severity of the disease, the fungus can account for up to 90% of the entire vaginal biocenosis. For comparison: the optimal vaginal biocenosis includes up to 90% lactic acid bacteria and up to 10% bifidobacteria. Opportunistic microorganisms account for less than 1%.

Thrush often develops against the background of vaginal dysbiosis as a consequence of weak local immunity and lack of protection in the form of lactic acid synthesized by Dederlein bacilli.

Symptoms of vaginal dysbiosis, aggravated by candidiasis:

discomfort in the vagina in the form of burning and itching, aggravated by urination and sexual intercourse;
pain in the lower abdomen (pulling nature);
discharge - thick yellow or white, with a sour odor;
menstrual irregularities.

The relationship between intestinal dysbiosis and thrush

Intestinal dysbiosis and thrush are interrelated; long-term dysbiosis in the small intestine often leads to problems with the reproductive system. In women suffering from intestinal dysbiosis, genital candidiasis is often diagnosed. The reasons are obvious:

with excessive bacterial growth in the intestines, the entire body is weakened, and as a result, the fungal flora is activated;
bacteria from the intestines can enter a woman’s genital tract due to poor hygiene and anatomical features.

Dysbacteriosis and thrush in infants

Every third newborn and infant is diagnosed with dysbacteriosis. The intestinal form is characteristic, accompanied by symptoms:

increased gas formation and flatulence;
attacks of intestinal colic;
loose stools with inclusions in the form of green or yellow mucus;
V severe cases streaks of blood may appear in the stool;
poor appetite, regurgitation and lack of weight gain.

Infants suffering from intestinal dysbiosis often develop oral thrush. Candidiasis is represented by white round spots on the tongue, gums, and upper palate. The reason for the appearance is fungal flora.

Thrush from dysbacteriosis in newborns develops due to unformed microflora in the intestines - specific gravity beneficial bacteria in the first months of life is small, the content of opportunistic microorganisms and fungi is much higher. Candida fungi enter the oral cavity from the intestines, causing a local inflammatory reaction.

As the gastrointestinal tract is populated with the “correct” microorganisms, dysbiosis disappears, and the risk of developing candidiasis becomes minimal. To speed up the colonization process beneficial microorganisms, pediatricians prescribe appropriate medications - children's Linex, Bifiform, Hilak-Forte.

Treatment tactics and prevention

Dysbacteriosis and thrush are treated comprehensively by gynecologists; there are a number of medications that can defeat both ailments. Preliminary diagnosis is necessary to identify specific microorganisms that caused the pathogenic process along with candida fungi. The selection of drugs is made taking into account the sensitivity of microbes and the severity of the disease.

When treating dysbiosis aggravated by thrush, you should avoid taking antibiotics - taking them will only worsen the situation. Opportunistic pathogenic flora and fungi can be replaced by preparations containing eubiotics and probiotics. It is possible to take antiseptics.

In the treatment of bacterial vaginosis and candidiasis, suppositories for topical use are popular. The advantage is the rapid penetration of the active ingredients to the site of inflammation, with a minimum of side effects.

The most effective suppositories for thrush and vaginal dysbiosis:

Vaginorm-S - suppositories with antiseptic and antifungal effects, due to the content of ascorbic acid increases local immunity, beneficial microflora is gradually restored;
Vagilak - suppositories containing lactobacilli and lactic acid streptococcus; the drug is prescribed for mixed infections, bacterial vaginosis and candidiasis;
Acylact - suppositories with increased content lactobacilli, the drug is safe and is prescribed even to pregnant women;
Terzhinan - tablets for vaginal use with an antimicrobial effect, capable of suppressing the growth of opportunistic microbes and fungi.

In the presence of an intestinal form of dysbiosis, treatment is carried out by oral administration of eubiotics - Linex, Bifidumbacterin, Normobact, Acipol. Eubiotics for oral administration will be useful in complex treatment thrush, reducing the risk of relapse and speeding up recovery.

Compliance with preventive measures will help avoid the development of diseases:

a balanced diet including fermented milk products will help maintain optimal biocenosis in the body;
Taking antibiotics to treat various diseases should only be done as prescribed by a doctor simultaneous administration pro- and prebiotics;
compliance with the rules of personal hygiene, including intimate hygiene;
reasonable sex life, with a regular partner and the use of contraception;
promptly seek medical help for any suspicious discharge or discomfort in the genital tract.

Various forms of dysbiosis and thrush are unpleasant diseases, so treatment should not be ignored. With timely and accurate diagnosis, both ailments can be successfully treated without leaving any adverse health consequences.

Is there a connection between intestinal dysbiosis and thrush?

Fungi of the genus candida are quite widespread in nature and enter the human body due to their contamination in food, water, and also in surrounding objects.

It should be noted that a person is constantly faced with the causative agent of intestinal candidiasis, but the disease manifests itself only in those who have a weaker immune system and cannot “cope” with the infection.

Forms of the disease "thrush"

As a rule, the owner of intestinal candidiasis is a transient carrier, and he does not have any obvious signs of this disease. If the immune system cannot cope with the pathogen, active reproduction of yeast fungi occurs and their spread to other organs and tissues.

Many experts argue that the main reason for the widespread prevalence of intestinal candidiasis is the current achievements of scientists in the field of treatment of cancer, including in the field of treatment of bacterial infections.

Candidiasis of the gastrointestinal tract can occur in several forms.

The next form of candidiasis is intestinal focal candidiasis. This type of candidiasis is a secondary process in the presence of a peptic ulcer of the tract (duodenum) or in the presence of ulcerative colitis, which causes a violation of the integrity of the epithelium and, as a result, invasive candidomycosis.

Causes of intestinal candidiasis

Most often, intestinal (non-invasive) candidiasis is caused by an unbalanced, poor-quality and unhealthy diet.

It is also known that certain foods can further promote yeast growth. These are usually products that are made with yeast or fermentable products. It could be beer, flour, sweets, carbonated sweet water, etc.

Also, developing candidiasis of this type in the intestines can be a consequence of treatment with antibiotics, the result of their long-term use without timely consultation with a doctor.

Also, candidiasis developing in the intestines may be a consequence of the presence of other diseases. This can be an ulcer and ulcerative diseases, frequent colitis and dysbacteriosis.

Also, candidiasis developing in the intestines can be a consequence of any internal chronic diseases or diabetes. Most often, in young girls, candidiasis (thrush) in the intestines, and as a result, dysbiosis, is a consequence of the use of drugs containing hormones.

Main symptoms of the disease

Deterioration of the condition is already a cause of panic, since this may be a signal of the presence of some disease or infection, including manifestations of thrush.

How does candidiasis actively developing in the intestines manifest? The symptoms of this disease depend on the type of candidiasis that develops.

