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P247 Fungal infections in children with inflammatory bowel disease

Majorová E.*1, Šusterová I.2, Kolarčik P.3, Fandakova I.4, Majlingová S.1, Gombošová K.1, Petrášová M.1

1Detská fakultná nemocnica, Paediatric Department, Košice, Slovakia 2Faculty of Medicine P.J.Šafarik University, Paediatric Department, Košice, Slovakia 3Faculty of Medicine P.J.Šafarik University, Department of Health Psychology, Košice, Slovakia 4Synlab Slovakia, Košice, Slovakia

Background

Paediatric inflammatory bowel disease is often considered the “purest” form of disease without many extraneous influences of adult behaviour, e.g. smoking or disease comorbidity. Although the exact relationship between fungi and Crohn disease has not been clearly established, some evidence points to the possible role of Candida albicans in the processes leading to, or maintaining, inflammation at this entity. The aim of our study is to compare the prevalence of Candida between IBD patients and control group

Methods

In cohort of 43 children with IBD (27 children with Crohn's disease and 16 with colitis ulcerosa, (mean age 16.44 (SD=2.92)) we considered fungal infection at the time of diagnosis and at least one time during the course of follow-up in and compared it with control group of 34 children with gastrointestinal symptomatology (mean age 9.16 (SD=5.16)). It was performed stool cultivation for isolation of fungi, blood analysis for antigen of Candida (mannan) and antibodies against Candida in class of IgM and IgG. Activity of bowel inflammation was evaluated by fecal calprotectin level in both of group. The obtained data were statistically analysed using chi-square test, spearman correlation and binary logistic regression.

Results

Patients with IBD showed significantly higher prevalence of positivity towards antigen of Candida, antigen of Aspergillus, antibodies against_Candida class of IgM, fungi in stool and calprotectin (χ2 range: 3.8–26.5, p<0.05) compared to control group. There was no significant difference in antibodies_against Candida class of_IgG prevalence. The amount of fungi in stool moderately correlated with the amount of calprotectin (ρ=0.455, p<0.001) in all patients. Positive antigen_Candida is associated with positive fungi in stool (OR=5.25, 95% CI: 1.32–20.92, p<0.05) and positive calprotectin (OR=10.08, 95% CI: 2.35–43.31, p<0.01).

Conclusion

Among the fungi colonizing the human gut, Candida species are the most prevalent in the digestive tract. Candida albicans is considered to be the most important commensal yeast in the human intestine. Bacterial composition in CD compared with healthy controls has been the subject of several investigations and several potentially disease-associated bacteria have been identified, but no study compared evidence of Candida in comparison with control group. Our study showed significant differences in evidence of Candida infection in IBD patients at time of diagnosis with comparison of control group of GI symptomatic patients.