Candida infection led to tear in GI tract in Delhi patient after Covid, cancer
After treating cases of tears in the small intestine due to mucormycosis, doctors from Sir Ganga Ram Hospital have now reported similar tears in the gastrointestinal tract of a patient due to another fungal infection called candida. The severe disease in the 49-year-old patient was because of her immunocompromised state – she had undergone surgery and chemotherapy for breast cancer and then contracted coronavirus disease (Covid-19).
“Candida is a very common infection and people walk around with it not even knowing they have it. However, it turned pathogenic in the patient because she was severely immunocompromised owing to the cancer, chemotherapy and Covid-19. there were perforations (tears) in the lower end of the food pipe. A part of the small intestine had developed gangrene and she had multiple thinned out patches in the wall of the colon with one small leak,” said Dr Samiran Nundy, advisor, department of surgical gastroenterology and liver transplantation.
He added, “Along with that, her bowel also had blood clots resulting from Covid-19.”
The patient was admitted to the hospital earlier this month with complaints of severe abdominal pain, vomiting, and constipation. She was in circulatory shock (a life-threatening complication) and had severe respiratory distress. A CT scan of her abdomen revealed air and moderate amount of free fluid in the abdominal cavity indicating a tear in the intestine.
A tube was placed to drain the fluid, which turned out to be a litre of bile-stained pus. A part of the bowel removed during the surgery was tested and she was found to have candida hyphae.
“Candida is a normal part of the gut flora but in immunosuppressed states caused by diabetes, injudicious use of steroids, overzealous broad spectrum antibiotics, and chemotherapy for an underlying malignancies, the candida migrates inwards disrupting the normal gut barriers. This is followed by intestinal complications like ulcers, bleeding, gangrene and perforation followed by the infection getting into the blood resulting in septicaemia (blood infection) and multi-organ failure,” said Dr Anil Arora, chairman of the institute of liver, gastroenterology and pancreaticobiliary sciences.
A recent Indian Council of Medical Research study had found that 6% of the secondary infections caused in people after Covid-19 was due to candida during the first wave of the pandemic.