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Cohen DL, Nakash S, Bermont A, Richter V, Shirin H. Predictors of Underlying Esophageal Motility Disorders in Patients Presenting with Esophageal Candidiasis. South Med J 2023; 116:701-706. [PMID: 37536701 DOI: 10.14423/smj.0000000000001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Esophageal motility disorders (EMDs) are a known risk factor for esophageal candidiasis (EC), but this relation has not been described particularly well. We sought to evaluate the predictors of underlying EMDs in patients presenting with EC. METHODS Cases of EC at a single medical center between 2010 and 2021 were identified retrospectively based on the International Classification of Diseases, Ninth Revision code. Demographic, clinical, endoscopic, and manometric data were reviewed. The diagnosis of EC was based on typical endoscopic appearance. RESULTS In total, 130 EC patients were identified (mean age 69.5 ± 14.6; 66.2% male). Of these, 12 (9.2%) had an underlying EMD (11 cases of achalasia; 1 case of esophagogastric junction outflow obstruction). Five (41.7%) of these patients had previously been diagnosed as having an EMD, whereas 7 were newly diagnosed only after their presentation with EC. No significant differences were noted between those with or without EMDs in terms of demographics, medical comorbidities, or medication use. Patients with an EMD, however, were more likely to complain of dysphagia (91.7% vs 30.5%, P < 0.001), and on endoscopy, they were more likely to have residual food in the esophagus, residual fluid in the esophagus, a dilated esophagus, and resistance to traversing the esophagogastric junction (all P < 0.001). Sixty-one (46.9%) patients with EC died during follow-up (mean 58 months). CONCLUSIONS EMDs are present in approximately 10% of patients presenting with EC, with half being diagnosed only after presenting with EC. Similar to non-EC patients, patients with EC with dysphagia and the typical endoscopic findings of achalasia are more likely to have an EMD and warrant prompt manometric evaluation.
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Affiliation(s)
- Daniel L Cohen
- From the Gonczarowski Family Institute of Gastroenterology and Liver Diseases
| | - Shiran Nakash
- Internal Medicine Unit "A," Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Anton Bermont
- From the Gonczarowski Family Institute of Gastroenterology and Liver Diseases
| | - Vered Richter
- From the Gonczarowski Family Institute of Gastroenterology and Liver Diseases
| | - Haim Shirin
- From the Gonczarowski Family Institute of Gastroenterology and Liver Diseases
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2
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Wu X, Hu Y. Photodynamic Therapy for the Treatment of Fungal Infections. Infect Drug Resist 2022; 15:3251-3266. [PMID: 35761978 PMCID: PMC9233483 DOI: 10.2147/idr.s369605] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
Cutaneous fungal infections are common in humans and are associated with significant physical and psychological distress to patients. Although conventional topical and/or oral anti-fungal medications are commonly recommended treatments, drug resistance has emerged as a significant concern in this patient population, and safer, more efficacious, and cost-effective alternatives are warranted. Recent studies have reported effectiveness of photodynamic therapy (PDT) against fungal infections without severe adverse effects. In this review, we briefly discuss the mechanisms underlying PDT, current progress, adverse effects, and limitations of this treatment in the management of superficial and deep fungal infections.
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Affiliation(s)
- Xuelin Wu
- Department of Dermatology and Venereology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, People's Republic of China
| | - Yongxuan Hu
- Department of Dermatology and Venereology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, People's Republic of China
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3
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Molkenthin F, Hertel M, Neumann K, Schmidt-Westhausen AM. Factors influencing the presence of Candida dubliniensis and other non-albicans species in patients with oral lichen planus: a retrospective observational study. Clin Oral Investig 2021; 26:333-342. [PMID: 34142239 PMCID: PMC8791885 DOI: 10.1007/s00784-021-04004-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/20/2021] [Indexed: 11/24/2022]
Abstract
Objectives The epidemiologic distribution of non-albicans species in the oral cavity of oral lichen planus (OLP) patients remains uncertain. Therefore, the aim of this study was to identify factors associated with the presence of C. dubliniensis and other non-albicans species. Furthermore, independent risk factors for Candida superinfection in OLP should be identified. Material and methods Epidemiologic data and microbiological findings from 268 symptomatic OLP patients who underwent continuous oral swab culture over a 5-year period (2015–2019) were retrospectively reviewed. Candida species identification and semi-quantification were obtained by culture on CHROMagar Candida, followed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Results C. albicans was the most frequently isolated species (72.3%), followed by C. glabrata (7.3%), C. dubliniensis (5.8%), C. krusei and C. parapsilosis (both 2.6%). The presence of C. dubliniensis was significantly associated with tobacco smoking. Other non-albicans spp. were significantly more often detected in patients using removable dentures. Increasing age and the intake of psychotropic drugs were identified as independent risk factors of Candida superinfection in OLP. Conclusion In OLP patients, certain local and systemic factors increase the risk of carrying potentially drug-resistant Candida species and the development of Candida superinfection of OLP lesions. Clinical relevance Due to the frequent detection of non-albicans species in OLP, resistance or at least reduced sensitivity to azole antifungals should be expected, especially in smokers and patients using removable dentures. In the case of oral complaints, a superinfection with Candida should be considered, whereby older patients and patients taking psychotropic drugs have an increased risk for oral infection with Candida.
