1
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Correia AA, Weber MA, Krishnan U. Prevalence, Predictive Factors, and Clinical Manifestations of Fungal Esophagitis in Children. J Pediatr Gastroenterol Nutr 2023; 77:610-617. [PMID: 37608450 DOI: 10.1097/mpg.0000000000003927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Fungal esophagitis (FE) is the most common cause of esophageal infection and its prevalence in immunocompetent adults is rising. However, there is minimal data on FE in children without human immunodeficiency virus. Therefore, the objective of this study was to determine the prevalence, symptoms, endoscopic appearances, and predictive factors of FE in children, regardless of immune status. METHODS A 2010-2020 retrospective case-control study was conducted on 1823 children presenting to Sydney Children's Hospital for elective endoscopy with esophageal biopsy. Histopathology reports were reviewed to identify FE cases and determine prevalence rates. Thirty-two patients with FE were age- and sex-matched (1:2) to 64 controls. Significant symptoms and risk factors of FE were identified via univariate and multivariate logistic regression analysis. RESULTS The prevalence of FE in children was 1.76%. Common symptoms included dysphagia (25%), heartburn (25%), poor oral intake (21.9%), vomiting (18.8%), cough (15.6%), nausea (12.5%), and weight loss (9.4%). No significant differences in symptoms were found between cases and controls. On endoscopy, although white plaques were associated with FE ( P < 0.001), visually normal findings were reported in 28.1% of cases. Topical swallowed corticosteroids were a significant independent risk factor for FE (adjusted odds ratio = 10.740, 95% confidence interval: 1.213-95.101, P = 0.033). CONCLUSIONS The prevalence of FE in this pediatric cohort reflects rates among immunocompetent adults. Given that many of these children presented with a wide range of gastrointestinal symptoms, esophageal biopsy is required to accurately diagnose FE. Pediatricians should consider the risk of FE when prescribing topical swallowed corticosteroids.
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Affiliation(s)
- Alison A Correia
- From the Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Martin A Weber
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- the Department of Anatomical Pathology, New South Wales Health Pathology East (Randwick Campus), Randwick, New South Wales, Australia
| | - Usha Krishnan
- the Department of Gastroenterology, Sydney Children's Hospital, Sydney, New South Wales, Australia
- the School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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2
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Koyama K, Anno T, Takenouchi H, Kimura T, Kaku K, Kaneto H. Case Report: Repeated esophageal obstruction in a patient with type 3C diabetes mellitus. Front Endocrinol (Lausanne) 2023; 14:1225385. [PMID: 37576980 PMCID: PMC10420082 DOI: 10.3389/fendo.2023.1225385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Although diabetic neuropathy is a well-known cause of gastrointestinal motility disorders, it is rare that diabetic neuropathy brings about esophageal obstruction. Here, we report a case with Type 3C diabetes mellitus (DM) lasting over 15 years and repeated esophageal obstruction resulting in chicken-meat-induced esophageal obstruction and candidiasis. This case highlights the importance of management of DM to prevent the development of complications such as diabetic neuropathy and associated symptoms.
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Affiliation(s)
- Katsumasa Koyama
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Takatoshi Anno
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
- Department of Diabetic Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Haruka Takenouchi
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Tomohiko Kimura
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Kohei Kaku
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
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3
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Kimchy AV, Ahmad AI, Tully L, Lester C, Sanghavi K, Jennings JJ. Prevalence and clinical risk factors for esophageal candidiasis in non-human immunodeficiency virus patients: A multicenter retrospective case-control study. World J Gastrointest Endosc 2023; 15:480-490. [PMID: 37397972 PMCID: PMC10308277 DOI: 10.4253/wjge.v15.i6.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/20/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Although esophageal candidiasis (EC) may manifest in immunocompetent individuals, there is a lack of consensus in the current literature about predisposing conditions that increase the risk of infection.
AIM To determine the prevalence of EC in patients without human immunodeficiency virus (HIV) and identify risk factors for infection.
METHODS We retrospectively reviewed inpatient and outpatient encounters from 5 regional hospitals within the United States (US) from 2015 to 2020. International Classification of Diseases, Ninth and Tenth Revisions were used to identify patients with endoscopic biopsies of the esophagus and EC. Patients with HIV were excluded. Adults with EC were compared to age, gender, and encounter-matched controls without EC. Patient demographics, symptoms, diagnoses, medications, and laboratory data were obtained from chart extraction. Differences in medians for continuous variables were compared using the Kruskal-Wallis test and categorical variables using chi-square analyses. Multivariable logistic regression was used to identify independent risk factors for EC, after adjusting for potential confounding factors.
RESULTS Of the 1969 patients who had endoscopic biopsies of the esophagus performed from 2015 to 2020, 295 patients had the diagnosis of EC. 177 of 1969 patients (8.99%) had pathology confirming the diagnosis of EC and were included in the study for data collection and further analysis. In comparison to controls, patients with EC had significantly higher rates of gastroesophageal reflux disease (40.10% vs 27.50%; P = 0.006), prior organ transplant (10.70% vs 2%; P < 0.001), immunosuppressive medication (18.10% vs 8.10%; P = 0.002), proton pump inhibitor (48% vs 30%; P < 0.001), corticosteroid (35% vs 17%; P < 0.001), Tylenol (25.40% vs 16.20%; P = 0.019), and aspirin use (39% vs 27.50%; P = 0.013). On multivariable logistic regression analysis, patients with a prior organ transplant had increased odds of EC (OR = 5.81; P = 0.009), as did patients taking a proton pump inhibitor (OR = 1.66; P = 0.03) or corticosteroids (OR = 2.05; P = 0.007). Patients with gastroesophageal reflux disease or medication use, including immunosuppressive medications, Tylenol, and aspirin, did not have a significantly increased odds of EC.
CONCLUSION Prevalence of EC in non-HIV patients was approximately 9% in the US from 2015-2020. Prior organ transplant, proton pump inhibitors, and corticosteroids were identified as independent risk factors for EC.
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Affiliation(s)
- Alexandra V Kimchy
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Akram I Ahmad
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20007, United States
| | - Lindsey Tully
- Department of Internal Medicine, Georgetown University School of Medicine, Washington, DC 20007, United States
| | - Connor Lester
- Department of Internal Medicine, Georgetown University School of Medicine, Washington, DC 20007, United States
| | - Kavya Sanghavi
- Department of Biostatistics and Biomedical Informatics, MedStar Research Institute, Hyattsville, MD 20781, United States
| | - Joseph J Jennings
- Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States
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4
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Abstract
Infectious esophagitis is the third most common cause of esophagitis after gastroesophageal reflux disease and eosinophilic esophagitis (EoE) and should always be considered in the differential of patients with dysphagia and odynophagia. The most common organisms causing disease are candida, Herpes simplex virus (HSV) and cytomegalovirus (CMV). It is well recognized that an impaired local or systemic immune system is a risk factor for disease; however, esophageal dysmotility and disruptions in esophageal homeostasis and the esophageal milieu are likely to represent additional risk factors in disease pathogenesis.