Invasive candidiasis in the intestines has the following symptoms: as a rule, these are frequent flatulence, diarrhea, dysbacteriosis, bad stool mixed with whitish cheesy discharge (can also be in the form of white “flakes”), discomfort and pain in the abdominal area and a feeling of incomplete emptying intestines (heaviness in the anus).

Treatment of candidiasis

It is possible to eliminate dysbacteriosis and dermatitis in adults and children that arise as a result of the disease if you take antifungal drugs. You should not use ketoconazole, itraconazole, fluconazole, amphotrecin B, since they are all adsorbed in the upper sections, not reaching the localization of the fungus.

When treating both adults and children over 3 years old, it is necessary to adhere to a diet.

Eliminate sugar, sweets, alcohol, flour, crackers, chips, pork, bacon, crackers, and spices from your diet. It is better to eat as much fresh fruits and vegetables, eggs, and yoghurt as possible.

In infants, the manifestations of perianal dermatitis can be eliminated by local treatment, for which the drugs dexpanthenol, ointments with zinc, and antiseptics are used. You can also make baths from string, chamomile and oak bark. But, such treatment is only effective if the infection is also treated in the intestines. Do not self-medicate your child; seek help from a pediatrician.

Thrush is a disease that gets its name from its main symptom - intense white cheesy discharge that occurs as a result of the inflammatory process of the vaginal mucosa. The inflammatory process is provoked by yeast-like fungi of the genus Candida.

The symptoms of the disease do not always manifest themselves, but if the intensity of yeast growth increases, candidiasis manifests itself quite clearly.

Establishing diagnosis
Preparations in the form of suppositories containing the substance

Establishing diagnosis

Diagnosis and treatment of the disease is carried out by a specialist in the field of gynecology, a gynecologist. The main unpleasant signs of vaginal candidiasis are:

Itching and burning sensation in the perineum.
Leucorrhoea that increases after sexual intercourse and showering, has a cheesy, heterogeneous consistency and a sour odor.
Swelling and redness in the external genital area.
Painful sensations during sexual intercourse and during urination.

Thrush that has become chronic is more difficult to cure, and it often leads to secondary diseases of the genital area.

There are many reasons leading to the occurrence of the disease:

Hormonal imbalance, including due to a woman taking inadequately selected oral contraceptives.
Treatment with antibiotics.
Decreased immune functions of the body.
Metabolic disorders in a woman's body.
State of pregnancy.
Consumption by woman large quantity sweets.
Synthetic underwear that does not allow air or moisture to pass through.
Washing the external genitalia too often.
Personal hygiene products containing aggressive ingredients.

Therapeutic therapy for vaginal candidiasis is carried out according to the basic principles:

Identify and eliminate the causes of the disease.
Normalize metabolism in the body.
Restore the body's protective functions.
Eliminate intestinal dysbiosis.
Normalize the acidity of the vaginal environment and its microflora.

After completing the course of treatment, the patient must undergo a re-examination to exclude the latent course of the disease and establish the fact of recovery.

Release forms and indications for use

In gynecology, Metronidazole is often prescribed to combat many diseases. The drug has a wide range of actions and is able to quickly improve the patient's condition. Since Metronidazole is an antimicrobial and antibacterial drug, it is used in combination with antifungal agents to treat thrush.

And due to its helplessness against certain types of fungi, before prescribing it, it is necessary to carefully determine which pathogenic organism caused the disease.

Metronidazole is available in several forms:

The drug in tablet form is effective against the unpleasant manifestations of vaginal candidiasis. Tablets can also be taken by men against candidiasis, as well as the drug in gel form.

Metronidazole can be prescribed if a patient is diagnosed with:

Taking medication for various genital ailments

Despite the possible side effects of taking the drug and its absolute incompatibility with alcoholic beverages, bacterial vaginosis can be successfully treated and there is virtually no risk of bacterial vaginosis developing into more complex forms and stages.

In addition to the use of tablets, bacterial candidiasis is treated with gel. It is inserted into the vagina at least twice a day. The course of treatment is five days.

For therapeutic therapy against Giardia, the dosage of a single dose is from 0.5 to 1.5 g, for a course of up to 5 days.

For patients diagnosed with gardnerellosis, Metronidazole is prescribed both topical use of the drug in the form of gel and suppositories, and oral tablets. The drug is used for gardnerellosis in the form of a gel or suppositories, mainly at night, introducing suppositories or gel into the vagina, and in the case of acute gardnerellosis, the drug is administered into the vagina several times a day, morning and evening.

The term “Dysbacteriosis” comes from the Greek “dys”, which means “negation” and the words “bacteria”, “bacteria or microorganism”. Intestinal dysbiosis is a quantitative and qualitative disturbance of the normal intestinal flora. The human intestine is populated by bacteria, about 2/3 of the contents are thick and small intestine represented by microorganisms. A certain quantity and quality of such microorganisms constitute the normal intestinal microflora. Normal intestinal flora is a biomass of obligate (obligatory) microbes involved in the development of immunity. With intestinal dysbacteriosis, there is a disruption in the development of immunity, the colonization of foreign microorganisms, and the development of putrefactive flora instead of the normal one. As a result, putrefactive flora causes chronic inflammation intestines, with characteristic clinical manifestations. An imbalance between microorganisms is the background for the development of various intestinal diseases (the most dangerous, intestinal cancer).

Anatomy and physiology of the intestine

In order to understand in which anatomical structures dysbiosis occurs, let’s talk a little about the anatomy of the intestine.

The intestine is the longest section of the digestive tract, located in the abdominal cavity, originating from the pylorus of the stomach and ending in the anus. The length of the entire intestine is about 4 meters. It is divided into the small intestine and the large intestine, each of which has its own anatomical features.

Small intestine, is the initial section of the intestine, consists of loops, longer than the thick one (from 2.2 to 4.4 m) and smaller in diameter (from 5 to 3 cm). The processes of digestion of proteins, fats and carbohydrates take place in it. The small intestine begins at the pylorus of the stomach and ends at the ileocecal angle. The small intestine is divided into 3 sections:

The initial section is the duodenum, starts from the pylorus of the stomach, has the shape of a horseshoe, goes around the pancreas;
The jejunum is a continuation of the duodenum, it makes up approximately the initial 6-7 loops of the small intestine, the border between them is not pronounced;
The ileum is a continuation of the jejunum and is represented by the following 7-8 loops. It ends at a right angle into the initial part of the large intestine (cecum).