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Affiliation(s)
- Florian Molkenthin
- CharitéCentre 3, Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4, 14197, Berlin, Germany.
| | - Moritz Hertel
- CharitéCentre 3, Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4, 14197, Berlin, Germany
| | - Konrad Neumann
- Institute of Medical Biometrics and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Andrea Maria Schmidt-Westhausen
- CharitéCentre 3, Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4, 14197, Berlin, Germany
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4
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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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5
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Jean-Baptiste S, Messika J, Hajage D, Gaudry S, Barbieri J, Duboc H, Dreyfuss D, Coffin B, Ricard JD. Clinical impact of upper gastrointestinal endoscopy in critically ill patients with suspected bleeding. Ann Intensive Care 2018; 8:75. [PMID: 29974284 PMCID: PMC6031555 DOI: 10.1186/s13613-018-0423-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/28/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND AIMS Upper gastrointestinal endoscopies' (UGE) profitability is undisputable in patients admitted for an overt upper digestive tract bleeding. In critically ill subjects admitted for other causes, its performances have scarcely been investigated despite its broad use. We sought to question the performance of bedside UGE in intensive care unit (ICU) patients, admitted for another reason than overt bleeding. METHODS This was a six-year (January 2007-December 2012) retrospective observational study of all UGE performed in a medico-surgical ICU. Exclusion of those performed: in patients admitted for a patent upper digestive bleeding; for a second-look gastroscopy of a known lesion; as a planned interventional procedure. Main demographic and clinical data were recorded; UGE indication and profitability were rated according to its findings and therapeutic impact. Operative values of the indications of UGE were calculated. This study received approval from the Ethics Committee of the French Society of Intensive Care (n° 12-363). RESULTS Eighty-four patients (74% male, mean age 61 ± 14 years) underwent a diagnostic UGE, all for a suspected upper digestive tract bleeding. The main symptoms justifying the procedure were anemia (52%), digestive bleeding (27%), vomiting (15%), hemodynamic instability (3%) and hyperuremia (3%). The profitability of UGE was rated as major (n = 5; 5.8%); minor (n = 34; 40.5%); or null (n = 45; 53.6%). CONCLUSIONS When ICU admission is not warranted by a digestive bleeding, UGE has limited diagnostic and therapeutic interest, despite being often performed.