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5
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Prevalence, Predictors, and Outcomes of Esophageal Candidiasis in Cirrhosis: An Observational Study With Systematic Re view and Meta-Analysis (CANDID-VIEW). J Clin Exp Hepatol 2022; 12:118-128. [PMID: 35068792 PMCID: PMC8766531 DOI: 10.1016/j.jceh.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/12/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Gastrointestinal candidiasis is often neglected and potentially serious infection in cirrhosis patients. Therefore, we evaluated the prevalence, risk factors, and outcomes of esophageal candidiasis (EC) in cirrhotics and did a systematic review to summarize EC's available evidence in cirrhosis. METHODS Consecutive patients with cirrhosis posted for esophagogastroduodenoscopy (EGD) at a tertiary care institute were screened for EC (cases) between January 2019 and March 2020. EC was diagnosed on EGD findings and/or brush cytology. Controls (without EC) were recruited randomly, and EC's risk factors and outcomes were compared between cases and controls.Four electronic databases were searched for studies describing EC in cirrhosis. Prevalence estimates of EC were pooled on random-effects meta-analysis, and heterogeneity was assessed by I2. A checklist for prevalence studies was used to evaluate the risk of bias in studies. RESULTS EC was diagnosed in 100 of 2762 patients with cirrhosis (3.6%). Patients with EC had a higher model for end-stage liver disease (MELD) (12.4 vs. 11.2; P = 0.007), acute-on-chronic liver failure (ACLF) (26% vs. 10%; P = 0.003) and concomitant bacterial infections (24% vs. 7%; P = 0.001), as compared with controls. A multivariable model, including recent alcohol binge, hepatocellular carcinoma (HCC), upper gastrointestinal (UGI) bleed, ACLF, diabetes, and MELD, predicted EC's development in cirrhosis with excellent discrimination (C-index: 0.918). Six percent of cases developed the invasive disease and worsened with multiorgan failures, and four patients with EC died on follow-up.Of 236 articles identified, EC's pooled prevalence from 8 studies (all with low-risk of bias) was 2.1% (95% CI: 0.8-5.8). Risk factors and outcomes of EC in cirrhosis were not reported in the literature. CONCLUSIONS EC is not a rare infection in cirrhosis patients, and it may predispose to invasive candidiasis and untimely deaths. Alcohol binge, HCC, UGI bleed, ACLF, diabetes, and higher MELD are the independent predictors of EC in cirrhosis. At-risk patients with cirrhosis or those with deglutition symptoms should be rapidly screened and treated for EC.
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Key Words
- ACLF
- ACLF, Acute-on-chronic liver failure
- AIC, Akaike's Information Criteria
- AIDS, Acquired Immunodeficiency Syndrome
- BIC, Bayesian Information Criteria
- Candida
- DM, Diabetes Mellitus
- EC, Esophageal Candidiasis
- EGD, Esophagogastroduodenoscopy
- EVL, Endoscopic Variceal Ligation
- HAART, Highly Active Anti-Retroviral Therapy
- HCC, Hepatocellular Carcinoma
- HIV, Human Immunodeficiency Virus
- IC, Invasive Candidiasis
- MELD, Model for End-stage Liver Disease
- MELD-Na, Model for End-stage Liver Disease-Sodium
- RRT, Renal Replacement Therapy
- SBP, Spontaneous Bacterial Peritonitis
- SIRS, Systemic Inflammatory Response Syndrome
- UGI, Upper Gastrointestinal
- cirrhosis
- esophagitis
- invasive fungal infections
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Saidani A, Rakkeh H, Belhaj A, Debaibi M, Chebbi F. Laparoscopic Sleeve Gastrectomy Esophageal Candidiasis an Exceptional Complication of Laparoscopic Sleeve Gastrectomy: First Case Report. Obes Surg 2021; 31:3851-3853. [PMID: 33866533 DOI: 10.1007/s11695-021-05398-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ahmed Saidani
- Universite de Tunis El Manar, Tunis, Tunisia.,Department of Digestive Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Hichem Rakkeh
- Universite de Tunis El Manar, Tunis, Tunisia. .,Department of Digestive Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia.
| | - Anis Belhaj
- Universite de Tunis El Manar, Tunis, Tunisia.,Department of Digestive Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Mahdi Debaibi
- Universite de Tunis El Manar, Tunis, Tunisia.,Department of Digestive Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Faouzi Chebbi
- Universite de Tunis El Manar, Tunis, Tunisia.,Department of Digestive Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
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7
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Hissong E, Schechter S, Mowers J, Yantiss RK, Slavik T, Cheng J, Lamps LW. The diagnosis of clinically significant oesophageal Candida infections: a reappraisal of clinicopathological findings. Histopathology 2021; 76:748-754. [PMID: 31944368 DOI: 10.1111/his.14063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/17/2019] [Accepted: 01/10/2020] [Indexed: 12/19/2022]
Abstract
AIMS Distinguishing true oesophageal Candida infections from oral contaminants is a common diagnostic issue. Historically, histological features believed to indicate true infection included epithelial invasion by pseudohyphae and intraepithelial neutrophils. Whether or not these features correlate with endoscopic lesions, symptoms and response to therapy has never been tested in a large cohort. The aim of this study was to determine whether specific histological features correlate with clinical and endoscopic findings when Candida is found in oesophageal biopsies. METHODS AND RESULTS We reviewed 271 biopsies in which Candida was detected. Cases were evaluated for the presence of desquamated epithelial cells, location/type of fungal forms, neutrophils, and ulceration. Medical records were reviewed for clinical history, endoscopic lesions, and response to antifungal therapy. Statistical analysis was used to determine whether any histological features significantly correlated with clinical variables. There were 120 males and 151 females with a mean age of 42 years. Fifty-nine per cent had symptoms referable to the oesophagus, particularly dysphagia (36%). Most (73%) patients had abnormal endoscopic findings, with plaques, ulcers, or macroscopic evidence of oesophagitis. Seventy-one per cent of patients with documented antifungal therapy showed symptomatic improvement. Overall, there was no statistically significant correlation between any histological feature and presenting symptoms, endoscopic findings, or response to therapy. Importantly, the lack of pseudohyphae, demonstrable invasion of intact epithelium or neutrophilic infiltrates did not exclude clinically significant infection. CONCLUSIONS We conclude that detection of Candida in oesophageal biopsies is always potentially clinically significant. Treatment decisions should be made on the basis of an integration of clinical, endoscopic and histological findings.
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Affiliation(s)
- Erika Hissong
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shula Schechter
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Mowers
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Tomas Slavik
- Ampath Pathology Laboratories, University of Pretoria, Pretoria, South Africa
| | - Jerome Cheng
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Laura W Lamps
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
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8
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Clinical Characteristics and Manifestations of Fungal Esophagitis: A Single-Center Experience in South China. Gastroenterol Res Pract 2021; 2021:8869494. [PMID: 33531895 PMCID: PMC7834832 DOI: 10.1155/2021/8869494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/22/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
Fungal esophagitis is a common infectious disease, although the pathogenic clinical characteristics remain incompletely clear, especially in South China. The goal of this study was to investigate the pathogenic clinical characteristics of fungal esophagitis and the efficacy of different therapeutic strategies at a tertiary hospital in South China. A retrospective study was conducted from January 2007 to December 2017. Data from 113,390 patients who were treated in the endoscopic unit were retrieved and analyzed. To further understand the pathogen and risk factors for fungal esophagitis, we performed a case-control analysis of 101 patients and 202 controls. Of the 113,390 patients, 932 (0.82%) were positive. The annual detection rate ranged from 0.345% to 1.106%, showing an initially increasing and subsequently decreasing trend. The patients' median age was 49 years (range from 8 to 85), and most were men (615/932, 65.99%). Candida albicans was found in samples collected from 36 patients, without any drug-resistant strains. Age (P = 0.018), malignancy (OR = 4.031, 95% CI: 1.562~10.407), cigarette smoking (OR = 3.017, 95% CI: 1.645~5.533), and the use of antibiotics (OR = 2.178, 95% CI: 1.078~4.400) or immunosuppressants (OR = 6.525, 95% CI: 1.089~39.105) were independently associated with esophageal candidiasis. Fluconazole had a better curative effect than nystatin (OR = 4.047, 95% CI: 1.282~12.772) or simple observation (OR = 8.91, 95% CI: 2.61~30.49). In conclusion, fungal esophagitis primarily affects men and elderly individuals; it develops in the setting of malignancy, smoking, and certain previous medication use. Candida albicans is the most common pathogen and is sensitive to antifungal agents. Fluconazole has a good therapeutic effect.
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9
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Trukhmanov AS, Makushina AA, Storonova OA, Ivashkina NY. [Evaluation and management of infectious esophagitis in immunocompromised patients and immunocompetent individuals]. TERAPEVT ARKH 2020; 92:108-117. [PMID: 33346470 DOI: 10.26442/00403660.2020.08.000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Indexed: 11/22/2022]
Abstract
Among the many causes of the inflammatory process in the esophagus, infectious diseases are becoming increasingly important due to their steady growth. Previously esophageal infections have traditionally been associated with immunodeficiency syndromes, but now in clinical practice, these disorders are becoming increasingly recognized in immunocompetent individuals. Early diagnosis of infectious esophagitis is necessary to develop effective treatment tactics, and, as a result, reduce the risk of complications and adverse outcomes of the disease. This study reviewed the most clinical relevant pathogens of infectious esophagitis, both among patients with immunodeficiency and among healthy individuals. Specific diagnostic, risk factors, clinical presentation and therapeutic features were considered depending on the immune status of patients.