Colon, is the final section of the digestive tract, where water is absorbed and formed feces are formed. It is located so that it borders (surrounds) the loops of the small intestine. Its wall forms protrusions (haustra), which is one of the differences from the wall of the small intestine. The length of the large intestine is about 150 cm and the diameter is from 8 to 4 cm, depending on the section. The large intestine consists of the following sections:

The cecum with the appendicular process is the initial section of the large intestine, located below the ileocecal angle, its length is from 3 to 8 cm;
Rising part colon, is a continuation of the cecum, occupies the extreme right lateral position of the abdominal cavity, rises up from the level of the ilium to the level of the lower edge of the right lobe of the liver, and ends with the right flexure of the colon;
The transverse colon starts from the right flexure of the colon (level of the right hypochondrium), passes in the transverse direction and ends with the left flexure of the colon (level of the left hypochondrium);
The descending part of the colon occupies the extreme left lateral position of the abdominal cavity. Starts from the left flexure of the colon, goes down to the level of the left ilium;
The sigmoid colon, 55 cm long, is a continuation of the previous section of the intestine, and at the level of the 3rd sacral vertebra it passes into the next section (rectum). The diameter of the sigmoid colon, compared with the diameter of the rest of the large intestine, is the smallest, about 4 cm;
The rectum, is the final section of the large intestine, has a length of about 18 cm. It starts from the level of the 3rd sacral vertebra (end of the sigmoid colon) and ends with the anus.

What is normal intestinal flora?

The human intestines contain microbes that are vital to the human body. The approximate amount of normal intestinal flora is about 10 14 microbes, which corresponds to 2 kilograms and includes about 500 species of bacteria. The concentration of microbes in different parts of the intestine is not the same: in the duodenum and jejunum there are about 10 5 microorganisms in 1 ml of intestinal contents, in the ileum about 10 7 - 10 8, in the large intestine about 10 11 microorganisms in 1 g of feces.
Normally, the intestinal flora is represented by 2 groups of bacteria:

Obligatory bacteria bifidobacteria (comprise about 85-95% of the flora), lactobacilli (1-5% of the flora), Escherichia coli (Escherichia), enterococci, peptostreptococci) are always part of the normal flora;
Facultative bacteria (peptococci, staphylococci, yeast-like fungi, clostridia and others), they are optional and non-permanent representatives. They enter the intestines with insufficiently thermally processed food. This group of bacteria is often present in healthy people without causing any problems, but when immunity decreases, they multiply and develop various infectious intestinal diseases.

Normal composition of bacteria in the intestines

bifidobacteria – 10 9 - 10 10 CFU/g;
lactobacilli – 10 7 – 10 8 CFU/g;
bacteroids – 10 7 – 10 9 CFU/g;
Escherichia – 10 6 – 10 8 CFU/g;
peptococci and peptostreptococci – 10 5 – 10 6 CFU/g;
eubacteria – 10 3 – 10 5 CFU/g;
staphylococci - 10 3 CFU/g;
streptococci – 10 4 – 10 5 CFU/g;
clostridia – 10 5 – 10 7 CFU/g;
yeast-like mushrooms – 10 9 – 10 10 CFU/g;
opportunistic enterobacteria - 10 3 CFU/g.

Functions of normal intestinal microflora

Protective function is to prevent the colonization of foreign microorganisms in the intestines, which can cause various infectious intestinal diseases. Microbes (bifidobacteria) of the normal intestinal flora produce special substances (lactic and acetic acid) that suppress the development of foreign microbes. In order for foreign bacteria to gain a foothold on the intestinal mucosa, they need to displace the normal flora, but the latter prevent this process, since the place is already “occupied.”
Immune stimulation, due to bifidobacteria, is to stimulate the formation of antibodies and other substances (cytokines, interferons) involved in the development of immunity.
Removal of toxins (detoxification function), consists in the absorption of various toxins (phenols, heavy metal compounds and others) by bifidobacteria of the intestinal flora.
Digestive function, bacteria of the intestinal flora are involved in the breakdown of proteins, fats, carbohydrates, into amino acids, fatty acids and monosaccharides. They also enhance intestinal motility, preventing the development of constipation.
synthesis function, Bacteria of normal intestinal flora are involved in the formation of vitamins (B, K, C), some acids, and enzymes.
Regulatory function those. flora bacteria regulate the gas composition of the intestines, water-salt metabolism, cholesterol and others.
Anticarcinogenic (anticancer) effect, consists in the absorption of precursors by bifidobacteria cancer cells.
Antiallergic effect, occurs with the help of lactobacilli.

Symptoms of intestinal dysbiosis

The 1st degree and most often the 2nd degree of intestinal dysbiosis do not manifest themselves clinically.
Symptoms characteristic of 3rd and 4th degree intestinal dysbiosis:

Abnormal stool:

Most often it manifests itself in the form loose stool(diarrhea), which develops as a result of increased formation of bile acids and increased intestinal motility, inhibit water absorption. Later, the stool becomes unpleasant, putrid odor, mixed with blood or mucus;
With age-related (in older people) dysbiosis, constipation most often develops, which is caused by a decrease in intestinal motility (due to a lack of normal flora).

Bloating, due to increased formation of gases in the large intestine. The accumulation of gases develops as a result of impaired absorption and excretion of gases by the altered intestinal wall. A swollen intestine may be accompanied by rumbling and cause unpleasant sensations in the abdominal cavity in the form of pain.
Cramping pain associated with an increase in pressure in the intestines, after the passage of gas or stool, it decreases. With dysbacteriosis of the small intestine, pain occurs around the navel; if the large intestine suffers, the pain is localized in the iliac region (lower abdomen on the right);
Dyspeptic disorders: nausea, vomiting, belching, loss of appetite are the result of impaired digestion;
Allergic reactions, in the form of itchy skin and rashes, develop after consuming foods that usually do not cause allergies, is the result of insufficient antiallergic action, disturbed intestinal flora.
Symptoms of intoxication: there may be a slight increase in temperature up to 38 0 C, headaches, general fatigue, sleep disturbance, are the result of the accumulation of metabolic products (metabolism) in the body;
Symptoms characterizing vitamin deficiency: dry skin, seizures around the mouth, pale skin, stomatitis, changes in hair and nails and others.

Complications and consequences of intestinal dysbiosis

Chronic enterocolitis, is a chronic inflammation of the small and large intestines that develops as a result long acting pathogenic intestinal flora.

Deficiency of vitamins and microelements in the body, leads to the development of iron deficiency anemia, hypovitaminosis of B vitamins and others. This group of complications develops as a result of impaired digestion and absorption in the intestines.
Sepsis(blood infection), develops as a result of pathogenic flora from the intestines entering the patient’s blood. Most often, this complication develops when the patient does not seek medical help in a timely manner.
Peritonitis, develops as a result of the aggressive action of pathogenic flora on the intestinal wall, with the destruction of all its layers and the release of intestinal contents into abdominal cavity.
Addition of other diseases, as a result of decreased immunity.
Gastroduodenitis, pancreatitis, develop as a result of the spread of pathogenic intestinal flora, according to digestive tract.
Reducing the patient's weight, develops as a result of impaired digestion.

Diagnosis of intestinal dysbiosis

The diagnosis of intestinal dysbiosis is made based on the patient’s complaints, an objective examination and the results of microbiological examination of stool.

