Vol 5, No 4 (2016)
Review article
Published online: 2016-11-03
Rare cases of bezoars in the urinary tract of diabetic patients — a review of case reports
DOI: 10.5603/DK.2016.0023
Clin Diabetol 2016;5(4):131-137.
Abstract
Bezoars are spherical conglomerates of foreign bodies or food debris, typically occurring in the gastrointestinal tract, primarily in the stomach. In exceptionally rare cases bezoars may also form within the urinary tract. In such cases, their formation is a result of an ongoing fungal infection in the urinary tract or a systemic infection, and the bezoar is most often composed primarily of hyphae, mostly of species Candida albicans, and fragments of necrotic tissue. Chronic hyperglycaemia impairs natural defence mechanisms of the immune system, both cellular as well as humoral, and thus predisposes towards fungal infections. This paper discusses selected examples of cases of fungal bezoars in the urinary tract in diabetic patients described to date, with an emphasis on risk factors for their formation and treatment methods.
Keywords: diabetes mellitusbezoarsurinary tractCandida albicansAspergillus
References
- Taczalska A, Nowosławska-Łuniewska K, Koziarkiewicz M, et al. Bezoary — trudności diagnostyczne na przykładzie własnych obserwacji i przegląd piśmiennictwa. Dev Period Med. 2013; 17: 265–269.
- Di Paola G, Mogorovich A, Fiorini G, et al. Candida bezoars with urinary tract obstruction in two women without immunocompromising conditions. ScientificWorldJournal. 2011; 11: 1168–1172.
- Doemeny JM, Banner MP, Shapiro MJ, et al. Percutaneous extraction of renal fungus ball. AJR Am J Roentgenol. 1988; 150(6): 1331–1332.
- Ku JH, Kim ME, Jeon YS, et al. Urinary ascites and anuria caused by bilateral fungal balls in a premature infant. Arch Dis Child Fetal Neonatal Ed. 2004; 89(1): F92–F93.
- Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016; 62(4): e1–50.
- Drozdowska A, Drzewoski J. Mycoses in diabetes — difficult diagnostic and therapeutic problem. Review of literature. Diabetol Dośw Klin. 2008; 8: 1–11.
- Ryba-Stanisławowska M. Zaburzenia regulacji reaktywności zapalnej w patogenezie cukrzycy typu 1: postępy patofizjologii i możliwość nowego rodzaju leczenia. Med Metab. 2015; 19: 50–63.
- Tatoń J. Profilaktyka zespołu stopy cukrzycowej oparta na patofizjologii. Med Metab. 2014; 18: 76–82.
- Haruyama N, Masutani K, Tsuruya K, et al. Candida glabrata fungemia in a diabetic patient with neurogenic bladder: successful treatment with micafungin. Clin Nephrol. 2006; 66(3): 214–217.
- Wang L, Ji X, Sun GF, et al. Fungus ball and emphysematous cystitis secondary to Candida tropicalis: A case report. Can Urol Assoc J. 2015; 9(9-10): E683–E686.
- Comiter CV, McDonald M, Minton J, et al. Fungal bezoar and bladder rupture secondary to candida tropicalis. Urology. 1996; 47(3): 439–441.
- Shimada S, Nakagawa H, Shintaku I, et al. Acute renal failure as a result of bilateral ureteral obstruction by Candida albicans fungus balls. Int J Urol. 2006; 13(8): 1121–1122.
- Pazos R, Esteban J, Pérez C, et al. [Bilateral hydronephrosis caused by a "fungus ball"]. Nefrologia. 2001; 21(3): 319–320.
- Patel B, Khosla A, Chenoweth JL. Bilateral fungal bezoars in the renal pelvis. Br J Urol. 1996; 78(4): 651–652.
- Latgé JP. Aspergillus fumigatus and Aspergillosis. Clin Microbiol Rev. 2009; 12: 310–350.
- Wosiewicz P, Hartleb M, Kochel-Jankowska A, et al. Inwazyjna aspergiloza u chorych z marskością wątroby. Gastroenterol Prakt. 2014; 4: 62–66.
- Gupta KL. Fungal infections and the kidney. Indian J Nephrol. 2001; 11: 147–157.
- Ahuja A, Aulakh BS, Cheena DK, et al. Aspergillus fungal balls causing ureteral obstruction. Urol J. 2009; 6(2): 127–129.
- Najafi N, Shokohi T, Basiri A, et al. Aspergillus terreus-related ureteral obstruction in a diabetic patient. Iran J Kidney Dis. 2013; 7(2): 151–155.
- Siczyńska B, Dyk D. Wybrane aspekty szpitalnych zakażeń grzybiczych. Pielęg Chir Angiol. 2013; 1: 1–6.
- Pałys M, Targoński Z. Produkcja kwasu mlekowego przez grzyby z rodzaju Rhizopus. Żywn Nauka Technol Jakość. 2013; 4: 21–36.
- Biliński P, Warzocha K. Diagnostyka i leczenie układowych zakażeń grzybiczych w onkohematologii. Onkol Prakt Klin. 2008; 4: 15–24.
- Garczewska B. Szpitalne zakażenia grzybicze. In: Dzierżanowska D (ed). Zakażenia szpitalne. A-medica press, Bielsko-Biała 2008: 409–425.
- Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. 2000; 13(2): 236–301.
- Lussier N, Laverdière M, Weiss K, et al. Primary renal mucormycosis. Urology. 1998; 52(5): 900–903.
- Weng DE, Wilson WH, Little R, et al. Successful medical management of isolated renal zygomycosis: case report and review. Clin Infect Dis. 1998; 26(3): 601–605.
- Palacio-Bedoya F, Cadena JA, Thompson GR, et al. A noninvasive renal fungus ball caused by Rhizopus--a previously unreported manifestation of zygomycosis. Med Mycol. 2010; 48(6): 866–869.