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Affiliation(s)
- A S Trukhmanov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A A Makushina
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O A Storonova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - N Y Ivashkina
- Sechenov First Moscow State Medical University (Sechenov University)
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10
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Piubelli MLM, Felipe-Silva A, Kanegae MY, Ferraz de Campos FP. Fatal necrotizing Candida esophagitis in a patient with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis. AUTOPSY AND CASE REPORTS 2019; 9:e2018070. [PMID: 30963052 PMCID: PMC6433139 DOI: 10.4322/acr.2018.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/24/2018] [Indexed: 12/15/2022] Open
Abstract
Esophageal infection by Candida spp. is a common opportunistic entity in immunocompromised hosts; however, systemic fungal dissemination due to perforation or transmural necrosis, also known as necrotizing Candida esophagitis (NCE), is rare. We report the case of a 61-year-old male patient with diagnosed ankylosing spondylitis, severe arteriosclerosis, and vasculitis under immunosuppressive therapy who presented NCE with fungal and bacterial septicemia diagnosed at autopsy. Necrotizing esophagitis is a rare manifestation of Candida infection, which may be a final complication in severely ill patients. Unfortunately, it may be underdiagnosed, and we call attention to this devastating complication in patients with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis.
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Affiliation(s)
| | - Aloisio Felipe-Silva
- Universidade de São Paulo (USP), Faculty of Medicine, Department of Pathology. São Paulo, SP, Brazil.,Universidade de São Paulo (USP), Hospital Universitário, Anatomic Pathology Service. São Paulo, SP, Brazil
| | - Marcia Yoshie Kanegae
- Universidade de São Paulo (USP), Hospital Universitário, Internal Medicine Division. São Paulo, SP, Brazil
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11
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Hoversten P, Kamboj AK, Katzka DA. Infections of the esophagus: an update on risk factors, diagnosis, and management. Dis Esophagus 2018; 31:5123414. [PMID: 30295751 DOI: 10.1093/dote/doy094] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/11/2022]
Abstract
Infectious esophagitis is a leading cause of esophagitis worldwide. While esophageal infections have traditionally been associated with immunocompromised patients, these disorders are becoming increasingly recognized in immunocompetent individuals. The three most common etiologies of infectious esophagitis are Candida, herpes simplex virus, and cytomegalovirus. Human papilloma virus infection can also involve the esophagus in the form of ulcerative lesions and papillomas. Less common etiologies include various other fungal, bacterial, and viral organisms. This review provides a comprehensive update on risk factors, diagnosis, and management of both common and less common infections of the esophagus.
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Affiliation(s)
- P Hoversten
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - A K Kamboj
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - D A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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12
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Mucosal inflammation in Candida esophagitis has distinctive features that may be helpful diagnostically. Mod Pathol 2018; 31:1653-1660. [PMID: 29921901 DOI: 10.1038/s41379-018-0060-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/28/2018] [Accepted: 03/24/2018] [Indexed: 12/13/2022]
Abstract
The diagnosis of Candida esophagitis can be challenging when the epithelium containing Candida filamentous forms is not readily seen or is entirely sloughed away. Mucosal inflammation could be helpful diagnostically, if distinctive. However it is thought to be nonspecific in Candida esophagitis. The goal of this retrospective study was to identify features of mucosal inflammation helpful in alerting a pathologist to the possibility of Candida esophagitis when Candida mycelia are not readily observed. The study group consisted of 99 consecutive cases of Candida esophagitis and a control group of 64 consecutive cases of reflux esophagitis diagnosed at our institution from 2008-2016. Band-like superficial intraepithelial neutrophils and increased intraepithelial lymphocytes were observed in 75 and 67% of Candida esophagitis cases, respectively and only in 14 and 19% of reflux esophagitis cases, respectively (p < .0001). Intraepithelial lymphocytes were peripapillary or CD4-predominant in 75% of Candida esophagitis cases with increased lymphocytes, in contrast to 17% of reflux esophagitis cases (p = .0011). Concurrent presence of intraepithelial neutrophils and increased lymphocytes showed increased specificity for Candida esophagitis and was observed in 61% of patients with Candida esophagitis and only in 2% of patients with reflux esophagitis (p < .0001). In addition, superficial band-like neutrophils were observed concurrently with increased peripapillary lymphocytes or CD4-predominant lymphocytes in 35 and 50% of Candida esophagitis cases, respectively, in contrast to no reflux esophagitis cases. Basal cell hyperplasia and elongation of stromal papillae were frequent in both groups. The data suggest that when Candida microorganisms are not readily observed, concurrent presence of superficial band-like neutrophils and increased lymphocytes may be indicative of Candida etiology of active esophagitis.
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13
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Mushi MF, Ngeta N, Mirambo MM, Mshana SE. Predictors of esophageal candidiasis among patients attending endoscopy unit in a tertiary hospital, Tanzania: a retrospective cross-sectional study. Afr Health Sci 2018; 18:66-71. [PMID: 29977259 PMCID: PMC6016994 DOI: 10.4314/ahs.v18i1.10] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Esophageal candidiasis is a common disease among patients with impaired cell mediated immunity. In the current study, we report esophageal candidiasis among patients with various co-morbidities attending the endoscopic unit at the Bugando Medical Centre. Methods This retrospective study was conducted from June to September 2015. All data of the patients who attended the endoscopic unit between 2009 and 2014 were retrieved and analyzed. Results A total of 622 patients who underwent oesophagogastroduodenoscopy were analyzed. A slight majority 334/622(53.7%) of patients were female. Out of 622 patients; 35(5.6%) had esophageal candidiasis. Decrease in age (OR 1.1, 95%CI; 1.0–1.1), female sex (OR 3.8, 95%CI; 1.1–13.1), drinking alcohol (OR 17.1, 95%CI; 4.9–58.9), smoking (OR 8.3, 95%CI; 1.7–41.0), antibiotic use (OR 5.7, 95%CI; 2.0–16.4), positive HIV status (OR 10.3, 95%CI; 4.6–6.0) and presence of peptic ulcer disease (OR 13.2, 95%CI; 3.5–49.0) independently predicted esophageal candidiasis. Conclusion Patients with a history of drinking alcohol, smoking, use of antibiotics and those with chronic diseases such as peptic ulcers were at high risk of developing esophageal candidiasis. Further studies are needed to identify Candida spp. and their anti-fungal susceptibility for proper management of esophageal candidiasis in HIV and non-HIV individuals.
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Affiliation(s)
- Martha F Mushi
- Microbiology and Immunology Department; Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Nathaniel Ngeta
- Department of Internal Medicine Weill Bugando School of Medicine. P.O. Box 1464 Mwanza, Tanzania
| | - Mariam M Mirambo
- Microbiology and Immunology Department; Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Stephen E Mshana
- Microbiology and Immunology Department; Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
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14
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Papp KA, Bachelez H, Blauvelt A, Winthrop KL, Romiti R, Ohtsuki M, Acharya N, Braun DK, Mallbris L, Zhao F, Xu W, Walls CD, Strober B. Infections from seven clinical trials of ixekizumab, an anti-interleukin-17A monoclonal antibody, in patients with moderate-to-severe psoriasis. Br J Dermatol 2017; 177:1537-1551. [PMID: 28600810 DOI: 10.1111/bjd.15723] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Infections are associated with biological therapies in psoriasis. OBJECTIVES To summarize the incidence of infections in patients with moderate-to-severe psoriasis treated with ixekizumab, an anti-interleukin-17A monoclonal antibody. METHODS Infections are summarized from an integrated database of seven controlled and uncontrolled ixekizumab psoriasis trials. Data are presented from placebo-controlled induction (weeks 0-12; UNCOVER-1, UNCOVER-2 and UNCOVER-3) and maintenance periods (weeks 12-60; UNCOVER-1 and UNCOVER-2), and all patients exposed to ixekizumab pooled from all seven trials. Comparisons with etanercept were made during the induction period of two trials (UNCOVER-2 and UNCOVER-3). Incidence and exposure-adjusted incidence rates (IRs) per 100 patient-years (PYs) are reported. RESULTS Overall, 4209 patients were treated with ixekizumab (6480 PY). During induction (weeks 0-12), overall infection rates were higher in patients treated with ixekizumab (27%) vs. placebo (23%, P < 0·05); however, specific infection rates were comparable overall across treatment groups. IRs of infections did not increase with longer-term exposure. For all patients treated with ixekizumab (all seven trials), the incidence of serious infections was low (2%, IR 1·3). Candida infections, including eight cases of oesophageal candidiasis, were adequately managed with antifungal therapy, were noninvasive and did not lead to discontinuation. CONCLUSIONS Overall, infections occurred in a higher percentage of patients treated with ixekizumab vs. placebo during the first 12 weeks of treatment; however, specific infection rates were comparable overall across treatment groups. Incidences of serious infections were low and similar across treatment groups.