With help objective examination, which includes palpation of the abdomen, soreness is determined along the small and/or large intestine.
Microbiological examination of stool: carried out to confirm the diagnosis of intestinal dysbiosis.

Indications for microbiological examination of stool:

Intestinal disorders last a long time, in cases where it is not possible to isolate a pathogenic microorganism;
Long period of recovery after acute intestinal infections;
The presence of purulent-inflammatory foci that are not amenable to antibiotic therapy;
Impaired bowel function in individuals undergoing radiotherapy or exposure to radiation;
Immunodeficiency conditions (AIDS, cancer and others);
Lag infant V physical development and others.

Rules for collecting stool for microbiological research: before stool collection, 3 days before, it is necessary, it is necessary to be on special diet which excludes products that increase fermentation in the intestines (alcohol, dairy sour foods), as well as any antibacterial drugs. The feces are collected in a special sterile container equipped with a lid and a screwed-in spoon. To correctly evaluate the results, it is recommended to conduct the study 2-3 times, with an interval of 1-2 days.

Degrees of intestinal dysbiosis
There are 4 degrees of intestinal dysbacteriosis:

1st degree: characterized by a quantitative change in ischerichia in the intestine, bifidoflora and lactoflora are not changed, most often not clinically manifested;
2nd degree: quantitative and qualitative changes in ischerichia, i.e. a decrease in the amount of bifid flora and an increase in opportunistic bacteria (fungi and others), accompanied by local inflammation of intestinal areas;
3rd degree: change (decrease) in bifido and lactoflora and development of opportunistic flora, accompanied by intestinal dysfunction;
4th degree: the absence of bifid flora, a sharp decrease in lacto flora and the growth of opportunistic flora, can lead to destructive changes in the intestine, with the subsequent development of sepsis.

Treatment of intestinal dysbiosis

Drug treatment

Treatment of intestinal dysbacteriosis is carried out with the help of drugs that restore normal intestinal flora and correct other disorders in the body (using enzymes, sorbents, vitamins). The dosage, duration of treatment and group of drugs are prescribed by the attending physician, depending on the degree of dysbacteriosis. Below are the dosages of drugs for adults; for children, the dosage depends on the weight and age of the child.
Groups of drugs used for intestinal dysbiosis:

Prebiotics- have a bifidogenic property, i.e. contribute to the stimulation and growth and reproduction of microbes that are part of the normal intestinal flora. Representatives of this group include: Hilak-forte, Duphalac. Hilak-forte is prescribed 40-60 drops 3 times a day.
Probiotics (eubiotics), these are preparations containing living microorganisms (i.e. bacteria of normal intestinal flora), they are used to treat grade 2-4 dysbiosis.

1st generation drugs: Bifidumbacterin, Lifepack probiotics. They are liquid concentrates of lactobacilli and bifidobacteria and are not stored for long (about 3 months). This group of drugs is unstable under the influence of gastric juice or enzymes of the gastrointestinal tract, which leads to their rapid destruction and the intake of insufficient concentrations, the main disadvantage of 1st generation probiotics. Bifidumbacterin is prescribed orally, 5 doses of the drug 2-3 times a day, 20 minutes before meals;
2nd generation drugs: Bactisubtil, Flonivin, Enterol. They contain spores of bacteria of normal intestinal flora, which in the patient’s intestines secrete enzymes for the digestion of proteins, fats and carbohydrates, stimulate the growth of bacteria of normal intestinal flora, and also suppress the growth of putrefactive flora. Subtil is prescribed 1 capsule 3 times a day, 1 hour before meals;
3rd generation drugs: Bifikol, Linex. They consist of several types of bacteria of the normal intestinal flora, therefore they have high efficiency, compared to the previous 2 generations of probiotics. Linex is prescribed 2 capsules 3 times a day;
4th generation drugs: Bifidumbacterin forte, Biosorb-Bifidum. This group of drugs consists of bacteria of normal intestinal flora in combination with an enterosorbent (with activated carbon or others). Enterosorbent is necessary to protect microorganisms when passing through the stomach, it actively protects them from inactivation by gastric juice or enzymes of the gastrointestinal tract. Bifidumbacterin forte is prescribed 5 doses 2-3 times a day, before meals.

Symbiotics(Bifidobac, Maltodophilus) , represent combination drugs(prebiotic + probiotic), i.e. simultaneously stimulate the growth of normal flora and replace the missing number of microbes in the intestines. Bifidobac is prescribed 1 capsule 3 times a day, with meals.
Antibacterial drugs, are used for the 4th degree of intestinal dysbiosis, to destroy pathogenic flora. The most commonly used antibiotics are: tetracyclines (Doxycycline), cephalosporins (Cefuroxime, Ceftriaxone), penicillins (Ampiox), nitroimidazoles: Metronidazole, prescribed 500 mg 3 times a day, after meals.
Antifungal drugs(Levorin) , are prescribed if there are yeast-like fungi such as Candida in the stool. Levorin is prescribed 500 thousand units 2-4 times a day.
Enzymes, are prescribed in case of severe digestive disorders. Mezim tablets, 1 tablet 3 times a day, before meals.
Sorbents, are appointed when pronounced signs intoxication. Activated carbon is prescribed 5-7 tablets at a time, for 5 days.
Multivitamins: Duovit, 1 tablet 1 time per day.

Diet for intestinal dysbiosis

Diet therapy is important point in the correction of intestinal flora. In case of intestinal dysbiosis, first of all, it is necessary to exclude the use of alcoholic beverages, acute, fatty foods, smoked meats and products that enhance fermentation processes in the intestines: sweets (cakes, candies, and others), homemade pickles, sauerkraut. Secondly, you need to eat fractionally, at least 4 times a day. Try not to drink water while eating, because it dilutes gastric juice and the food is not digested enough. Eliminate from the diet foods that increase flatulence (gas formation) and intestinal motility: legumes (beans, peas, soy and others), bran bread, carbonated drinks. It is necessary to increase the amount of protein in the diet through boiled or stewed meat (lean). Try not to eat fresh bread, dry it a little before using.

Try to cook all food with herbs (parsley, dill and others), as it enhances the effect of normal intestinal flora against pathogenic ones. Products that enhance the restoration of intestinal microflora include: wheat, rice, buckwheat, oats, fresh vegetables or salads, non-acidic fruits. Indispensable products for restoring normal intestinal microflora are all lactic acid products: kefir, fermented baked milk, yogurt and others. You can also use special products that are enriched with biocultures: yoghurts, biokefirs and others. Has excellent prebiotic properties applesauce, and it also has an astringent effect and is recommended for diarrhea. Before going to bed, it is recommended to drink a glass of kefir.

