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Intractable Biliary Candidiasis in Patients with Obstructive Jaundice and Regional Malignancy: A Retrospective Case Series

Authors Al manasra ARA, Jadallah K, Aleshawi A, Al-Omari M, Elheis M, Reyad A, Fataftah J, Al-Domaidat H

Received 10 January 2021

Accepted for publication 24 February 2021

Published 4 March 2021 Volume 2021:14 Pages 83—89

DOI https://doi.org/10.2147/CEG.S301340

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Anastasios Koulaouzidis


Abdel rahman A Al manasra,1 Khaled Jadallah,2 Abdelwahab Aleshawi,1 Mamoon Al-Omari,3 Mwaffaq Elheis,3 Ahmad Reyad,1 Jehad Fataftah,4 Hamzeh Al-Domaidat1

1Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Radiology, Faculty of Medicine, The Hashemite University, Zarqa, Jordan

Correspondence: Abdel rahman A Al manasra
Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, Jordan
Tel +962 796453510
Email [email protected]

Background: Candida species are infrequently grown in bile cultures. An association between biliary candidiasis and regional malignancy may exist. The role of fungus membranes in frequent biliary stent occlusion is also presented in this case series.
Methods: We retrospectively identified patients who underwent percutaneous trans-hepatic cholangiogram (PTC) for obstructive jaundice between January 2014 and January 2019. The results of bile cultures – obtained by PTC – for all patients were analyzed, and patients with fungus growth were determined; their medical records were reviewed.
Results: A total of 71 patients with obstructive jaundice underwent PTC between January 2015 and January 2019. Five patients (all male; mean age 55.8 years) had candida species growth in bile cultures. Two patients were diagnosed with cholangiocarcinoma, one with adenocarcinoma of the head of the pancreas, one with gallbladder cancer, and one with locally advanced gastric adenocarcinoma. Formation of fungal balls predisposed to frequent PTC drain clogging. Eradication of Candida was achieved in 4 patients after 10 days to 3 weeks of antifungal therapy.
Conclusion: We present a case series of biliary candidiasis in patients with obstructive jaundice and regional malignancy. We suggest that patients with obstructive jaundice and regional malignancy should be screened for biliary candidiasis. Persistent cholestasis may be caused by the recurrent formation of fungal membranes (balls).

Keywords: Candida, obstructive jaundice, cholangiocarcinoma, biliary, PTC

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