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Matsuo T, Singh BA, Wurster S, Jiang Y, Bhutani MS, Chatterjee D, Kontoyiannis DP. The modern face of esophageal candidiasis in an oncology center: Correlating clinical manifestations, endoscopic grade, and pathological data in 323 contemporary cancer patients. J Infect 2024:106172. [PMID: 38735485 DOI: 10.1016/j.jinf.2024.106172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Clinical presentation and outcomes of esophageal candidiasis (EC) in cancer patients are scarcely studied in the azole era, as is the correlation between clinical, endoscopic, and histopathological EC manifestations. METHODS We retrospectively reviewed the risk factors, clinical features, and outcomes of pathology-documented EC cases at MD Anderson Cancer Center. We further assessed associations between presence of symptoms, standardized 4-stage endoscopic grade (Kodsi classification), histopathological data, and fluconazole treatment failure. RESULTS Among 323 cancer patients with EC, 89% had solid tumors, most commonly esophageal cancer (29%). Thirty-three percent of EC patients were asymptomatic. The proportion of symptomatic EC patients significantly increased with endoscopic grade (P=0.005). Among 202 patients receiving oral fluconazole, 27 (13%) had treatment failure. Underlying esophageal disease was the only independent predictor of fluconazole treatment failure (odds ratio: 3.88, P=0.005). Endoscopic grade correlated significantly with Candida organism burden (Correlation coefficient [ρ]=0.21, P<0.01) and neutrophilic inflammation (ρ=0.18, P<0.01). Candida invasion of the squamous mucosal layer was associated with treatment failure (P=0.049). CONCLUSIONS EC was predominantly encountered in patients with solid tumors. One third of EC patients were asymptomatic, challenging traditional symptom-based diagnosis. Development of integrated clinicopathological scoring systems could further guide therapeutic management of cancer patients with EC.
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Affiliation(s)
- Takahiro Matsuo
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, 1515 Holcombe Boulevard Unit 1460 Houston, TX, USA 77030
| | - Ben Allen Singh
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, 1515 Holcombe Boulevard Unit 1466 Houston, TX, USA 77030
| | - Sebastian Wurster
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, 1515 Holcombe Boulevard Unit 1460 Houston, TX, USA 77030
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, 1515 Holcombe Boulevard Unit 1460 Houston, TX, USA 77030
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, 1515 Holcombe Boulevard Unit 1466 Houston, TX, USA 77030
| | - Deyali Chatterjee
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, 1515 Holcombe Boulevard Unit 085 Houston, TX, USA 77030
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, 1515 Holcombe Boulevard Unit 1460 Houston, TX, USA 77030.
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Andres B, Kathi PR, Tey K. White Esophagus: The Result of Polypharmacy. Cureus 2023; 15:e34415. [PMID: 36874643 PMCID: PMC9977629 DOI: 10.7759/cureus.34415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
Candida esophagitis can occur in immunocompetent patients through impairment of host defense mechanisms including salivation, esophageal motility, acidic pH, and innate immunity. Commonly prescribed medications inhibit these mechanisms, and polypharmacy has been shown to have an additive effect on promoting Candida infection. We present the case of an immunocompetent patient who was chronically prescribed multiple medications associated with Candida esophagitis but experienced infection only after the addition of oral delayed-release budesonide, which has not previously been associated with Candida esophagitis.
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Affiliation(s)
- Brendan Andres
- Internal Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA
| | - Pradeep R Kathi
- Internal Medicine/Gastroenterology, University of Arizona, Tucson, USA
| | - Kai Tey
- Gastroenterology and Hepatology, University of Arizona College of Medicine - Tucson, Tucson, USA
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Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
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Affiliation(s)
- Tara Narasimhalu
- Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Kristin A Olson
- Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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