Prevention of intestinal dysbiosis

In first place in the prevention of intestinal dysbiosis is correct application antibiotics, which are one of the main causes of disruption of the normal flora. Antibiotics should be used strictly according to indications, after the results of a bacteriological examination with an antibiogram. In order to select the dose of an antibiotic for a particular patient, the attending physician must take into account the age and weight of the patient. Under no circumstances should you self-medicate by taking antibiotics for minor illnesses (for example, a runny nose). In cases where you have been prescribed long-term antibiotic therapy, you must take them in parallel with prebiotics, with periodic monitoring of the state of the intestinal flora (microbiological examination of stool).
In second place for the prevention of intestinal dysbiosis is a balanced diet and a rational regimen.

In third place are all acute and chronic diseases that lead to intestinal dysbiosis, primarily diseases of the gastrointestinal tract. General strengthening therapy for patients with chronic diseases. Timely treatment Such diseases can reduce the number of patients with intestinal dysbiosis.

Persons who are exposed occupational hazards(radiation) should be included in your diet dairy products.

Is there any intestinal dysbiosis at all? Does such a disease exist?

Officially, such a diagnosis does not exist. Dysbacteriosis is not an independent disease, but always a consequence of some other diseases. In itself, a change in the composition of the intestinal microflora is not the main problem. Usually, once the underlying disease is cured, dysbiosis goes away on its own. If the symptoms continue to bother you, the person is not fully treated. In such a situation, it is pointless to continue the fight against dysbiosis - you need to look for the root cause.
Western doctors never give this diagnosis to their patients. IN Russian healthcare Dysbacteriosis is mentioned in the document entitled “Standards (protocols) for the diagnosis and treatment of diseases of the digestive system,” approved by order of the Ministry of Health of the Russian Federation No. 125 dated April 17, 1998. But even here it does not appear as an independent disease, but only in connection with other intestinal diseases .
Surely, when you took a blood test, you heard terms such as “increased leukocytosis”, “increased ESR”, “anemia”. Dysbacteriosis is something similar. This is a microbiological concept, one of the manifestations of the disease, but not the disease itself.

How is intestinal dysbiosis designated in the ICD?

International Classification of Diseases(ICD) is a document that lists all possible human diseases, each assigned its own code. In the ICD there is no such concept as dysbiosis. A doctor who makes such a diagnosis for a patient finds himself in a difficult situation - after all, he must indicate the code in the medical documentation.
Most often, such doctors use two codes: .
Sometimes dysbiosis is a temporary condition, for example, in travelers, especially if they have poor personal hygiene. “Foreign” microflora enters the intestines, which a person does not encounter at home.

Which doctor treats intestinal dysbiosis?

Since dysbiosis is not independent disease, then it is necessary to look for the original cause, and then begin treatment with an appropriate specialist.
Most often, diseases that lead to disruption of the intestinal microflora should be treated by an infectious disease specialist or gastroenterologist. A number of diseases are treated by a general practitioner in adults and by a pediatrician in children.

What is the best treatment for intestinal dysbiosis?

Since such a diagnosis does not exist, “treatment of dysbiosis” is a meaningless term, in principle.
Although, relevant recommendations still exist - they are specified in the OST 91500.11.0004-2003 standard. It was put into effect by Order of the Ministry of Health of the Russian Federation dated 06/09/2003 N 231. This document proposes to treat dysbacteriosis with the help prebiotics And eubiotics, antibacterial And antifungal drugs.
But the effectiveness of these drugs against dysbiosis has not been proven. In the same OST there is the following phrase: “the degree of persuasiveness of evidence is C.” This means that there is not enough evidence. There is no evidence on which to recommend treatment of dysbiosis with these drugs.
Here it is once again appropriate to remember that doctors who work in clinics outside the CIS never give such a diagnosis to their patients, much less prescribe treatment against dysbiosis.

Is there a connection between intestinal dysbiosis and thrush?

Thrush, or candidiasis- a disease that is caused yeast-like fungi sort of Candida.
The infection can develop in any organ. In this regard, candidiasis of the skin and nails, oral mucosa (this form is called thrush), intestines, and genitals is isolated. The most severe form of the disease is generalized candidiasis, or candidal sepsis when the fungus affects the skin, mucous membranes, and internal organs.
Candida – fungi opportunistic. They are not always capable of causing infection, but only under certain conditions. One of these conditions is decreased immunity. Thrush may well be combined with intestinal damage, which leads to dysbiosis. There is, in fact, a connection between these two conditions.
In this case, the same reasons lead to the development of thrush and intestinal dysbiosis - decreased immunity and fungal infection. They need to be treated.

Is it possible to use folk remedies to treat intestinal dysbiosis?

Traditional medicine, if proven remedies are used correctly, can improve the condition and alleviate the symptoms of the disease. But it can only be used as a supplement to the main treatment prescribed by a doctor.
Due to the fact that the topic is inflated and very popular, “remedies against dysbacteriosis” are offered by all kinds of traditional healers, healers, manufacturers of dietary supplements, and MLM companies. Food producers did not stand aside either.
As already mentioned above, dysbiosis as a disease does not exist, it does not have its own specific symptoms, and it cannot be cured without eliminating the root cause. Therefore, first of all, you need to visit a doctor, undergo an examination, establish correct diagnosis and start treatment.

What can a dysbacteriosis test show?

Most reputable doctors and scientists deeply doubt the informativeness of microbiological analysis of stool for dysbacteriosis. There are certain reasons for this:

The concept of “normal microflora” is very vague. Nobody knows the exact standards. Therefore, if you force any healthy person to take a test, many will be “identified” as having dysbacteriosis.
The content of bacteria in feces differs from their content in the intestines.
While the stool is delivered to the laboratory, the composition of the bacteria present in it may change. Especially if it is collected incorrectly, in a non-sterile container.
The composition of microflora in the human intestine can vary depending on different conditions. Even if we take the analysis in different time in the same healthy person, the results can vary greatly.

IN last decades opportunistic infections caused by opportunistic fungi occupy special place in the practice of clinicians of various specialties.

Paradoxically, this is partly due to the successes that modern medicine has achieved in the treatment of cancer and in the fight against pathogens of serious infections. In addition, it is obvious that in recent decades there has been an increase in the intensity of exposure to the human body external factors, causing the development of immunosuppressive conditions.

In addition, the end of the 20th century was marked by a significant spread of a fatal disease - HIV infection.

Pathological conditions caused by the influence of fungi of the genus Candida on the human body also belong to the category of opportunistic mycoses.

Characteristics of the pathogen

Members of the genus Candida are yeasts related to Ascomycetes.

The genus Candida includes various species (Candida spp.), among which the main ones as causative agents of candidiasis are: Candida albicans, Candida tropicalis, Candida parapsilosis, Candida glabrata, Candida dubliniensis, Candida lusitaniae, Candida krusei.

Candida spp. They are a component of microflora that is symbiont for humans. In 10–25% of the population without clinical signs of fungal infection, Candida spp. are inconsistently detected in the oral cavity, in 65–80% - in the intestinal contents. Candida spp. are found in the detritus of gastroduodenal ulcers in approximately 17% of cases.

