Table 12.

Summary of colonic infection caused by fungi

Fungal infections	Prevalence of colonic involvement	Risk factors	Clinical manifestations	Dissemination	Lesions	Distribution	Initial treatment	Response
Paracoccidioidomycosis45–50,72	29%	• Endemic area (South America) • Any host	Diarrhea, abdominal pain, fever	50%	Ulcer, mass, polyp, stricture	Whole colon	Co-trimoxazole, sulfadiazine, amphotericin B, or itraconazole	71%
Histoplasmosis20,21	28%	• Any host	Diarrhea, abdominal pain, LGIB, fever, weight loss	83%	Ulcer, edema mucosa mass	Whole colon but predominantly right side of colon and rectum	Amphotericin B	77%
Candidiasis13,73	20% of intestinal candidiasis in autopsy	• Malignancy, immunosuppressive agents, neutropenia, AIDS, ESRD • No immunocompetent patients	Diarrhea, abdominal pain, fever	71%	Ulcer, plaque, erosion	Whole colon	Fluconazole or caspofungin	100%
Cryptococcosis26–35	17% of disseminated or pulmonary cryptococcosis	• AIDS, immunosuppressive agents, hematologic malignancy, splenectomy, Job’s syndrome, cirrhosis • Immunocompetent patients (23%)	• Symptoms: LGIB, fever, abdominal pain, diarrhea, rectal abscess • 20% asymptomatic	71% (all patients immunocompromised)	Mass, perirectal abscess, colonic ulcer, patchy lesions, stricture, polyp	Whole colon	Amphotericin B + flucytosine ± surgery	60%
Aspergillosis9,39–44,74	9.2%	• Malignancy, chemotherapy, neutropenia, immunosuppressive agents, DM, burn • No immunocompetent patients	Fever, abdominal pain, LGIB, diarrhea	86%	Ulcer, necrosis	Whole colon	Amphotericin B or caspofungin ± surgery	50%
Penicilliosis36–38,68	1.9%	• Endemic area (Southeast Asia, southern China, Hong Kong, and India) • Mostly AIDS (75%) • No immunocompetent patients	Fever, diarrhea, abdominal pain, LGIB	50%	Ulcer	Predominantly in right side of colon and spare rectum	Amphotericin B	75%
Zygomycosis22–25	0.85%	• Immunosuppressive agent, malnutrition, renal failure, DM, hematologic malignancy • I mmunocompetent patients (33.3%)	Abdominal pain, abdominal distension, fever, LGIB, diarrhea	38%	Ulcer, necrosis, mass	Whole colon but predominantly in the right side of the colon	Amphotericin B + surgery	50%
Pneumocystosis51	Only one case	• AIDS	Fever, diarrhea	100%	Edema mucosa	Whole colon	Pentamidine	100%
Scedosporiosis52	Only one case	• Post-liver transplantation, immunosuppressive agents	Diarrhea, abdominal pain	100%	Ulcer	Whole colon	Amphotericin B	100%

Abbreviations: AIDS, acquired immunodeficiency syndrome; DM, diabetes mellitus; ESRD, end-stage renal disease; LGIB, lower gastrointestinal bleeding.