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Affiliation(s)
- K A Papp
- K. Papp Clinical Research, Waterloo, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada
| | - H Bachelez
- Service de Dermatologie, AP-HP Hôpital Saint Louis, Sorbonne Paris Cité Université Paris Diderot, Paris, France
| | - A Blauvelt
- Oregon Medical Research Center, Portland, OR, U.S.A
| | - K L Winthrop
- Oregon Health and Science University, Portland, OR, U.S.A
| | - R Romiti
- Departament of Dermatology, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - M Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - N Acharya
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - D K Braun
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - L Mallbris
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - F Zhao
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - W Xu
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - C D Walls
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - B Strober
- Probity Medical Research, Waterloo, ON, Canada.,Department of Dermatology, University of Connecticut Health Center, Farmington, CT, U.S.A
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15
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Yamada Y, Rodriguez C, Mannan AASR, Harrington M. Not so Obvious: Acute Herpes Esophagitis. Am J Med 2017; 130:1161-1162. [PMID: 28601544 DOI: 10.1016/j.amjmed.2017.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Yuji Yamada
- Department of Medicine, Mt Sinai Beth Israel Hospital, New York, NY.
| | - Carlos Rodriguez
- Department of Medicine, Mt Sinai Beth Israel Hospital, New York, NY
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16
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Salehi F, Esmaeili M, Mohammadi R. Isolation of Candida Species from Gastroesophageal Lesions among Pediatrics in Isfahan, Iran: Identification and Antifungal Susceptibility Testing of Clinical Isolates by E-test. Adv Biomed Res 2017; 6:103. [PMID: 28904931 PMCID: PMC5590398 DOI: 10.4103/2277-9175.213662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Candida species can become opportunistic pathogens causing local or systemic invasive infections. Gastroesophageal candidiasis may depend on the Candida colonization and local damage of the mucosal barrier. Risk factors are gastric acid suppression, diabetes mellitus, chronic debilitating states such as carcinomas, and the use of systemic antibiotics and corticosteroids. The aim of this study is collection and molecular identification of Candida species from gastroesophageal lesions among pediatrics in Isfahan, and determination of minimum inhibitory concentration (MIC) ranges for clinical isolates. Materials and Methods: A total of 200 patients underwent endoscopy (130 specimens from gastritis and 70 samples from esophagitis) were included in this study between April 2015 and November 2015. All specimens were subcultured on sabouraud dextrose agar, and genomic DNA of all strains was extracted using boiling method. Polymerase chain reaction and DNA sequencing of the ITS1-5.8SrDNA-ITS2 region were used for the identification of all Candida strains. MIC ranges were determined for itraconazole (ITC), amphotericin B (AmB), and fluconazole (FLU) by E-test. Results: Twenty of 200 suspected patients (10%) were positive by direct microscopy and culture. Candida albicans was the most common species (60%) followed by Candida glabrata (30%), Candida parapsilosis (5%), and Candida kefyr (5%). MIC ranges were determined for FLU (0.125–8 μg/mL), ITC (0.008–0.75 μg/mL), and AmB (0.008–0.75 μg/mL), respectively. Conclusion: Every colonization of Candida species should be considered as a potentially factor of mucocutaneous candidiasis and should be treated with antifungal drugs.
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Affiliation(s)
- Fatemeh Salehi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehran Esmaeili
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasoul Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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17
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Alsomali MI, Arnold MA, Frankel WL, Graham RP, Hart PA, Lam-Himlin DM, Naini BV, Voltaggio L, Arnold CA. Challenges to "Classic" Esophageal Candidiasis: Looks Are Usually Deceiving. Am J Clin Pathol 2017; 147:33-42. [PMID: 28158394 DOI: 10.1093/ajcp/aqw210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives We undertook the first case control study of histologically confirmed esophageal candidiasis (EC). Methods A computer search from July 2012 through February 2015 identified 1,011 esophageal specimens, including 40 cases of EC and 20 controls. Results The EC incidence was 5.2%; it was associated with immunosuppression and endoscopic white plaques and breaks. Smoking was a predisposing factor, and alcohol was protective. EC had no unique symptoms, and 54% of endoscopic reports did not suspect EC. Important histologic clues included superficial and detached fragments of desquamated and hyper-pink parakeratosis, acute inflammation, intraepithelial lymphocytosis, dead keratinocytes, and bacterial overgrowth. Thirty percent had no neutrophilic infiltrate. Pseudohyphae were seen on H&E in 92.5% (n = 37/40). "Upfront" periodic acid-Schiff with diastase (PAS/D) on all esophageal specimens would have generated $68,333.49 in patient charges. Our targeted PAS/D strategy resulted in $13,044.87 in patient charges (cost saving = 80.9%, $55,288.62). Conclusions We describe the typical morphology of EC and recommend limiting PAS/D to cases where the organisms are not readily identifiable on H&E and with at least one of the following: (1) ulcer, (2) suspicious morphology, and/or (3) clinical impression of EC.
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Affiliation(s)
- Mohammed I Alsomali
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Michael A Arnold
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Wendy L Frankel
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | | | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus
| | - Dora M Lam-Himlin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
| | - Bita V Naini
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | | | - Christina A Arnold
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
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18
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Abstract
Studies were reviewed from PubMed for risk factors for the development, recurrence, prevention and therapy of Candida esophagitis, and for mechanisms induced by acid-suppressing therapy potentially influencing these factors. Documented observations included greatly increased Candida populations in the mouth, esophagus, stomach, and upper small intestine induced by acid-suppressing therapy. Among patients without HIV disease, PPI consumers more frequently had developed Candida esophagitis than did non-consumers and had also developed its recurrences more frequently. Similar phenomena associated with H2 -blocker use were less intense, and the possibility of similar phenomena in patients with HIV disease apparently had not yet been examined in spite of their high frequency of this disorder. PPI-induced elimination of the gastric acid barrier is a major mechanism leading to oro-pharyngeal and esophageal candida colonization, while PPI-induced impairment of absorption of most orally administered antifungal agents may limit the prophylactic and therapeutic success of these agents. These observations suggest potential value in limiting PPI use in populations of patients with Candida infections including esophagitis, as well as in patients at risk for their development, and also suggest that post-PPI rebound acid hypersecretion may provide additional anti-Candida benefit. Studies designed to develop the risk-benefit ratios of PPI use in these patients deserve investigation with high priority appropriate for studies in patients with HIV disease.
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Affiliation(s)
- H W Daniell
- Department of Family Practice, University of California Medical School at Davis, Davis, California, USA
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19
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Lee SP, Sung IK, Kim JH, Lee SY, Park HS, Shim CS. The clinical course of asymptomatic esophageal candidiasis incidentally diagnosed in general health inspection. Scand J Gastroenterol 2016; 50:1444-50. [PMID: 26083902 DOI: 10.3109/00365521.2015.1057519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Esophageal candidiasis mostly occurs in the immunocompromised host. However, it may also affect healthy people and is frequently asymptomatic. The clinical significance of asymptomatic esophageal candidiasis (AEC) is still unclear. The aims of the study were to investigate the prevalence of AEC during health inspection and to identify its predisposing factors and clinical significance. MATERIALS AND METHODS A total of 49,497 subjects who underwent a health inspection that included upper endoscopy were enrolled. We retrospectively reviewed the subject's self-reporting questionnaires, medical records and endoscopic findings. We considered "long-term" follow-up to be >6 months with at least one more follow-up endoscopy. RESULTS One hundred and seventy (0.4%) subjects were endoscopically diagnosed as esophageal candidiasis and 141 subjects were AEC. Multivariate analysis revealed that old age (≥60 years) was an independent risk factor for AEC (OR, 1.862, p = 0.005). The number of subjects with long-term follow-up was 79 (195.3 person-years). Among these, AEC of 64 subjects (81.0%) had disappeared on the follow-up endoscopy and was not recurrent. The other 15 subjects had AEC diagnosed more than once on the follow-up endoscopy, and 5 of them were spontaneously healed during the follow-up period. The remaining 10 subjects whose candidiasis was sustained up to the last endoscopy did not complain of symptoms during the follow-up period, and their endoscopic findings did not worsen. CONCLUSIONS AEC is rare and old age is the only risk factor. AEC does not require medical care because it is a self-limited disease.
