The mycotic flora in proctological patients with and without pruritus ani

Abstract

The perianal mycotic flora was studied in proctological patients with and without pruritus ani, as well as in control subjects. Four groups of patients underwent perianal mycoculture. In Group 1, 53 patients with anal pruritus were treated for benign anorectal disease. In Group 2, 24 patients with no underlying disease presented with anal pruritus. Both of these groups underwent concomitant chemical and parasitical examination of the faeces and an oral glucose tolerance test. In Group 3, 50 patients without pruritus ani at present or in the past were treated for benign anorectal diseases. In Group 4, 47 surgical patients without pruritus ani were treated for benign (9) and malignant (38) non-proctological diseases. In Group 1 the mycoculture was positive in 24/53 patients (Candida albicans 14, dermatophytes 10). In Group 2 fungal infections were seen in 16/24 patients (C. albicans 7, dermatophytes 9). No parasites or diabetes were found in either group. In Group 3 C. albicans was isolated in 14/50 patients. In Group 4 C. albicans was found in 11/47 cases (2 in benign, 9 in malignant diseases). Infection by C. albicans was observed in all groups studied, independent of the presence of disease or anal pruritus. The presence of dermatophytes was always associated with pruritus ani.

Pruritus Ani

“…5,[10][11][12] Dermatophytes should be considered pathogenic and treated. 12 Candida albicans is comensal, but becomes pathogenic in a diabetic individual, after steroid and systemic antibiotic use; it should be eradicated in these cases. 11,12 Surgery for anal conditions eradicated Candida spp.…”

“…12 Candida albicans is comensal, but becomes pathogenic in a diabetic individual, after steroid and systemic antibiotic use; it should be eradicated in these cases. 11,12 Surgery for anal conditions eradicated Candida spp. and dermatophytes in over 85% in one study.…”

Perianal Skin Conditions

“…The potential pathogens Staphylococcus aureus and Candida species are common commensals as is Staphylococcus epidermidis of skin origin and Bacteroides species, Enterococcus faecalis , and Enterobacteriaceae of the lower gastrointestinal tract. Fungal colonization with Candida albicans is commonly asymptomatic [ 2 ].…”

Mycotic and Bacterial Infections

“…1 Mycotic infections of the perineum may commonly present in patients with previous mycotic infections of other regions, including feet and hair. 4 Fungal species, such as C. albicans, are commensal and found within the intertriginous zones of healthy individuals. 1,3 Mycotic infections may also occur as an opportunistic reaction in patients with impaired immune systems, or in patients who have been treated for long periods with systemic antibiotics or steroid therapy.…”