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Aktuelle Ernährungsmedizin 2003; 28(2): 87-92
DOI: 10.1055/s-2003-37989
Originalbeitrag
© Georg Thieme Verlag Stuttgart · New York

Unexplained Diarrhoea, Candida in the Faeces

Ungeklärte Diarrhö, Candida im StuhlD.  Jonkers1 , R.  Stockbrügger1
  • 1Dept. of Gastroenterology, University Hospital Maastricht, The Netherlands
Manuskript nach einem Vortrag auf dem Kongress „Ernährung und Immunsystem” 15./16.2.2002 in Berlin
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Publication History

Publication Date:
20 March 2003 (online)

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Zusammenfassung

Candida ist ein opportunistischer Pilz und gilt als normaler Bestandteil des Verdauungstrakts. Bei 50 - 80 % gesunder Probanden ist Candida spp. im Stuhl in Mengen unterhalb 103 cfu/g Fäzes nachweisbar. Am häufigsten ist C. albicans, gefolgt von C. glabrata, C. tropicalis und C. krusei. Diese kommensale Sprosspilzflora ist bei Immunkompetenz harmlos und eine „normale” Darmflora bietet den besten Schutz gegen eine Candida-Überwucherung. Eine Candida-Überwucherung liegt bei einem Bestand gleich oder größer als 105 - 106 cfu/g Fäzes vor und kann bei prädisponierten Personen vorkommen und/oder bei herabgesetztem Allgemeinwiderstand. Fäkale Candida-Überwucherung kann Diarrhö verursachen. Eine Prävalenz erhöhter Candida-Bestände bei Patienten mit unklarer Durchfallursache schwankt von Studie zu Studie erheblich zwischen 1,3 und 77 % und kann von der Definition einer Diarrhö und von der Anzahl der an der Studie teilnehmenden Patienten abhängen. Die Diagnose einer durch Candida verursachten Diarrhö erfordert den Ausschluss anderer ätiologischer Faktoren. Mehrere Berichte vermuteten Candida als Ursache des Durchfalls, da Candida der einzige identifizierbare pathogene Bestandteil des Stuhls war und der Durchfall meist nach antifungaler Behandlung oder nach Absetzen von Antibiotika aufhörte. Es hat sich herausgestellt, dass eine Behandlung mit Antibiotika der häufigste prädisponierende Faktor für einen Candida-assoziierten Durchfall ist. Andererseits stellten viele Studien keinen ursächlichen Zusammenhang zwischen fäkalen Candida-Beständen und Diarrhö fest. Es fand sich auch kein Zusammenhang zwischen Candida und fäkal nachweisbaren Leukozyten oder Erythrozyten; Veränderungen der Darmschleimhaut werden kaum beschrieben. Es fehlt allgemein an plazebogesicherten Studien hinsichtlich der Behandlung von Candida-assoziiertem Durchfall mit Antifungiziden. Zusammenfassend lässt sich sagen, dass die Rolle von Candida als Ursache ungeklärten Durchfalls noch immer kontrovers ist. Findet man keine anderen Ursachen eines Durchfalls, aber eine erhöhte Anzahl Candida (größer oder gleich 105 cfu/g Fäzes) oder wenn Fadenpilze im Stuhl festgestellt werden, kann eine fungizide Behandlung erwogen werden.

Abstract

Candida is an opportunistic fungus and can be considered as a normal inhabitant of the gastrointestinal tract. In 50 - 80 % of adult healthy volunteers, Candida spp. can be found in the faeces in amount < 103 cfu/g faeces. C. albicans is the most predominant species, followed by C. glabrata, C. tropicalis and C. krusei. This commensal yeast flora is harmless in an immune-competent host and a „normal” intestinal bacterial flora is the best protection against Candida overgrowth. Overgrowth of Candida in the faeces is defined as ≥ 105 - 106 cfu/gram faeces and may occur in people predisposed to illness and/or with a reduction of local defence mechanisms. Faecal Candida overgrowth may cause diarrhoea. The prevalence of increased Candida counts in patients with unexplained diarrhoea, varies widely among different studies (1.3 - 77 %) and may depend on the definition of diarrhoea and the patient population included. The diagnosis of Candida-associated diarrhoea requires the exclusion of other etiological factors. A number of reports has suggested that Candida might cause the observed diarrhoea as they found Candida to be the only identifiable pathogen in the faeces and the diarrhoea mostly resolved after treatment with anti-fungal medication or after withdrawal of antibiotics. Antibiotic therapy is found to be the main predisposing factor for Candida-associated diarrhoea. On the other hand, several studies do not find an association between faecal Candida and diarrhoea. Furthermore, no association is found between Candida and leukocytes or erythrocytes in the faeces and changes in the intestinal mucosa are hardly described. Finally, placebo-controlled trials with regard to the treatment of Candida-associated diarrhoea with anti-fungal medications are generally lacking. In conclusion, the role of Candida as a cause of unexplained diarrhoea is still controversial. When no other causes of the diarrhoea can be found and when increased amounts of Candida (≥ 105 cfu/gram faeces) or mycelial forms can be detected in the faeces, anti-fungal therapy can be considered.

Schlüsselwörter

Candida - Diarrhö - Fäzes - Diagnose - Behandlung

Key words

Candida - diarrhoea - faeces - diagnosis - therapy

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D. Jonkers

University Hospital Maastricht · Dept. of Gastroenterology and Hepatology

PO Box 5800

6202 AZ Maastricht · The Netherlands

Phone: + 31/43/3875021

Fax: + 31/43/3875006

Email: DJO@LMIB.AZM.NL