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Affiliation(s)
- Sang Pyo Lee
- Department of Internal Medicine, Konkuk University School of Medicine , Seoul , Korea
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20
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Ahuja NK, Clarke JO. Evaluation and Management of Infectious Esophagitis in Immunocompromised and Immunocompetent Individuals. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2016; 14:28-38. [PMID: 26847359 DOI: 10.1007/s11938-016-0082-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Among the many inflammatory processes that may account for esophageal symptoms, infection represents an important etiologic category with numerous clinically relevant subdivisions. While features of the history and physical exam are informative, diagnosis often hinges on endoscopic visualization and histopathologic analysis. This chapter will review in series the most clinically relevant causative agents for infectious esophagitis, with specific diagnostic and therapeutic features of note divided into one of two immune milieus. Our discussion focuses primarily on Candida species, herpes simplex virus, and cytomegalovirus as the most common causes of infectious esophagitis while also addressing a number of less common pathogens worth keeping in mind.
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Affiliation(s)
- Nitin K Ahuja
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, A Building, Room 344B, Baltimore, MD, 21224, USA
| | - John O Clarke
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, A Building, Room 344B, Baltimore, MD, 21224, USA.
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21
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Chen KH, Weng MT, Chou YH, Lu YF, Hsieh CH. Epigastric Distress Caused by Esophageal Candidiasis in 2 Patients Who Received Sorafenib Plus Radiotherapy for Hepatocellular Carcinoma: Case Report. Medicine (Baltimore) 2016; 95:e3133. [PMID: 26986168 PMCID: PMC4839949 DOI: 10.1097/md.0000000000003133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Sorafenib followed by fractionated radiotherapy (RT) has been shown to decrease the phagocytic and candidacidal activities of antifungal agents due to radiosensitization. Moreover, sorafenib has been shown to suppress the immune system, thereby increasing the risk for candida colonization and infection. In this study, we present the 2 hepatocellular carcinoma (HCC) patients suffered from epigastric distress caused by esophageal candidiasis who received sorafenib plus RT. Two patients who had received sorafenib and RT for HCC with bone metastasis presented with hiccups, gastric ulcer, epigastric distress, anorexia, heart burn, and fatigue. Empiric antiemetic agents, antacids, and pain killers were ineffective at relieving symptoms. Panendoscopy revealed diffuse white lesions in the esophagus. Candida esophagitis was suspected. Results of periodic acid-Schiff staining were diagnostic of candidiasis. Oral fluconazole (150 mg) twice daily and proton-pump inhibitors were prescribed. At 2-weak follow-up, esophagitis had resolved and both patients were free of gastrointestinal symptoms. Physicians should be aware that sorafenib combined with RT may induce an immunosuppressive state in patients with HCC, thereby increasing their risk of developing esophagitis due to candida species.
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Affiliation(s)
- Kuo-Hsin Chen
- From the Department of Surgery (K-HC), Department of Internal Medicine (M-TW), Department of Anatomical Pathology (Y-HC), Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City (Y-FL, C-HH), Department of Electrical Engineering (K-HC), Department of Chemical Engineering & Materials Science, Yuan-Ze University, Taoyuan (M-TW), Department of Medicine (C-HH), and Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (C-HH)
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22
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Min YW, Kim E, Son HJ, Kim JJ, Rhee PL. Antifungal Treatment is Not Required for Immunocompetent Individuals With Asymptomatic Esophageal Candidiasis. Medicine (Baltimore) 2015; 94:e1969. [PMID: 26559270 PMCID: PMC4912264 DOI: 10.1097/md.0000000000001969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Although esophageal candidiasis (EC) is an opportunistic infection, asymptomatic EC (AEC) is occasionally encountered in otherwise healthy individuals. This study evaluates the impact of antifungal treatment in immunocompetent individuals with AEC and investigates risk factors for persistent or recurrent EC. The authors identified patients with biopsy-proven AEC from the database of individuals receiving screening endoscopy (n = 99,255). After excluding patients receiving immunosuppressive therapy, being positive for human immunodeficiency virus, receiving no follow-up endoscopy, or having no antifungal treatment data, a total of 142 patients were divided into remission and nonremission groups. Remission was defined when EC was not detectable on follow-up endoscopy. On baseline comparison, nonremission group was older (57.5 ± 10.3 versus 52.5 ± 10.5 years, P = 0.017) and more likely to have cardiovascular disease (12.9% versus 1.8%, P = 0.021) and history of pulmonary tuberculosis (PTB) (22.6% versus 4.5%, P = 0.004) and exhibited a lower triglyceride level (101.4 ± 37.4 versus 122.6 ± 79.6 mg/dL, P = 0.039) than remission group, whereas grade of EC and concomitant endoscopic findings did not differ between 2 groups. Antifungal treatment was also similarly performed between 2 groups. Multivariate analysis revealed that history of PTB is independently associated with nonremission (odds ratio 4.495, 95% confidence interval 1.023-19.762, P = 0.047). No patients demonstrated EC-related complications during a mean follow-up of 28.0 ± 12.0 months. In conclusion, our results suggested that antifungal treatment is not required for immunocompetent individuals with AEC and past history of PTB is an independent predictor for persistent or recurrent EC.
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Affiliation(s)
- Yang Won Min
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (HJS); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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23
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Takahashi Y, Nagata N, Shimbo T, Nishijima T, Watanabe K, Aoki T, Sekine K, Okubo H, Watanabe K, Sakurai T, Yokoi C, Kobayakawa M, Yazaki H, Teruya K, Gatanaga H, Kikuchi Y, Mine S, Igari T, Takahashi Y, Mimori A, Oka S, Akiyama J, Uemura N. Long-Term Trends in Esophageal Candidiasis Prevalence and Associated Risk Factors with or without HIV Infection: Lessons from an Endoscopic Study of 80,219 Patients. PLoS One 2015. [PMID: 26208220 PMCID: PMC4514810 DOI: 10.1371/journal.pone.0133589] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of candida esophagitis (CE) might be changing in an era of highly active antiretroviral therapy (HAART) among HIV-infected patients or today’s rapidly aging society among non-HIV-infected patients. However, few studies have investigated long-term CE trends, and CE risk factors have not been studied in a large sample, case-control study. This study aimed to determine long-term trends in CE prevalence and associated risk factors for patients with or without HIV infection. Methods Trends in CE prevalence were explored in a cohort of 80,219 patients who underwent endoscopy between 2002 and 2014. Risks for CE were examined among a subcohort of 6,011 patients. In risk analysis, we assessed lifestyles, infections, co-morbidities, immunosuppressants, and proton-pump inhibitors (PPIs). All patients were tested for HIV, hepatitis B or C virus, and syphilis infection. For HIV-infected patients, sexual behavior, CD4 cell count, history of HAART were also assessed. Results CE prevalence was 1.7% (1,375/80,219) in all patients, 9.8% (156/1,595) in HIV-infected patients, and 1.6% (1,219/78,624) in non-HIV-infected patients. CE prevalence from 2002-2003 to 2012-2014 tended to increase in non-HIV-infected patients (0.6% to 2.5%; P<0.01) and decrease in HIV-infected patients (13.6% to 9.0%; P=0.097). Multivariate analysis revealed increasing age (odds ratio [OR], 1.02; p=0.007), HIV infection (OR, 4.92; p<0.001), and corticosteroid use (OR, 5.90; p<0.001) were significantly associated with CE, and smoking (OR, 1.32; p=0.085) and acetaminophen use (OR, 1.70; p=0.097) were marginally associated. No significant association was found with alcohol consumption, hepatitis B or C virus, syphilis, diabetes mellitus, cardiovascular disease, cerebrovascular disease, chronic kidney disease, liver cirrhosis, anticancer, or PPIs use. In HIV-infected patients, CD4 cell count <100/μL (OR, 4.83; p<0.001) and prior HAART (OR, 0.35; p=0.006) were independently associated with CE, but sexual behavior was not. Among corticosteroid users, CE was significantly associated with higher prednisone-equivalent dose (p=0.043 for trend test). Conclusions This large, endoscopy-based study demonstrated that CE prevalence increased in non-HIV-infected patients but decreased in HIV-infected patients over 13 years. Risk analysis revealed that increasing age, HIV infection, and corticosteroids use, particularly at higher doses, were independently associated with CE, but alcohol, other infections, diabetes, anticancer drugs, and PPIs use were not.
