Clinical Features of Fungal Peritonitis with Candida Albicans Infection after Gastric and Duodenal Perforation

Background: Acute fungal peritonitis due to gastric and duodenal perforation has been rarely reported. Methods: In this study, we retrospectively analyzed 15 cases with acute fungal peritonitis infected with Candida after gastric and duodenal perforation. Results: Gastric ulcer perforation was diagnosed in 5 cases and perforation of the duodenum was diagnosed in 10 cases. The medical background of patients included tuberculosis (TB) and long-term anti-TB therapy (5 cases), hypertension (4 cases), Type 2 diabetes (3 cases), rheumatoid arthritis (3 cases), hypoproteinemia (5 cases), and moderate anemia (7 cases). Two patients had a long-term history of drug abuse. All patients underwent surgery to repair the hole and suture the omentum over the perforation. All fungal peritonitis cases were caused by Candida, including C. albicans in 10 cases, C. tropicalis in 2 cases, C. Parapsilosis in 2 cases, and C. kefyr in 1 case. Fluconazole (400 mg for first day, then 200 mg/day for 7-14 days) was effective as anti-fungal treatment. The average length of hospital stay was 15.5 ± 4.1 days. Ten patients fully recovered. Incision infection was found in 3 patients. Two patients died due to multiple organ failure. Conclusion: Our study suggests that fungal culture is necessary for patients with gastrointestinal ulcer perforation, C. albicans is the most common fungal infection, and anti-fungal therapy is effective for acute fungal peritonitis due to Candida infection.