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Affiliation(s)
- Sylvain Jean-Baptiste
- Medico-Surgical Intensive Care Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
| | - Jonathan Messika
- Medico-Surgical Intensive Care Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
- IAME, UMR 1137, INSERM, 75018 Paris, France
- IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - David Hajage
- Département de Biostatistiques, Santé Publique et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Univ Pierre et Marie Curie, Sorbonne Universités, 75013 Paris, France
- ECEVE, U1123, CIC-EC 1425, INSERM, 75010 Paris, France
- ECEVE, UMRS 1123, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France
| | - Stéphane Gaudry
- Medico-Surgical Intensive Care Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
- ECEVE, U1123, CIC-EC 1425, INSERM, 75010 Paris, France
- ECEVE, UMRS 1123, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France
| | - Julie Barbieri
- Gastroenterology Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
| | - Henri Duboc
- Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - Didier Dreyfuss
- Medico-Surgical Intensive Care Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
- IAME, UMR 1137, INSERM, 75018 Paris, France
- IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - Benoit Coffin
- Gastroenterology Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
- Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - Jean-Damien Ricard
- Medico-Surgical Intensive Care Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
- IAME, UMR 1137, INSERM, 75018 Paris, France
- IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
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6
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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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7
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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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8
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James KM, MacDonald KW, Chanyi RM, Cadieux PA, Burton JP. Inhibition of Candida albicans biofilm formation and modulation of gene expression by probiotic cells and supernatant. J Med Microbiol 2016; 65:328-336. [PMID: 26847045 DOI: 10.1099/jmm.0.000226] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Oral candidiasis is a disease caused by opportunistic species of Candida that normally reside on human mucosal surfaces. The transition of Candida from budding yeast to filamentous hyphae allows for covalent attachment to oral epithelial cells, followed by biofilm formation, invasion and tissue damage. In this study, combinations of Lactobacillus plantarum SD5870, Lactobacillus helveticus CBS N116411 and Streptococcus salivarius DSM 14685 were assessed for their ability to inhibit the formation of and disrupt Candida albicans biofilms. Co-incubation with probiotic supernatants under hyphae-inducing conditions reduced C. albicans biofilm formation by >75 % in all treatment groups. Likewise, combinations of live probiotics reduced biofilm formation of C. albicans by >67 %. When live probiotics or their supernatants were overlaid on preformed C. albicans biofilms, biofilm size was reduced by >63 and >65 % respectively. Quantitative real-time PCR results indicated that the combined supernatants of SD5870 and CBS N116411 significantly reduced the expression of several C. albicans genes involved in the yeast-hyphae transition: ALS3 (adhesin/invasin) by 70 % (P < 0.0001), EFG1 (hyphae-specific gene activator) by 47 % (P = 0.0061), SAP5 (secreted protease) by 49 % (P < 0.0001) and HWP1 (hyphal wall protein critical to biofilm formation) by >99 % (P < 0.0001). These findings suggest the combination of L. plantarum SD5870, L. helveticus CBS N116411 and S. salivarius DSM 14685 is effective at both preventing the formation of and removing preformed C. albicans biofilms. Our novel results point to the downregulation of several Candida genes critical to the yeast-hyphae transition, biofilm formation, tissue invasion and cellular damage.
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Affiliation(s)
- K M James
- Fanshawe College, London, Ontario, Canada.,Integra Medical Inc., Stiller Center for Technology Commercialization, Western University Research Park, London, Ontario, Canada
| | - K W MacDonald
- Integra Medical Inc., Stiller Center for Technology Commercialization, Western University Research Park, London, Ontario, Canada
| | - R M Chanyi
- Fanshawe College, London, Ontario, Canada.,Integra Medical Inc., Stiller Center for Technology Commercialization, Western University Research Park, London, Ontario, Canada.,Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada
| | - P A Cadieux
- Fanshawe College, London, Ontario, Canada.,Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada.,Canadian Centre for Human Microbiome and Probiotics, Lawson Health Research Institute, London, Ontario, Canada
| | - J P Burton
- Canadian Centre for Human Microbiome and Probiotics, Lawson Health Research Institute, London, Ontario, Canada.,Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada.,Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada
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9
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Patil S, Rao RS, Majumdar B, Anil S. Clinical Appearance of Oral Candida Infection and Therapeutic Strategies. Front Microbiol 2015; 6:1391. [PMID: 26733948 PMCID: PMC4681845 DOI: 10.3389/fmicb.2015.01391] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/23/2015] [Indexed: 02/05/2023] Open
Abstract
Candida species present both as commensals and opportunistic pathogens of the oral cavity. For decades, it has enthralled the clinicians to investigate its pathogenicity and to improvise newer therapeutic regimens based on the updated molecular research. Candida is readily isolated from the oral cavity, but simple carriage does not predictably result in development of an infection. Whether it remains as a commensal, or transmutes into a pathogen, is usually determined by pre-existing or associated variations in the host immune system. The candida infections may range from non-life threatening superficial mucocutaneous disorders to invasive disseminated disease involving multiple organs. In fact, with the increase in number of AIDS cases, there is a resurgence of less common forms of oral candida infections. The treatment after confirmation of the diagnosis should include recognizing and eliminating the underlying causes such as ill-fitting oral appliances, history of medications (antibiotics, corticosteroids, etc.), immunological and endocrine disorders, nutritional deficiency states and prolonged hospitalization. Treatment with appropriate topical antifungal agents such as amphotericin, nystatin, or miconazole usually resolves the symptoms of superficial infection. Occasionally, administration of systemic antifungal agents may be necessary in immunocompromised patients, the selection of which should be based upon history of recent azole exposure, a history of intolerance to an antifungal agent, the dominant Candida species and current susceptibility data.
