Colonic mucosa‐associated candida assessed by biopsy culture is associated with disease severity in ulcerative colitis: A prospective study

Abstract

Objective: To evaluate the relationship of mucosa-associated candida (MAC) and disease severity in patients with ulcerative colitis (UC).Methods: We prospectively investigated the presence, nature, and quantification of MAC in patients with UC and its relationship with disease severity. Consecutive patients with UC were assessed for clinical, endoscopic, histological features and serum markers of disease severity. All patients underwent mucosal brushing cytology, brushing culture, and biopsy culture for candida growth. MAC was considered present if mucosal biopsy culture grew candida. Candida spp. identification was performed by matrix-assisted laser desorption/ionization. Serum β-D-glucan was measured with a Fungitell assay. Patients with irritable bowel syndrome who had undergone similar investigations were included as controls.Results: Ninety-six patients with UC showed evidence of MAC more often than the controls (n = 20) based on biopsy culture (33.3% vs 5.0%, P = 0.011), brush cytology (30.2% vs 5.0%, P = 0.019), and brush culture (36.5% vs 10.0%, P = 0.021). Patients with UC had higher candida colony counts (≥10 3 CFU/mL) than controls (34.4% vs 5.0%, P = 0.007). Median β-D-glucan values were higher in patients with UC than in controls (103.26 pg/mL vs 66.51 pg/mL, P = 0.011). The UC group with MAC had a higher median total Mayo score, C-reactive protein, fecal calprotectin, β-D-glucan, and histological activity than those without MAC.Conclusions: Patients with UC more often show evidence of MAC and a higher candida colony count than controls. The presence of MAC is associated with high disease severity in patients with UC. K E Y W O R D S C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, β-D-glucan; ulcerative colitis The abstract of this article has been published on the Indian Journal of Gastroenterology. 2018;37(Suppl 1): A19-A20 and in the Journal of Crohn's and Colitis. 2019;13(Suppl): S545-S546.

Oral Fluconazole Therapy in Patients With Active Ulcerative Colitis Who Have Detectable Candida in the Stool

“…It is likely to colonize the mucosal defects and further perpetuates the inflammation 14. In our previous study, we found that mucosa associated Candida was associated with increase in disease severity and mucosal inflammation 6. In quantitative mucosa biopsy cultures, patients with UC had higher Candida colony counts (≥10 3 CFU/mL) than controls.…”

“…In quantitative mucosa biopsy cultures, patients with UC had higher Candida colony counts (≥10 3 CFU/mL) than controls. The species of Candida isolated were C. albicans , Candida tropicalis , Candida metapsilosis , Candida parapsilosis , Candida lustinaie , and Candida glabrata 6 . Candida is known to inhibit mucosal immunity and promote mucosal inflammation 26,27.…”

“…Among the fungi Candida is the most commonly isolated fungus in the human feces. Patients with IBD are more likely to be colonized by Candida 6. Mucosal defects in patients with UC provides a platform for Candida colonization, which in turn is likely to perpetuate the inflammatory process 7,8.…”

“…Patients with IBD are more likely to be colonized by Candida. 6 Mucosal defects in patients with UC provides a platform for Candida colonization, which in turn is likely to perpetuate the inflammatory process. 7,8 In murine models, Candida colonization is associated with increased neutrophil infiltration, higher tissue levels of myeloperoxidase and tumor necrosis factor-α, increase in interleukin-17 and interleukin-23 production, increased gut permeability, decrease in colonic blood flow and delayed healing.…”

Interplay of intestinal microbiota and mucosal immunity in inflammatory bowel disease: a relationship of frenemies

“…21 Numbers of Bacteroides and Candida have been observed to significantly increase in feces of patients with UC. 25,26 Another analysis has reported that less butyrate is synthesized by Clostridium in the luminal flora of patients with UC, suggesting a protective role of Clostridium in the initiation of UC. 27 Moreover, a fecal metabolomics study further revealed an increased frequency of symbiotic Escherichia coli during intestinal inflammation, and its respiration and formate oxidation have been proved to participate in the occurrence of microbial imbalance and intestinal inflammatory response.…”