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Affiliation(s)
- Yuta Takahashi
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
- * E-mail:
| | | | - Takeshi Nishijima
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Koji Watanabe
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomonori Aoki
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsunori Sekine
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hidetaka Okubo
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazuhiro Watanabe
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Toshiyuki Sakurai
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Chizu Yokoi
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masao Kobayakawa
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hirohisa Yazaki
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsuji Teruya
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Gatanaga
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimi Kikuchi
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Sohtaro Mine
- Department of Pathology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Toru Igari
- Department of Pathology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuko Takahashi
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akio Mimori
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichi Oka
- Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo, Japan
| | - Junichi Akiyama
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naomi Uemura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan
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24
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Muriithi RW, Muchiri LW, Lule GN. Esophageal cytology sponge diagnostic test results in kenyatta national referral hospital, kenya. Acta Cytol 2014; 58:483-8. [PMID: 25402761 DOI: 10.1159/000368793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 09/30/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe the cytological findings of the esophagus using sponge cytology as a triage test in patients referred for esophageal endoscopy at Kenyatta National Hospital. STUDY DESIGN A cross-sectional descriptive study was undertaken to obtain specimens from the esophagus for cytological evaluation using a sponge. The cellular yield and pattern of esophageal cytological findings was described by cytopathologists using the Bethesda system. The cytological findings were compared with endoscopy findings and whenever possible with biopsy results. RESULTS All the participants (100%) swallowed the encapsulated sponge successfully and had smears with satisfactory material for evaluation. Negative smears for intraepithelial lesion or malignancy were the most common (86.6%), with intestinal metaplasia reported in 10% of all patients, high-grade squamous intraepithelial lesions in 1.7% and squamous cell carcinoma in 1.7%. There was good agreement between endoscopic and cytological findings. CONCLUSION Sponge cytology is a simple and inexpensive technique which seems to have promising results as a primary test as well as a triage test whenever there is any suspicion of an esophageal lesion, especially in clinical settings where endoscopic facilities and medical professionals are not available. Hence, further evaluation using a larger sample size is recommended.
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Affiliation(s)
- Ruth W Muriithi
- Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
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26
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Asayama N, Nagata N, Shimbo T, Nishimura S, Igari T, Akiyama J, Ohmagari N, Hamada Y, Nishijima T, Yazaki H, Teruya K, Oka S, Uemura N. Relationship between clinical factors and severity of esophageal candidiasis according to Kodsi's classification. Dis Esophagus 2014; 27:214-9. [PMID: 23826847 DOI: 10.1111/dote.12102] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Severe Candida esophagitis (CE) may lead to development of strictures, hemorrhage, esophagotracheal fistula, and a consequent decrease in quality of life. Although the severity of CE has been classified based on macroscopic findings on endoscopy, the clinical significance remains unknown. The aim of the study was to elucidate the predictive clinical factors for endoscopic severity of CE. Patients who underwent upper endoscopy and answered questionnaires were prospectively enrolled. Smoking, alcohol, human immunodeficiency virus (HIV) infection, diabetes mellitus, chronic renal failure, liver cirrhosis, systemic steroids use, proton pump inhibitor use, H2 blocker use, and gastrointestinal (GI) symptoms were assessed on the same day of endoscopy. GI symptoms including epigastric pain, heartburn, reflux, hunger cramps, nausea, dysphagia, and odynophagia were assessed on a 7-point Likert scale. Endoscopic severity was classified as mild (Kodsi's grade I/II) or severe (grade III/IV). Of 1855 patients, 71 (3.8%) were diagnosed with CE (mild, n = 48; severe, n = 23). In the CE patients, 50.0% (24/48) in the mild group and 23.1% (6/23) in the severe group did not have any GI symptoms. In HIV-infected patients (n = 17), a significant correlation was found between endoscopic severity and declining CD4 cell count (Spearman's rho = -0.90; P < 0.01). Multivariate analysis revealed that GI symptoms (odds ratio [OR], 3.32) and HIV infection (OR, 3.81) were independently associated with severe CE. Patients in the severe group experienced more epigastric pain (P = 0.02), reflux symptoms (P = 0.04), dysphagia (P = 0.05), and odynophagia (P < 0.01) than those in the mild group. Of the GI symptoms, odynophagia was independently associated with severe CE (OR 9.62, P = 0.02). In conclusion, the prevalence of CE in adults who underwent endoscopy was 3.8%. Silent CE was found in both mild and severe cases. Endoscopic severity was associated with characteristic GI symptoms and comorbidity of HIV infection. A decline in immune function correlated with CE disease progression.
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Affiliation(s)
- N Asayama
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
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Brazilian guidelines for the management of candidiasis - a joint meeting report of three medical societies: Sociedade Brasileira de Infectologia, Sociedade Paulista de Infectologia and Sociedade Brasileira de Medicina Tropical. Braz J Infect Dis 2013; 17:283-312. [PMID: 23693017 PMCID: PMC9427385 DOI: 10.1016/j.bjid.2013.02.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/16/2013] [Indexed: 01/07/2023] Open
Abstract
Candida infections account for 80% of all fungal infections in the hospital environment, including bloodstream, urinary tract and surgical site infections. Bloodstream infections are now a major challenge for tertiary hospitals worldwide due to their high prevalence and mortality rates. The incidence of candidemia in tertiary public hospitals in Brazil is approximately 2.5 cases per 1000 hospital admissions. Due to the importance of this infection, the authors provide a review of the diversity of the genus Candida and its clinical relevance, the therapeutic options and discuss the treatment of major infections caused by Candida. Each topography is discussed with regard to epidemiological, clinical and laboratory diagnostic and therapeutic recommendations based on levels of evidence.
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Kim KY, Jang JY, Kim JW, Shim JJ, Lee CK, Dong SH, Kim HJ, Kim BH, Chang YW. Acid suppression therapy as a risk factor for Candida esophagitis. Dig Dis Sci 2013; 58:1282-6. [PMID: 23306845 DOI: 10.1007/s10620-012-2520-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 12/03/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM As the prevalence of reflux esophagitis increases, so does the use of gastric acid suppressants. This study aimed to document the prevalence of Candida esophagitis (CE) at a single Korean university hospital over the last 5 years and to evaluate its risk factors. METHODS To investigate the prevalence of CE, we conducted a retrospective analysis of 55,314 individuals who underwent a screening esophagogastroduodenoscopy as part of a health check-up between January 2006 and December 2010 at Kyung Hee University Hospital in Seoul, Korea. A total of 250 patients who were treated for CE between January 2008 and August 2011 and 500 age- and sex-matched non-CE patients were enrolled in this study. The rates of recent gastric acid suppression therapy and other well-known risk factors in the two groups were compared. RESULTS The prevalence of CE was 0.35 % and increased each year (linear-by-linear association, P = 0.001). Univariate analysis showed that gastric acid suppression therapy, malignancy, DM and steroid therapy were related to CE. Multivariate analysis also showed that gastric acid suppression therapy (OR 5.11, 95 % CI 2.92-8.93 and P < 0.001), malignancy (OR 18.68, 95 % CI 6.37-54.75 and P < 0.001), DM (OR 2.67, 95 % CI 1.70-4.21 and P < 0.001) and steroids therapy (OR 6.74, 95 % CI 1.37-33.05 and P = 0.019) were related to CE. CONCLUSIONS The prevalence of CE in Korea is increasing. Also, our results indicate that acid suppression therapy is a meaningful risk factor for CE.