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Affiliation(s)
- Shankargouda Patil
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences Bangalore, India
| | - Roopa S Rao
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences Bangalore, India
| | - Barnali Majumdar
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences Bangalore, India
| | - Sukumaran Anil
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University Riyadh, Saudi Arabia
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10
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Kakati B, Kotwal A, Biswas D, Sahu S. Fluconazole Resistant Candida Oesophagitis in Immunocompetent Patients: Is Empirical Therapy Justifiable? J Clin Diagn Res 2015; 9:DC16-8. [PMID: 26816890 DOI: 10.7860/jcdr/2015/15171.6975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION C. albicans (Candida albicans) is the foremost cause of fungal oesophagitis, however other species such as Candida tropicalis, Candida krusei and Candida stellatoidea have also been implicated to cause this condition. Although, numerous studies have identified risk factors for C. albicans oesophagitis, data for non- C. albicans species is still sparse. AIM To determine the aetiology of Candida oesophagitis in our medical centre over a two year period. Additionally, to investigate predisposing conditions for oesophageal candidiasis caused by different Candida species. MATERIAL AND METHODS All consecutive patients posted for upper gastrointestinal endoscopy at the endoscopy unit of a tertiary care hospital in north India with findings consistent with oesophagitis were screened for the presence of Candida oesophagitis by performing KOH (potassium hydroxide) examination and culture on SDA (Sabouraud's dextrose agar). Antifungal susceptibility testing as per CLSI guidelines was performed for fluconazole, a most common empirically prescribed antifungal for the condition. RESULTS A total of 1868 patients with no known immune-compromised condition underwent upper gastroscopy at our centre during the study period. The prevalence of Candida oesophagitis was 8.7% (n = 163). C. albicans was recovered from majority of infections (52.1%), followed by C. tropicalis (24%), C. parapsilosis (13.4%), C. glabrata (6.9%) and C. krusei (3.6%). Alarmingly, among the C. albicans isolates 8.6% were resistant to fluconazole. CONCLUSION With rising reports of antifungal drug resistance among the isolates of Candida species, an increasing prevalence of this organism could have an impact on the treatment of Candidal oesophagitis and it should be approached with caution by the clinician.
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Affiliation(s)
- Barnali Kakati
- Associate Professor, Department of Microbiology, Himalayan Institute of Medical Sciences , Jolly Grant, Dehradun, India
| | - Aarti Kotwal
- Associate Professor, Department of Microbiology, Himalayan Institute of Medical Sciences , Jolly Grant, Dehradun, India
| | - Debasis Biswas
- Additional Professor, Department of Microbiology, AIIMS , Bhopal, Saket Nagar, Bhopal, India
| | - Shantanu Sahu
- Professor, Department of Surgery, Himalayan Institute of Medical Sciences , Jolly Grant, Dehradun, India
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11
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Brown CS, Lapin B, Wang C, Goldstein JL, Linn JG, Denham W, Haggerty SP, Talamonti MS, Howington JA, Carbray J, Ujiki MB. Reflux control is important in the management of Barrett's Esophagus: results from a retrospective 1,830 patient cohort. Surg Endosc 2015; 29:3528-34. [PMID: 25676204 DOI: 10.1007/s00464-015-4103-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/27/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND It is unknown whether acid/reflux control prevents progression in Barrett's esophagus. In this study, we investigate whether medical or surgical control of reflux is associated with a decreased risk of progression to dysplasia/esophageal adenocarcinoma. METHODS We retrospectively collected and analyzed data from a cohort of Barrett's esophagus patients participating in this single-center study comprised of all patients diagnosed with Barrett's esophagus at NorthShore University Health System hospitals and clinics over a 10-year period. Patients were followed in order to identify those progressing from Barrett's esophagus to low-grade dysplasia, high-grade dysplasia, and esophageal adenocarcinoma. We collected information from the patient's electronic medical records regarding demographic, endoscopic findings, histological findings, smoking/alcohol history, medication use including proton-pump inhibitors, and history of bariatric and antireflux surgery. Risk-adjusted modeling was performed using multivariable logistic regression. RESULTS This study included 1,830 total Barrett's esophagus patients, 102 of which had their Barrett's esophagus progress to low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma (confirmed by biopsy) with an annual incidence rate of 1.1%. Mean follow-up period