According to modern ideas, in normal conditions the main “habitat” of Candida spp. in the human body is the intestines. The proportion of these fungi in the intestinal microbial population is negligible. Growth of colonies of Candida spp. in the human body it is partly regulated due to the work of the immune system. The main place in this process is occupied by the links of nonspecific immunity - mononuclear phagocytes (monocytes/macrophages) and polymorphonuclear leukocytes.

Bacteria - intestinal symbionts - also play a very important role in limiting the growth of the Candida population. Normal microflora, inhabiting the lumen of the gastrointestinal tract, produces substances with antibacterial activity(in particular, bacteriokines and short-chain fatty acids), which prevent the introduction of pathogenic microorganisms and excessive growth, the development of opportunistic flora. E. coli, enterococci, bifidobacteria and lactobacilli have the most pronounced antagonistic properties.

The term “candidiasis” implies a pathological process, the basis of which is the excessive growth of Candida, primarily in the gastrointestinal tract and secondarily in other areas (on the mucous membrane of the genitals, bronchi, and parenchymal organs).

Candida virulence factors

Fungi of the genus Candida are adhesive to epithelial cells. Attachment to the mucous membrane is one of the conditions for further invasion of the microorganism into the underlying tissue.

The adhesion capacity of different Candida species varies considerably; this ability is highest in C. albicans, C. tropicalis, C. dubliniensis; the smallest is in Candida glabrata, Candida krusei. As a protective barrier that prevents microbes from attaching to the mucous membrane, important role plays mucin, a glycoprotein of the cell wall of epithelial cells.

Factors of aggression of these microorganisms include proteases and glycosidases that can intensively break down mucin.

The ability to rapidly form filaments of pseudomycelium is also considered as a virulence factor; this feature is most pronounced in C. albicans.

The virulence of microorganisms is subject to intraspecific variability, depending on the genotype.

Risk factors for developing candidiasis

As general factors predisposing to the development of candidiasis of the digestive organs and subsequent lympho-hematogenous dissemination of fungi, as in the cases of other opportunistic infections, are conditions in which there is a lack of immune defense of the body. These include:

1) Physiological immunodeficiencies (newborn period and early childhood, senile immunodeficiency, pregnancy, stress conditions).

2) Congenital immunodeficiencies (Di-George, Nezelof, Shediac-Higashi syndrome, etc.).

3) Infection with the human immunodeficiency virus in the terminal stage (acquired immunodeficiency syndrome). Mycoses make up 70% of the structure clinical manifestations HIV infections.

4) Oncological diseases(including hemoblastoses); chemotherapy malignant tumors accompanied by severe granulocytopenia (<1х109 гранулоцитов в л). Развитие кандидоза на фоне противоопухолевой терапии обычно связывают с подавлением функций иммунной системы, наблюдающимся как нежелательный эффект лечения.

At the same time, there are suggestions that cytostatics and radiation therapy inhibit the protective functions of the intestinal epithelium and promote the translocation of Candida to other organs. During chemotherapy, the percentage of fungal microorganisms adhering to enterocytes increases.

5) Autoimmune and allergic diseases, especially when prescribing glucocorticosteroids.

6) Organ transplantation (use of immunosuppressants in the post-transplant period). More than half of patients scheduled for bone marrow transplantation have a picture of systemic candidiasis even before transplantation.

7) Endocrinopathies (decompensated diabetes mellitus, autoimmune polyglandular syndrome).

8) Other diseases and conditions (shock conditions, anemia, hepatitis, cirrhosis of the liver, chronic infections, malabsorption syndrome, etc.). In pathological conditions accompanied by a decrease in blood supply to the intestines, the translocation of fungi into other tissues increases. Digestion and absorption disorders are accompanied by excessive growth of microorganisms in the intestinal lumen.

9) Antibiotic therapy (usually long-term use of broad-spectrum drugs). The introduction of antibacterial drugs can lead to an imbalance in the microbial biocenosis of the intestine, as a result of which excessive development of the candidal population in the intestine is possible. Prescription of tuberculostatic drugs for 3–4 months. accompanied by the development of intestinal candidiasis in 58–62% of cases.

The risk of developing idiopathic antibiotic-associated diarrhea depends on the dose of antibiotic administered; this disease usually occurs without fever and leukocytosis in the blood and in the absence of laboratory signs of Clostridium difficile infection. It is believed that in about a third of cases, the development of idiopathic antibiotic-associated diarrhea is caused by intestinal candidiasis.

10) Unbalanced nutrition (deficiency in the diet of proteins, vitamins). An animal experiment showed that insufficient protein intake into the body is accompanied by a decrease in the phagocytic and bactericidal activity of the macrophage unit, incomplete phagocytosis and an increase in the permeability of the intestinal barrier to Candida albicans.

According to autopsy data, candidiasis of the duodenum, small and large intestine is found in approximately 3% of dead patients (only macroscopic changes were taken into account). Moreover, half of the cases occur in patients receiving chemotherapy for malignant neoplasms.

Pathogenesis of the development of intestinal candidiasis

Research in recent years has largely clarified the patterns of interaction between Candida fungi and the host organism. According to modern concepts, two fundamentally different mechanisms of the pathogenesis of candidiasis of the digestive organs can be distinguished: invasive and non-invasive candidiasis.

Invasive candidiasis is caused by the introduction of a filamentous form of the Candida fungus into tissues. The first stage of candidiasis, as an infectious process, is adhesion to epithelial cells, then invasion occurs into the epithelial layer, penetration beyond the basement membrane.

These manifestations of microbial aggression macroscopically correspond to erosive and ulcerative defects of the intestinal wall of various sizes and shapes, cracks, membrane deposits (similar to those in pseudomembranous colitis), polypoid or segmental circular formations.

With progressive invasion, the development of lympho-hematogenous dissemination of fungi is possible (systemic candidiasis with damage to the mucous membranes of other organs; generalized candidiasis with damage to visceral organs).

An experimental model of animals orally infected with C. albicans under conditions of immunosuppression showed the initial occurrence of erosions and ulcers of the mucous membrane in the ileum, colonization of intestinal lymphoid formations, their necrosis and further dissemination. The absence of macroscopic changes should probably not be considered as evidence against invasive candidiasis.

In disseminated forms of candidiasis, multinucleated giant cells containing fungi are found in the lymph nodes and ducts, which probably reflects the phenomenon of incomplete phagocytosis.

Invasive candidiasis is more often observed in organs lined with stratified squamous epithelium (oral cavity, esophagus), and less often with columnar epithelium (stomach, intestines), which is probably due to the peculiarities of local immune defense.

