Surgical pathology and the diagnosis of invasive visceral yeast infection: two case reports and literature review

Abstract

Invasive mycoses are life-threatening opportunistic infections that have recently emerged as a cause of morbidity and mortality following general and gastrointestinal surgery.Candida species are the main fungal strains of gut flora. Gastrointestinal tract surgery might lead to mucosal disruption and cause Candida spp. to disseminate in the bloodstream.Here we report and discuss the peculiar clinical and morphological presentation of two cases of gastrointestinal Candida albicans lesions in patients who underwent abdominal surgery.Although in the majority of cases reported in the literature, diagnosis was made on the basis of microbiological criteria, we suggest that morphological features of fungi in histological sections of appropriate surgical specimens could help to detect the degree of yeast colonization and identify patients at risk of developing severe abdominal Candida infection.Better prevention and early antifungal treatments are highlighted, and relevant scientific literature is reviewed.

Figure 1

Histological section. A) Very thin and totally necrotic gastric wall. B, C) Numerous fungal yeasts were present. PAS stain (A) ×100; (B) ×200; (C) ×400.

Figure 2

Histological section. A) Necrotic tissue from the cutaneous specimen, with fungal hyphae. B-C) Hyphae in the small bowel specimen. In C some of them appear to cross the vessel wall. PAS stain (A) ×200; GMS stain (B) ×400, PAS stain (C) ×200.