Erschwerter Verlauf von Ösophagusperforationen durch Pilzinfektion

Abstract

Perforations of the oesophagus are characterized by a high mortality rate, varying between 7 and 49%. In the analyzed group of patients between the years 1986 and 2003, the mortality rate of 28% was caused by septic complications such as mediastinitis and pneumonia. Microbiological examinations of samples from different locations and various secretions, detected mycoses in 28% of the patients (n = 16). Compared with the total of mycoses, a higher mortality of 50% was calculated. The invasive Candida infection of the oesophagus itself can cause a perforation. In perforations of the oesophagus, simultaneous mycoses arise by fungi invading sterile compartments or by haematogenous and lymphogenous dissemination up to sepsis. Uncomplicated courses do not need antimycotic therapy. At the beginning of the treatment, a microbiological monitoring should be provided, particularly with regard to the intraoperative facts. In relation to the course and the risk factors of the patients, an antimycotic therapy is initiated. Surgical clearing and sufficient drainage of the collateral compartments such as pleural and mediastinal compartments is highly significant.

The impact of systemic fungal infection in patients with perforated oesophagus

“…In their series of 58 patients,Jungbluth et al found that the mortality rate was 50% among patients with positive fungal cultures compared with 28% overall 22 . The mean time spent in the ICU was greater in the group of patients with positive fungal cultures and this group was also more likely to develop septic complications such as mediastinitis, pneumonia and empyema.…”

“…Jungbluth et al recommend only targeted therapy, 22 despite the high risk of complications, while Bauer et al advocate empirical therapy for all cases although their recommendation is only based on a report of two cases 11 …”