was 5.51 years (10,083 patient-years). Compared to the group that did not progress, the group that progressed was older (69.3 ± 13.7 vs. 63.9 ± 13.4 years. p < 0.001) and likely to be male (75 vs. 61%, p < 0.01). In the multivariable analysis, patients who had a history of antireflux surgery (n = 44) or proton-pump inhibitor use without surgery (n = 1,641) were found to progress at significantly lower rates than patients who did not have antireflux surgery or were not taking PPI's (OR 0.18, 95% CI 0.09-0.36). CONCLUSIONS Reflux control was associated with decreased risk of progression to low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma. These results support the use of reflux control strategies such as proton-pump inhibitor therapy or surgery in patients with non-dysplastic Barrett's esophagus for the prevention of progression to dysplasia/adenocarcinoma.
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Affiliation(s)
- Craig S Brown
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA.
- Pritzker School of Medicine, University of Chicago, Chicago, IL, 60637, USA.
| | - Brittany Lapin
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA
| | - Chi Wang
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA
| | - Jay L Goldstein
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA
| | - John G Linn
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA
| | - Woody Denham
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA
| | - Stephen P Haggerty
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA
| | - Mark S Talamonti
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA
| | - John A Howington
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA
| | - Joann Carbray
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA
| | - Michael B Ujiki
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA.
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Kalla R, Kaushik V. A candidal oesophageal stricture responsive to fluconazole therapy. Frontline Gastroenterol 2014; 5:17-19. [PMID: 28839745 PMCID: PMC5369705 DOI: 10.1136/flgastro-2013-100337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/11/2013] [Indexed: 02/04/2023] Open
Abstract
We report a case of candidal oesophageal stricture in an 81 year-old man with a 2 year history of gradual onset dysphagia and odynophagia to solids. Although rare, most cases have reported treatment success with oesophageal balloon dilation. We report the first case of candidal oesophageal stricture resolution with a prolonged course of anti-fungal therapy.
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Affiliation(s)
- Rahul Kalla
- Department of Gastroenterology, Manchester Royal Infirmary, Manchester, UK
| | - Vishal Kaushik
- Department of Gastroenterology, Royal Blackburn Hospital, Blackburn, UK
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13
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Qiu H, Mao Y, Gu Y, Zhu J, Wang Y, Zeng J, Huang N, Liu Q, Yang Y. The potential of photodynamic therapy to treat esophageal candidiasis coexisting with esophageal cancer. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2013; 130:305-9. [PMID: 24378331 DOI: 10.1016/j.jphotobiol.2013.11.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/30/2013] [Accepted: 11/30/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) has been used in recent years to deal with fungal infections because of the prevalence of fungi resistance to drugs. However, PDT for gastrointestinal fungal infection has not been reported. This study was conducted to assess the potential of PDT to deal with esophageal candidiasis. METHODS Two male patients with histological evidence of esophageal candidiasis coexisting with esophageal cancer were included in this retrospective study. Both patients were treated with PDT. This treatment was repeated at least 1month after the initial PDT if the patient still had residual cancer or esophageal candidiasis. Short-term efficacy was evaluated on the basis of endoscopy and histology findings. Further follow-up data were obtained from endoscopy results or telephone conversation. RESULTS The esophageal candidiasis located 21-24cm and 25-28cm from the incisors of case 1 reached complete remission after one and two PDT sessions, respectively. The esophageal cancer coexisting with esophageal candidiasis located 21-24cm from the incisors reached complete remission after two PDT sessions. No recurrence was found at a 14-month follow-up. The esophageal cancer located 30-35cm from the incisors reached partial response after three PDT sessions. Both of the esophageal candidiasis and the coexisting esophageal cancer at 23-26cm from the incisors of case 2 reached complete remission and the esophageal cancer at 34-37cm from the incisors reached complete remission after one PDT session. No recurrence was found at a 24-month follow-up. There were no serious adverse events found in either of the two cases. CONCLUSION Results of this preliminary study indicate that PDT may be a potential method to deal with esophageal candidiasis.
