Fungal infections in patients with inflammatory bowel disease: A systematic review

Abstract

Summary Background Despite reports of fungal infections in patients with inflammatory bowel disease (IBD), their clinical and microbiological characteristics remain unknown. Objectives The aim of this systematic review was to examine all available evidence regarding fungal infections in patients with IBD. Methods Systematic search of PubMed (through 27 May 2017) for studies providing data on clinical, microbiological, treatment and outcome data of fungal infections in patients with IBD. The primary study outcome was to record the most common fungal species in patients with IBD. Secondary outcomes were classified into 3 categories: (i) characteristics of fungal infections; (ii) data on IBD and (iii) treatment and outcomes of fungal infections in patients with IBD. Results Fourteen studies with data on 1524 patients were included in final analysis. The most common fungal infections in patients with IBD were caused by Candida species (903 infections); the most commonly reported site of Candida infection was the gastrointestinal tract. Available evidence shows that most fungal infections occur within 12 months of IBD treatment and within 6 months when anti-TNFa agents are used. Conclusions This systematic review thoroughly describes fungal infections in patients with IBD and provides important information for the early detection and management of these infections.

Kodamaea ohmeri infections in humans: A systematic review

“…Even though, this methodology was the only reliable way to systematically study K ohmeri infections. If case reports, case series and studies describing less than 4 patients were excluded, as other investigators have done, 54 there would be only 1 study left for inclusion with only 5 patients being currently analysed 14 . On the other hand, since K ohmeri infections are rare, it is reasonable to consider this study to be representative enough, including all possible clinical presentations.…”

Review article: fungal alterations in inflammatory bowel diseases

“…With documented alterations in gut mycobiota on IBD activity based on data on mycobial profiling, detection and ASCA and quantitative PCR analysis, modulation of the fungal community may offer therapeutic approaches to IBD. Fluconazole, an anti‐fungal drug, is not a common treatment for IBD, and it is mostly used to eradicate fungal infection, candidiasis or candidaemia in immunocompromised IBD patients . IBD patients with single nucleotide polymorphisms and mutations in the major genetic loci have altered function of pathogen‐associated molecular patterns (PAMPs) and cytokine production and are more susceptible to fungal infections.…”

“…Fluconazole, an anti-fungal drug, is not a common treatment for IBD, and it is mostly used to eradicate fungal infection, candidiasis or candidaemia in immunocompromised IBD patients. 62,63 IBD patients with single nucleotide polymorphisms and mutations in the major genetic loci have altered function of pathogen-associated molecular patterns (PAMPs) and cytokine production and are more susceptible to fungal infections. Table 2 shows the genetic mutations and single nucleotide polymorphisms associated with increased susceptibility to fungi infections in IBD.…”

Review article: managing the adverse events caused by anti‐TNF therapy in inflammatory bowel disease

“…Patients with IBD are known to be at an increased risk of fungal infections. This is due to multiple factors such as severity of disease activity, comorbidities, treatment with opioids, surgery, poor nutritional status, leucopenia and older age . Another factor is immunosuppressive therapy, important of which are anti‐TNFs.…”

“…Another factor is immunosuppressive therapy, important of which are anti‐TNFs. A risk factor analysis by one recent systematic review reported anti‐TNF therapy as the predominant factor associated with fungal infections …”