الفهرس 
STRUCTURE AND GENERAL charACTERISTICS OF FUNGIOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
he presence of fungus in urine or funguria is a relatively common clinical finding, and it is considerably more prevalent in patients with severe illnesses compared with healthy individuals. The prevalence of funguria is increasing worldwide, because of the the increased use of antibiotics and immunosuppressive therapy, as well as the other predisposing factors.
The causative organisms varies between Candida, Aspergillus, Cryptococcus, Zygomyces, Blastomyces, Coccidioides, H. capsulatum and other types of Fungi. By far the most common isolated species is Candida,but the other fungi have their geographic destribution and predisposing factors.
Despite the frequent isolation of Candida spp from urine cultures, the clinical significance is often unclear. It is difficult to determine if the funguria is caused by contamination, colonization, or a true urinary tract infection (UTI)—there is no test to reliably differentiate between these three possibilities.
The predisposing factors of Funguria are Use of broad spectrum antibiotics,urine drainage instruments,Diabetes Mellitus, debilitating diseases, immunosupression either by diseases as AIDS,DM or by immunosuppressive drugs as corticosteroids,old age, burns and extended hospitalization especially in the ICU.
The Fungal infection of the urinary tract may be asymptomatic while in other cases it may be symptomatic. Clinical picture of funguria can be presented as pyelonephritis, cystitis, vaginits, prostatitis, ileostomatitis and pyelostomatitis.
Fungemia is a life threatening condition which can be a clinical picture for fungal infection of the urinary tract or may be a complication of the fungal infection of the urinary tract. It appears as it is a vicious circle. Systemic antifungals are highly recommended in fungemia.
Complications of fungal infections of the urinary tract vary from mild to severe leading to loss of the affected organ as in emphysematous and xanthogranlomatous pyelonephritis.
Investigations of fungal infections of the urinary system varies between laboratory tests and imaging. Laboratory test can be for detection of predisposing factors as AIDS or elevated blood sugar in Diabetes Mellitus. Also Laboratory test can be for fungal detection, it can be urinalysis, Direct microscopic examination, Culture and sensitivity, Serologic tests for detection of antibodies, antigen and Molecular methods eg, polymerase chain reaction. Mannan antigen and anti-mannan antibodies are recent and accurate method for fungal detection.Each has its advantages and disadvantages. Imaging varies between abdominopelvic ultrasonography,plain X ray on the urinary tract and CT on abdomen and pelvis, and Transrectal ultrasound.
Despite the frequent isolation of Candida spp from urine cultures, the clinical significance is often unclear. It is difficult to determine if the funguria is caused by contamination, colonization, or a true urinary tract infection (UTI)—there is no test to reliably differentiate between these three possibilities. Asymptomatic funguria requires no treatment while symptomatic funguria requires treatment.
Treatment includes control on predisposing factors as much as you can eg removal of urethral catheter, control of Diabetes Mellitus and cessation of broad spectrum antibiotics misuse. Treatment of Funguria is mainly medical but in some cases,surgical intervention is really required. Medical treatment includes Amphotericin B and azoles. Each drug has its own mechanism of action,dose,side effects and interactions. Other treatment modalities as Allylamines and Transfer factor can also be used. Surgical intervention may be needed as in removal of fungal balls in the kidney or bezoars in the bladder. Other surgical interventions as abscess drainage and adrenalectomy can be operated in specific cases.