Non-invasive candidiasis is not accompanied by the transformation of the fungus into a filamentous form; There is an excessive growth of its colonies in the lumen of a hollow organ - the intestine. It is assumed that the disruption of cavity and parietal digestion, the penetration of microbial components and metabolites into the systemic bloodstream, and the development of a more or less pronounced systemic immune-inflammatory reaction are of great pathogenetic importance.

Based on all of the above, it should be emphasized once again that mucosal candidiasis of extraintestinal localization or generalized candidiasis with damage to parenchymal organs is a manifestation of the translocation of fungi from the intestinal lumen, where the bulk of these saprophytic fungi are represented. Candidiasis of extraintestinal localization (for example, the oral cavity or genitals) is a manifestation of systemic candidiasis, “originating” from the intestines.

The following is the classification of candidiasis of the digestive organs:

1. Oro-pharyngeal candidiasis (cheilitis, gingivitis, seizures, glossitis, stomatitis, pharyngitis).

2. Candidiasis of the esophagus (complications – bleeding, stricture).

3. Gastric candidiasis:

– diffuse (specific erosive-fibrinous gastritis);

– focal (secondary to gastric ulcer).

4. Intestinal candidiasis:

– invasive diffuse;

– focal (secondary for duodenal ulcer, with nonspecific ulcerative colitis);

– non-invasive (overgrowth of Candida in the intestinal lumen).

5. Ano-rectal candidiasis:

– invasive candidiasis of the rectum,

– perianal candidal dermatitis.

Below we describe the main manifestations of candidiasis of the intestine, which, as mentioned above, is the basis for the development of systemic manifestations.

Clinical picture of intestinal candidiasis

The features of the course of intestinal candidiasis are not clearly defined, not well studied and little known to most practicing doctors. It is characteristic that in patients who died from various causes and whose autopsy revealed macroscopic changes in the intestine corresponding to invasive candidiasis, during their lifetime, as a rule, very scanty symptoms from the gastrointestinal tract were noted, and the endoscopic diagnosis was often erroneous.

Often, when single ulcerations of the intestinal wall are detected, the doctor finds it difficult to interpret them, and based on the results of a morphological study, a conclusion is given about nonspecific inflammatory changes in the edges of ulcerative defects, while a targeted mycological study is not carried out.

Clinical manifestations of intestinal candidiasis may vary depending on the level of damage.

With diffuse invasive intestinal candidiasis, there are manifestations of enterocolitis: complaints of spastic abdominal pain, flatulence, the presence of pathological impurities in the stool (blood and mucus), there are usually signs of systemic candidiasis (damage to the mucous membranes of the oral cavity, genitals). Endoscopic examination reveals changes similar to fibrinous-ulcerative colitis.

With invasive focal intestinal candidiasis, the manifestations of the disease may resemble a persistent course of duodenal ulcer or nonspecific ulcerative colitis, resistant to traditional therapy.

With non-invasive intestinal candidiasis, patients complain of loose stools, flatulence, abdominal discomfort, with positive clinical and laboratory dynamics when treated with antifungal drugs.

With invasive candidiasis of the rectum, symptoms of proctitis (pain, tenesmus, pathological impurities in the stool) may be observed. In some cases, this is accompanied by the phenomenon of perianal candidodermatitis.

Intestinal candidiasis is often accompanied by low-grade fever.

Complications

As complications of intestinal candidiasis, it is possible to develop intestinal perforation, penetration of ulcers into surrounding organs, bleeding, generalization with damage to parenchymal organs, and the development of fungal sepsis.

Damage to parenchymal organs (liver, gall bladder, pancreas, etc.) very often accompanies deep neutropenia (less than 500 neutrophils per mm3 of blood) and is observed in the terminal phase of AIDS.

The mortality rate for invasive candidiasis reaches 25–55%. For some categories of patients (transplant recipients, patients with acute leukemia), invasive mycoses are the main cause of death.

Diagnostics

The issue of diagnosing intestinal candidiasis and determining indications for antifungal therapy is extremely important.

In recognizing mucosal candidiasis, it is necessary to distinguish between physiological “candidiasis” and the infectious process caused by this fungus.

For the diagnosis of candidiasis, the detection of Candida in sterile fluids (cerebrospinal fluid, lavage fluid, peritoneal fluid, etc.) or the detection of fungi in tissues (changes such as granulomas with necrosis are often found) are absolutely informative.

To increase the sensitivity of cultural and morphological methods for diagnosing candidiasis, it is recommended to examine several biopsies of the mucous membrane.

The biopsied tissue is collected in 2 sterile Petri dishes or sterile jars with a screw cap; one sample is filled with a 10% formaldehyde solution and sent for histological examination, the second is used for mycological examination.

The material is transported to the microbiological laboratory, protected from direct sunlight. It is necessary that the material be delivered for mycological examination no later than 1 hour after collection when stored at room temperature or no more than 3 hours when stored at +4°C.

Microscopic examination must be carried out in native and stained preparations.

The CHIC reaction (treatment with chromic acid) or its modification - Gridley staining - allows you to identify the pathogen in a tissue or smear by staining the polysaccharide components of the cell wall; To suppress the color of surrounding tissues, a “counter-paint” with light green, methanil yellow, etc. is used.

In this case, only invading fungal cells are detected, while at the same time it is impossible to judge the reaction of the surrounding tissues. Therefore, it is also necessary to evaluate preparations “counter-stained” with hematoxylin and eosin.

Pseudomycelium of Candida can also be detected in an impression smear of the mucous membrane or an impression smear from the bottom of the ulcer (Romanovsky-Giemsa stain).

An imprint is made on the surface of a dense nutrient medium in a Petri dish with a piece of tissue being examined, then sieving is carried out with a loop. The same piece of tissue is placed in 50 ml of liquid nutrient medium (Sabouraud medium, wort) and incubated at +37°C for 5 days.

Methods for rapid identification of C. albicans are widely used. This species of Candida is capable of forming germ tubes and short filaments of pseudomycelium within 2–4 hours at +37°C on blood serum, egg white and other similar media. For the species C.albicans, this phenomenon is typical in 90% of cases.

For effective treatment, it is necessary to strive to determine the species of Candida fungi and determine the individual sensitivity of the strain to antimycotic agents; some strains of Candida lusitanlae are resistant to amphotericin, and Candida krusei and Candida glabrata are resistant to fluconazole.

Detection of Candida in the blood allows a diagnosis of generalized candidiasis to be made only in combination with appropriate clinical symptoms (re-detection of Candida in the blood is especially informative). It should be remembered that in 70–80% of patients who actually suffer from generalized candidiasis, fungi cannot be detected by blood culture.

The value of serological methods consists mainly in identifying patients with probable invasive mycoses. False-positive results of serological tests are possible with mycocarriage and in healthy people sensitized by fungal antigens; false-negative tests can occur in immunodeficiency.

Original procedures for the detection of antigens and antibodies of some metabolites of fungal cells are proposed; special diagnostic kits have been created. As an example, Pastorex Candida can be used to determine, in the “latex agglutination” reaction, repeating oligomannose epitopes of antigenic structures expressed on a large number of fungal macromolecules.