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Affiliation(s)
- Haixia Qiu
- Department of Laser Medicine, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China.
| | - Yongping Mao
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China.
| | - Ying Gu
- Department of Laser Medicine, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China.
| | - Jianguo Zhu
- Department of Laser Medicine, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China.
| | - Ying Wang
- Department of Laser Medicine, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China.
| | - Jing Zeng
- Department of Laser Medicine, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China.
| | - Naiyan Huang
- Department of Laser Medicine, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China.
| | - Qingsen Liu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China.
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China.
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15
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Costa ACBP, Pereira CA, Junqueira JC, Jorge AOC. Recent mouse and rat methods for the study of experimental oral candidiasis. Virulence 2013; 4:391-9. [PMID: 23715031 PMCID: PMC3714131 DOI: 10.4161/viru.25199] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The Candida genus expresses virulence factors that, when combined with immunosuppression and other risk factors, can cause different manifestations of oral candidiasis. The treatment of mucosal infections caused by Candida and the elucidation of the disease process have proven challenging. Therefore, the study of experimentally induced oral candidiasis in rats and mice is useful to clarify the etiopathology of this condition, improve diagnosis, and search for new therapeutic options because the disease process in these animals is similar to that of human candidiasis lesions. Here, we describe and discuss new studies involving rat and mouse models of oral candidiasis with respect to methods for inducing experimental infection, methods for evaluating the development of experimental candidiasis, and new treatment strategies for oral candidiasis.
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Affiliation(s)
- Anna C B P Costa
- Department of Microbial Pathogenicity Mechanisms; Hans-Knoell-Institute; Jena, Germany
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16
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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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Williams DW, Kuriyama T, Silva S, Malic S, Lewis MAO. Candida biofilms and oral candidosis: treatment and prevention. Periodontol 2000 2011; 55:250-65. [PMID: 21134239 DOI: 10.1111/j.1600-0757.2009.00338.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Williams D, Lewis M. Pathogenesis and treatment of oral candidosis. J Oral Microbiol 2011; 3. [PMID: 21547018 PMCID: PMC3087208 DOI: 10.3402/jom.v3i0.5771] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/03/2011] [Accepted: 01/04/2011] [Indexed: 02/07/2023] Open
Abstract
Oral infections caused by yeast of the genus Candida and particularly Candida albicans (oral candidoses) have been recognised throughout recorded history. However, since the 1980s a clear surge of interest and associated research into these infections have occurred. This has largely been due to an increased incidence of oral candidosis over this period, primarily because of the escalation in HIV-infection and the AIDS epidemic. In addition, changes in medical practice leading to a greater use of invasive clinical procedures and a more widespread use of immunosuppressive therapies have also contributed to the problem. Whilst oral candidosis has previously been considered to be a disease mainly of the elderly and very young, its occurrence throughout the general population is now recognised. Candida are true ‘opportunistic pathogens’ and only instigate oral infection when there is an underlying predisposing condition in the host. Treatment of these infections has continued (and in some regards continues) to be problematic because of the potential toxicity of traditional antifungal agents against host cells. The problem has been compounded by the emergence of Candida species other than C. albicans that have inherent resistance against traditional antifungals. The aim of this review is to give the reader a contemporary overview of oral candidosis, the organisms involved, and the management strategies that are currently employed or could be utilised in the future.
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Nagano H, Yoshifuku K, Kurono Y. Association of a globus sensation with esophageal diseases. Auris Nasus Larynx 2010; 37:195-8. [DOI: 10.1016/j.anl.2009.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 03/25/2009] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
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Tumbarello M, Sanguinetti M, Trecarichi EM, La Sorda M, Rossi M, de Carolis E, de Gaetano Donati K, Fadda G, Cauda R, Posteraro B. Fungaemia caused by Candida glabrata with reduced susceptibility to fluconazole due to altered gene expression: risk factors, antifungal treatment and outcome. J Antimicrob Chemother 2008; 62:1379-85. [DOI: 10.1093/jac/dkn381] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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