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Affiliation(s)
- Kyung-Yup Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Hoegi-dong 1, Dongdaemoon-gu, Seoul, 130-702, South Korea
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Choi JH, Lee CG, Lim YJ, Kang HW, Lim CY, Choi JS. Prevalence and risk factors of esophageal candidiasis in healthy individuals: a single center experience in Korea. Yonsei Med J 2013; 54:160-5. [PMID: 23225813 PMCID: PMC3521253 DOI: 10.3349/ymj.2013.54.1.160] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Esophageal candidiasis (EC) is the most frequent opportunistic fungal infection in immunocompromised host. However, we have found EC in healthy individuals through esophagogastroduodenoscopy (EGD). The aim of this study was to determine the prevalence and risk factors for EC in healthy individuals. MATERIALS AND METHODS We retrospectively reviewed the medical records of 281 patients who had been incidentally diagnosed with EC. We also conducted age and sex matched case control study to identify the risk factor for EC. RESULTS The prevalence of EC was 0.32% (281/88125). The most common coexisting EGD finding was reflux esophagitis (49/281, 17.4%). An antifungal agent was prescribed in about half of EC, 139 cases (49.5%). Follow-up EGD was undertaken in 83 cases (29.5%) and 20 cases of candidiasis was persistently found. Case control study revealed EC were more often found in user of antibiotics (p=0.015), corticosteroids (p=0.002) and herb medication (p=0.006) as well as heavy drinking (p<0.001). CONCLUSION The prevalence of EC was 0.32% (281/88125) in Korea. Use of antibiotics, corticosteroids and herb as well as heavy drinking were significant risk factors for EC in healthy individuals.
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Affiliation(s)
- Jae Hyeuk Choi
- Departments of 1Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
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Brazilian guidelines for the management of candidiasis: a joint meeting report of three medical societies – Sociedade Brasileira de Infectologia, Sociedade Paulista de Infectologia, Sociedade Brasileira de Medicina Tropical. Braz J Infect Dis 2012. [DOI: 10.1016/s1413-8670(12)70336-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Shin MJ, Chang JH, Ko HY, Shin YB, Cha YS, Ryu DY. Candida esophagitis with fever alone in a patient with stroke. Brain Inj 2012; 26:896-8. [DOI: 10.3109/02699052.2012.666371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fan YJ, Liu B, Wang LD, Li L, Lan Y. Clinical significance of RASSF1A promoter methylation in gastric cardiac carcinoma and esophageal squamous cell carcinoma. Shijie Huaren Xiaohua Zazhi 2011; 19:84-88. [DOI: 10.11569/wcjd.v19.i1.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the methylation status of the promoter region of the RASSF1A gene in gastric cardiac adenocarcinoma (GCA) and esophageal squamous cell carcinoma (ESCC) in the distal esophagus and to analyze their clinical significance.
METHODS: Thirty-three GCA patients and 36 ESCC patients who came from a high-incidence region of ESCC in Linzhou, Henan and were treated at Yaocun Esophageal Cancer Hospital and Linzhou Center Hospital were enrolled in this study. No statistical differences were found in sex, age, and tumor differentiation between GCA and ESCC patients. No patients received chemotherapy or radiotherapy before operation. Methylation-specific polymerase chain reaction (MSP) was used to investigate the methylation status of the promoter region of the RASSF1A gene in the two groups of patients.
RESULTS: For GCA patients, the frequencies of RASSF1A promoter methylation in cancer tissue (CA), matched dysplasia tissue (DYS) and normal tissue (NOR) were 63.6%, 20% and 4.2%, respectively. For ESCC patients, the frequencies of RASSF1A promoter methylation in tumor tissue, matched dysplasia tissue and normal tissue were 66.7%, 25% and 16.7%, respectively. High methylation frequency was found in both types of cancer tissue. With the evolution of lesions (NOR-DYS-CA), the frequency of RASSF1A promoter methylation showed an increasing tendency in both GCA (χ2 = 22.173, P < 0.001) and ESCC patients (χ2 = 19.324, P < 0.001). The frequency of RASSF1A promoter methylation in normal tissue from GCA patients was lower than that from ESCC patients.
CONCLUSION: RASSF1A promoter hypermethylation is a molecular event that occurs in both GCA and ESCC patients. RASSF1A is a potential candidate biomarker for early detection of carcinoma of the esophagogastric junction.
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Trichosporon inkin Esophagitis: An Uncommon Disease in a Patient with Pulmonary Cancer. Mycopathologia 2010; 171:279-83. [PMID: 20862548 DOI: 10.1007/s11046-010-9367-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Accepted: 09/08/2010] [Indexed: 10/19/2022]
Abstract
Trichosporon species are usually opportunistic pathogens. Here, we present a case of esophagitis caused by T. inkin in a 54-year-old woman with pulmonary cancer and severe neutropenia in whom the susceptibility profile of the isolate against azoles and polyenes was verified. The patient was diagnosed with esophagitis grade I of Wilcox, presenting scattered whitish plaques and exudates in upper two-thirds of the esophageal mucosa. Antifungal therapy involving oral fluconazole (150 mg/day for 14 days) was ineffective. In vitro, the isolate showed no resistance to this azole and sensitivity to amphotericin B. Since T. inkin is of growing importance as an agent of invasive infections in immunocompromised patients, we stress that the diagnosis of esophagitis by this species should be followed by an assessment of the therapeutic sensitivity of the strain involved.
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Macêdo DPC, Oliveira NT, Farias AMA, Silva VKA, Wilheim AB, Couto FM, Neves RP. Esophagitis caused byCandida guilliermondiiin diabetes mellitus: first reported case. Med Mycol 2010; 48:862-5. [DOI: 10.3109/13693780903582614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Wilcox R, Hart J. Esophageal Eosinophilia. Surg Pathol Clin 2010; 3:277-95. [PMID: 26839132 DOI: 10.1016/j.path.2010.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The presence of esophageal eosinophilia encompasses a broad differential diagnosis, and at times a specific histologic diagnosis is not possible. This content provides a systematic approach to esophageal squamous eosinophilia with emphasis on specific, distinguishing features within this expansive differential.
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Affiliation(s)
- Rebecca Wilcox
- Department of Pathology, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - John Hart
- Department of Pathology, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
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Candida esophagitis complicated by an esophago-airway fistula: report of a case. Surg Today 2009; 39:972-8. [PMID: 19882320 DOI: 10.1007/s00595-009-3958-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 02/04/2009] [Indexed: 10/20/2022]
Abstract
Candida esophagitis rarely involves life-threatening complications, such as necrosis, perforation, or fistula formation between the esophagus and the airway. We herein report a case of Candida esophagitis complicated by esophagobronchial and esophagopulmonary fistulas. The patient in our study was a 70-year-old man with a 3-month history of dysphagia. Based on endoscopy and histological findings, he was diagnosed with a coinfection of Candida spp. and herpes simplex virus. Antifungal and antiviral therapy was administered without success. The esophagopulmonary fistula formation and a lung abscess were identified 7 months later. The patient was deemed intolerable to an esophagectomy due to his poor general condition, thus necessitating a two-stage operation. A cervical esophagostomy and a tube drainage of the thoracic esophagus were followed by an esophageal bypass using the pedicled jejunum via an antethoracic route. Although the lung abscess resolved, the inflammation of the esophagus persisted. A fistula between the esophagus and the left main bronchus eventually formed postoperatively and the patient died due to respiratory failure.