The Platelia Candida kit can be used to detect Candida mannan antigen, for example, in the blood serum of a patient with the organism circulating. Using the first kit, the threshold for determining antigenic structures is 2.5 ng/ml, using the second in conjunction with the method, the threshold for determining is 0.5 ng/ml.

In the diagnosis of non-invasive intestinal candidiasis, in which there is no tissue biopsy material for mycological examination, it is proposed to use the following criteria as a diagnostic standard: growth over 1000 CFU/g Candida spp. when inoculating intestinal contents taken under sterile conditions, in combination with symptoms of intestinal dyspepsia and positive clinical and laboratory dynamics during treatment with antimycotic drugs.

Unfortunately, proper collection of intestinal contents for culture is technically challenging; The widespread method of “stool culture for dysbacteriosis” in our country cannot serve as a basis for assessing the actual composition of the intestinal microflora.

In diagnosing any form of candidiasis of the digestive organs, it is important to take into account the presence of predisposing risk factors in the patient. “Random” detection of candidiasis should serve as an incentive to search for such a background factor. It is important to remember that candidiasis can act as an early manifestation of common diseases accompanied by the development of immunodeficiency.

Considering the above, it would probably not be entirely correct to formulate the diagnosis briefly as “Candida” without indicating the underlying condition.

The differential diagnosis of invasive intestinal candidiasis (if macroscopic changes in the intestine are detected) must be made with chronic inflammatory bowel diseases, antibiotic-associated diarrhea due to C. difficile infection, malignant lesions, and ischemic colitis.

The non-invasive form of candidiasis should be differentiated from a wide range of enteritis and colitis of other etiologies. Indirect evidence in favor of the presence of intestinal candidiasis may be extraintestinal systemic manifestations of candidiasis.

Treatment

It should be emphasized once again that the mere detection of fungi of the genus Candida during bacteriological analysis of feces (according to the accepted method in Russia), regardless of the presence or absence of symptoms of intestinal dyspepsia, cannot serve as an indication for prescribing antifungal drugs to the patient.

To treat intestinal candidiasis, it is necessary to prescribe drugs that are not absorbed from the intestinal lumen.

Today there are a variety of antimycotic agents. Drugs such as amphotericin B, itraconazole, ketoconazole, fluconazole have a systemic effect and can be used topically, orally and intravenously.

When administered orally, these drugs are almost completely adsorbed from the upper gastrointestinal tract and do not reach the level of the ileum, where the main population of fungi is concentrated. In addition, the use of “systemic” antifungal drugs is often accompanied by side effects, in particular, the development of toxic hepatitis.

Practically non-absorbable antimycotic agents include levorin, nystatin and natamycin (Pimafucin). The prescription of levorin and nystatin with a fairly high frequency is accompanied by the development of side effects (dyspeptic symptoms, allergies, toxic hepatitis).

Pimafucin (natamycin) is a broad-spectrum antifungal polyene antibiotic. Has fungicidal potential. Pimafucin binds sterols of cell membranes, disrupting their integrity and functions, which leads to the death of microorganisms. Most pathogenic yeasts are sensitive to natamycin, most notably Candida albicans.

Pimafucin is more effective than nystatin. There have been no cases of natamycin resistance in clinical practice; with repeated use of this drug, its minimum inhibitory concentration against C. albicans does not change. Pimafucin tablets act only in the intestinal lumen and are practically not absorbed from the gastrointestinal tract.

When using tablets in the first days of treatment, dyspeptic symptoms are possible - nausea and diarrhea, which do not require discontinuation of the drug and resolve independently during treatment. The only contraindication to the use of Pimafucin is hypersensitivity to the components of the drug. Pimafucin can be prescribed during pregnancy and lactation, as well as newborns.

To treat intestinal candidiasis, a course of treatment with non-absorbable antifungal drugs is necessary for 7–10 days. Nystatin is prescribed 250,000 units 6-8 times a day (daily dose - up to 3 million units) for 14 days. It is prescribed 100 mg (1 tablet) 2–4 times a day for 7–10 days.

Based on the above provisions and clinical experience, we have to admit that the tactics of treating candidiasis of the mucous membranes of extraintestinal localization only with local antifungal agents or systemic drugs absorbed from the gastrointestinal tract are inherently erroneous.

Since the source of lympho-hematogenous spread of virulent Candida strains that cause systemic candidiasis is the intestine, without suppressing the growth of fungi in its lumen, antifungal therapy is ineffective or only a short-term unstable effect is observed.

For systemic candidiasis, the dose of nystatin can be increased to 4–6 million units/day, while a locally active antifungal agent is prescribed. For systemic candidiasis, Pimafucin is used in the same dose while simultaneously prescribing a locally active antifungal agent. In severe cases, drugs with systemic action are added to complex therapy.

Timely recognition and treatment of intestinal candidiasis is especially important as a prevention of systemic and generalized candidiasis in patients at risk, which primarily include patients receiving antitumor radiation and/or chemotherapy, anti-tuberculosis drugs, and patients preparing for planned operations on the abdominal organs.

In these situations, it is most preferable to prescribe non-absorbable antifungal drugs, since their long-term and repeated use does not significantly affect the pharmacodynamics of other drugs.

The main criterion for the effectiveness of therapy is not obtaining a negative culture result for fungi, but, first of all, the disappearance of the main manifestations of the disease, normalization of the number of fungi according to mycological research (if adequate culture of intestinal contents is possible). To achieve an effect, it is often necessary to resort to repeated courses of treatment.

This article aimed to expand the understanding of practitioners about the flexibility of interaction between the human body and symbiont microflora, about the pathogenic potential possessed by the harmless intestinal commensal - Candida.

Internists and specialists in medical mycology are faced with the urgent tasks of clearly determining the prevalence and clinical significance of fungal infections in clinical practice, developing a diagnostic algorithm and indications for treatment of intestinal candidiasis.

Literature:

1. Zlatkina A.R., Isakov V.A., Ivanikov I.O. Intestinal candidiasis as a new problem in gastroenterology. // Russian Journal of Gastroenterology, Hepatology, Coloproctology. – 2001. – No. 6. – P.33–38.

2. Danna P.L., Urban C., Bellin E., Rahal J.J. Role of Candida in the pathogenesis of antibiotic–associated diarrhoea in elderly patients.//Lancet/–1991.–Vol.337.–P.511–514.

3. Prescott R.J., Harris M., Banerjee S.S. Fungal infections of small and large intestine.//J.clin.Path.–1992.–Vol.45.–P.806–811.

4. Redmond H.P., Shou J., Kelly C.J. et al. Protein–calorie malnutrition impairs host defense against Candida albicans.//J.Surg.Res.–1991.–Vol.50.–P.552–559.