Fístula traqueoesofágica por Candida galbrata: una patología infrecuente / Tracheoesophageal fistula due to candida galbrata: a rare pathology

La fístula traqueoesofágica consiste en una comunicación anómala entre el sistema respiratorio y el digestivo, que puede ser a causa de una enfermedad congénita, o bien secundaria a una patología tal como la infecciosa, la tumoral o postraumática. Entre las etiologías infecciosas, Candida o Aspergillus son dos hongos que provocan esofagitis fúngica, la cual podría complicarse con esta entidad, aunque son casos extremadamente raros. El diagnóstico de las fístulas se basa en la clínica, las pruebas de imagen como la TC y la endoscopia, donde se podrá apreciar la solución de continuidad. Este defecto debe ser tratado mediante cirugía o endoscópicamente

The tracheoesophageal fistula consists of an abnormal communication between the respiratory and digestive systems, which may be due to a congenital disease or secondary to a pathology such as infectious, tumorous or post-traumatic. Among the infectious etiologies, Candida or Aspergillus are two fungi that cause fungal esophagitis, which could be complicated by this entity, although they are extremely rare cases. The diagnosis of fistulas is based on the clinic, imaging tests such as CT and endoscopy, where the solution of continuity can be appreciated. This defect must be treated surgically or endoscopically, a technique that is currently on the rise due to its fewer complications

A rare case of chronic benign tracheo-oesophageal fistula, with Candida albicans cultured from a pleural effusion.

We present a case of chronic benign tracheo-oesophageal fistula in an immunologically competent elderly female, cured with a period of nasogastric feeding.

[Microbiological monitoring in therapy of patients with iatrogenic esophageotracheal fistula].

The results of the microbiological diagnosis of infective inflammatory complications in patients with iatrogenic esophageotracheal fistula and the tactics of their antibacterial prophylaxis and therapy within a 9-year observation period (2003-2011) were analysed. The main organisms colonizing the tracheobronchial tree in the patients were S. epidermidis, S. aureus, enteric bacteria, P. aeruginosa and Candida. An increase of the S. epidermidis resistance to rifampicin, moxifloxacin and especially ciprofloxacin was observed. The resistance of S. aureus did not significantly change. Within the observation period, high susceptibility of all the Staphylococcus isolates to vancomycin and linezolid remained stable. Among the nonfermenting gramnegative bacteria, the P. aeruginosa isolates were the most frequent and characterized by a lower portion of the isolates with preserved susceptibility to the agents (except polymyxin B) known earlier as antipyocyanic antibiotics, i.e. to imipenem and cefepim. Since the proportion of P. aeruginosa in the etiology of pyoinflammatory processes in the region of esophageotracheal fistula ranged within 9.3 to 17.5%, the fact should be considered in the antibiotic therapy. There was observed an increase in the frequency of infectious complications due to other nonfermenting gramnegative bacteria (acinetobacters) and first of all A.baumannii. Various Candida isolates were characterized by dependence of the susceptibility on the selective pressure of irrational therapy, as well as their species (the presence of such species as C. Krusei and C. glabrata with natural resistance), that required not only the species identification but also determination of the Candida isolates resistance in every particular case.

[Aspergillus niger responsible for a tracheo-oesophageal fistula in an immunocompetent patient]. / Aspergillus niger responsable d'une fistule trachéo-oesophagienne chez un sujet immunocompétent.

Tracheal or bronchial aspergillar locations are rare. They are mainly found in patients with general or localised immune deficiency. The authors report the case of a 53-year-old Vietnamese immunocompetent patient without any factors of risk who suddenly came down with a perforation syndrome indicating a tracheo-oesophageal fistula. The bronchial samples helped identify Aspergillus niger as the agent incriminated. Surgical treatment associated with an antifungal treatment provided a cure without any recurrence for 3 years.

Endoscopic features of esophageal tuberculosis.

BACKGROUND: Esophageal tuberculosis is rare. Clinical and endoscopic features are variable, diverse, nonspecific, and poorly described. These findings may be confused with those of esophageal cancer and deep fungal infection. METHODS: Medical records from a 5-year period (January 1997 to December 2001) were searched for cases of esophageal tuberculosis. For identified cases, the clinical, radiologic, and endoscopic features were evaluated. OBSERVATIONS: Four cases of esophageal tuberculosis were encountered during the 5-year period studied. Three of the patients presented with dysphagia and weight loss. One patient had aspiration pneumonia and another fatal hematemesis. Endoscopic features included deep and large proximal esophageal ulcers in 2 patients, tracheo-esophageal fistula in one, and nonhealing proximal esophageal ulcer in another patient. CONCLUSION: The present case series indicates that certain endoscopic features, such as deep and large esophageal ulcers, tracheoesophageal fistula, and nonhealing ulcer, are strongly suggestive of tuberculosis-related esophageal lesions.

Methicillin-resistant Staphylococcus aureus neck infections resulting in a delayed abscess and a tracheo-oesophageal fistula.

We describe 2 cases of methicillin-resistant Staphylococcus aureus neck infections resulting in a deep neck abscess in one and formation of a tracheo-oesophageal fistula in the other. Predisposing factors, preventive measures and the principles of management are discussed. The role of carrier detection and rational use of antibiotics are highlighted.

Tracheoesophageal fistula in AIDS: stent versus primary repair.

Tracheoesophageal fistula arising secondary to Mycobacterium tuberculous infection in AIDS patients is extremely rare. We describe a case with a fistula lesion that initially failed to close using a four-drug antituberculosis regimen. The original lesion closed following placement of an esophageal stent. However, the stent migrated, causing an iatrogenic tracheoesophageal fistula that needed surgical repair. Tracheoesophageal fistula (TEF) is an uncommon clinical condition, most frequently arising as a sequelae to esophageal malignancy. Iatrogenic injury to the membraneous trachea secondary to cuffed endotracheal or tracheostomy tubes in the presence of an in-dwelling nasogastric tube and corrosive burns, accounts for most of the remainder of occurring fistulas. Infections such as candidiasis, syphilis, and tuberculosis are also known to cause this condition. We report stent migration with perforation and subsequent TEF formation in an HIV-positive patient who originally had stent placement for a tuberculous tracheoesophageal fistula.

Tracheoesophageal fistula caused by mycobacterial tuberculosis adenopathy.

Tracheoesophageal fistulas resulting from a Mycobacterium tuberculosis infection are uncommon. We describe a patient with such a lesion that had the radiologic and clinic appearance of a malignant tracheoesophageal fistula. Use of an anterior cervical approach with one-stage esophageal repair along with tracheal resection and anastomosis allowed definitive diagnosis and treatment of this life-threatening complication.

Bacterial colonisation of the upper pouch in neonates with oesophageal atresia.

The bacterial flora in the upper oesophageal pouch of forty neonates with oesophageal atresia was studied at daily intervals preoperatively. Of the twenty-nine infants whose oesophagus was anastomosed within 24 hours of admission, no organisms were isolated in sixteen, despite the fact that only nine of these patients had antibiotics. The remaining thirteen grew oropharyngeal organisms. Of eleven infants having delayed anastomosis eight received antibiotics. All eleven grew organisms in the upper pouch. Pseudomonas and serratia grew only in those receiving antibiotics. These results suggest that prophylactic antibiotics are rarely indicated. Efficient continuous aspiration of the pouch is probably more important.