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Wilheim AB, Miranda-Filho DDB, Nogueira RA, Rêgo RSDM, Lima KDM, Pereira LMMB. The resistance to fluconazole in patients with esophageal candidiasis. ARQUIVOS DE GASTROENTEROLOGIA 2009; 46:32-7. [PMID: 19466307 DOI: 10.1590/s0004-28032009000100011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 12/22/2008] [Indexed: 11/22/2022]
Abstract
CONTEXT Esophageal candidiasis is often observed in patients with risk factors for its development and fluconazole is the therapeutic choice for the treatment of this disease. OBJECTIVES To determine its frequency, by performing upper digestive endoscopy; to determine Candida species involved in its pathogenesis and verify their distribution according with the predisposing factors and to determine susceptibility to fluconazole in the samples. METHODS From March 2006 to April 2007, all patients submitted to esophagogastroduodenoscopy at the Digestive Endoscopy Unit in the Oswaldo Cruz University Hospital, Recife, PE, Brazil, were eligible for the study. Samples were collected from patients who presented lesions consistent with esophageal candidiasis in order to identify Candida species and verify their susceptibility to fluconazole. The predisposing factors for the occurrence of esophageal candidiasis were described. RESULTS Of 2,672 patients referred to upper endoscopy at the Digestive Endoscopy Unit, 40 (1.5%) had endoscopic findings compatible with esophageal candidiasis. The average age was 49.1 years. Twenty one patients (52.5%) were less than 50 years old, of which 82.6% were infected with HIV. Most of them (52.5%) were males and 65.0% were inpatients. Diseases were identified in 90% of the patients and 21 (52.5%) were HIV positive. Concerning endoscopic findings, severe forms of esophagitis were found in 50% of the patients with CD4 count <200. Non-albicans Candida species were isolated in 22.7% of HIV positive and in 45% HIV negative patients. A total of 6 (14.28%) samples were resistant to fluconazole, while 2 (4.76%) samples had dose depending susceptibility to this drug. CONCLUSIONS Esophageal candidiasis prevalence was low, although within the results described by other authors. Male and inpatients were the most affected. The species isolated varied according to the characteristics of each group studied. Both, resistance and dose-depending susceptibility to fluconazole were considered high.
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Affiliation(s)
- Ana Botler Wilheim
- Department of Internal Medicine, School of Medical Sciences, University of Pernambuco, Recife, PE, Brazil.
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Hasosah MY, Showail M, Al-Sahafi A, Satti M, Jacobson K. Esophageal candidiasis in an immunocompetent girl. World J Pediatr 2009; 5:152-4. [PMID: 19718541 DOI: 10.1007/s12519-009-0031-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 08/26/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infections of the esophagus are rare and most commonly seen in children with immune suppression resulting from malignancy, chronic metabolic or infectious disease, or immunosuppressive drug therapy. METHODS An 18-month-old girl on inhaled corticosteroid for bronchial asthma presented with coffee-ground emesis and melena. Upper endoscopy revealed yellow-white plaques scattered over the mucosa of the distal esophagus. Biopsy results showed chronic esophagitis with features of reflux disease. Gram staining of esophageal brushing showed pseudohyphae, and the culture was positive for candida species. RESULTS The patient was treated with omeprazole 2 mg/kg per day and fluconazole 6 mg/kg per day for three weeks. Immunological workup was normal and she was negative for human immunodeficiency virus. Post treatment endoscopy showed normal appearance of esophageal mucosa and normal histology. At 12 months after treatment, the child remained asymptomatic and continued to thrive. CONCLUSIONS We believe that this child developed esophageal candidiasis secondary to long-term use of inhaled corticosteroid associated with immune suppression on a background of reflux esophagitis. Anti-acid and antifungal therapies are effective in the treatment.
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Affiliation(s)
- Mohammed Yahya Hasosah
- Department of Pediatrics, King Abdul-Aziz Medical City, National Guard Hospital, Jeddah, Saudi Arabia.
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Kliemann DA, Pasqualotto AC, Falavigna M, Giaretta T, Severo LC. Candida esophagitis: species distribution and risk factors for infection. Rev Inst Med Trop Sao Paulo 2009; 50:261-3. [PMID: 18949340 DOI: 10.1590/s0036-46652008000500002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 08/27/2008] [Indexed: 01/01/2023] Open
Abstract
Although Candida albicans is the main cause of fungal esophagitis, other species such as C. tropicalis, C. krusei and C. stellatoidea have also been implicated. Several studies have identified risk factors for C. albicans esophagitis. However, data for non-C. albicans species is still sparse. The aim of this study was to determine the etiology of Candida esophagitis in our medical centre over an 18-month period. Additionally, we aimed to investigate predisposing conditions for esophageal candidosis caused by different Candida species. A total of 21,248 upper gastroscopies were performed in Santa Casa Complexo Hospitalar between January 2005 and July 2006. The prevalence of Candida esophagitis was 0.74% (n = 158). C. albicans caused the vast majority of infections (96.2%), followed by C. tropicalis (2.5%), C. lusitaniae (0.6%) and C. glabrata (0.6%). There were 81 women (51.3%) and 77 men (48.7%). No case of mixed infection occurred. Concomitant oral candidosis was documented for 10.8% (n = 17). Most of cases (55.1%) involved outpatients. Around one fifth of patients in our cohort had no identifiable risk factors for esophageal candidosis (20.8%). Since nearly all infections were caused by C. albicans we were not able to determine risk factors for esophagitis caused by other Candida species.
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Affiliation(s)
- Dimas Alexandre Kliemann
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Attwood SEA, Lamb CA. Eosinophilic oesophagitis and other non-reflux inflammatory conditions of the oesophagus: diagnostic imaging and management. Best Pract Res Clin Gastroenterol 2008; 22:639-60. [PMID: 18656822 DOI: 10.1016/j.bpg.2007.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Non-reflux inflammatory conditions of the oesophagus are at present rarely encountered in routine clinical practice. However there has been a recent increase in their diagnosis notably due to heightened awareness of their existence and because of the emergence of a number of immunological diseases and deficiencies. Of all the non-reflux conditions, most interest and literature is emerging on the natural history, pathophysiology, endoscopic pattern and management of eosinophilic oesophagitis. This condition, which until five years ago was unknown to most physicians has now been studied worldwide and although the true prevalence remains unclear, the incidence is increasing annually. In this paper we discuss diagnostic imaging and management of non-reflux inflammatory disorders of the oesophagus with particular reference to eosinophilic oesophagitis and Crohn's disease, both conditions of probable over active immunology, to other conditions associated with immune deficiency such as infective oesophagitis (candida, CMV, HSV, HIV) and tuberculous oesophagitis, as well as drug induced oesophageal injury.
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Affiliation(s)
- Stephen E A Attwood
- Department of Surgery, Newcastle University, Newcastle, upon Tyne, NE1 7RU, UK.
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Abstract
The incidence of cardia adenocarcinoma (CA) has been increasing during the past few decades. CA and esophageal adenocarcinoma (EA) are known to share the same epidemiologic features. Barrett's esophagus (BE) is judged to be the precursor of EA. Thus, the question of whether BE is a risk factor for CA is currently much discussed. In this review, we describe the progress in the study of CA, and the relationship between CA and BE.
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Mimidis K, Papadopoulos V, Margaritis V, Thomopoulos K, Gatopoulou A, Nikolopoulou V, Kartalis G. Predisposing factors and clinical symptoms in HIV-negative patients with Candida oesophagitis: are they always present? Int J Clin Pract 2005; 59:210-3. [PMID: 15854199 DOI: 10.1111/j.1742-1241.2004.00249.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Candida oesophagitis (CO) is scarce among immunocompetent patients. This study aimed at evaluating predisposing factors, clinical symptoms and endoscopic findings in this group. We retrospectively reviewed 55 patients diagnosed as CO endoscopically (whitish plaques) and cytologically (fungal mycelia on brush cytology). Carcinoma, diabetes, acid suppression, steroids, gastric surgery and oesophageal motility disorders were considered as predisposing factors. Twenty of 55 patients lacked any predisposing factor for CO. These patients were more frequently asymptomatic (8/20) when compared with those with known predisposing factors (5/35) (p = 0.031). Moreover, dysphagia was more prevalent in the latter group (24/35 vs. 8/20; p = 0.039). Endoscopic findings correlated with the presence of neither predisposing factors nor symptoms (Wilcoxon p > 0.05). Thus, CO can be discovered in patients without apparent predisposing risk factors and clinical symptoms. Further studies are needed to elucidate the mechanisms of transition from colonisation to infection.
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Affiliation(s)
- K Mimidis
- Department of Internal Medicine, Endoscopy Unit, Democritus University of Thrace, Alexandroupolis, Greece.
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