Usually present with dysphagia or odynophagia. However, the patients may be asymptomatic.
It often occurs together with oral thrush; however absence of thrush does not preclude a diagnosis of oesophageal candidiasis.
C. albicans is almost always the infecting organism. Symptomatic infections caused by C. glabrata and C. krusei alone have been described
Risk Factors:
- HIV infection- oesophageal candidiasis is an AIDS defining illness and occurs with CD4 counts less than 200/microL.
- Haematological and non-haematological malignancies
- Chemotherapy or use of broad spectrum antibiotics
- Use of inhaled steroids
- Systemic antifungal therapy is always required for treatment. Oral fluconazole (200 to 400 mg daily for 14 to 21 days) is the drug of choice due to its lack of toxicity and cost. Symptoms improve within 7 days.
- For fluconazole-refractory disease, itraconazole solution at a dosage of 200 mg daily, posaconazole suspension at a dosage of 400 mg twice daily, or voriconazole at a dosage of 200 mg twice daily administered intravenously or orally for 14– 21 days is recommended.
- Intravenous fluconazole at a dosage of 400 mg (6 mg/kg) daily, Amphotericin B at a dosage of 0.3–0.7 mg/kg daily, or an echinocandin (caspofungin, micafungin and anidulafungin) should be used for patients who cannot tolerate oral therapy.
- Suppressive therapy with fluconazole at a dosage of 100–200 mg 3 times weekly is recommended for recurrent infections
These findings are most consistent with candida esophagitis. While the classic presentation is usually odynophagia, patients can present with dysphagia alone especially in the immune compromised situation. This infectious esophagitis is most commonly found in immunocompromised hosts, especially those with HIV. Other immunodeficiency states are possible such as classically common variable immune deficiency can give rise to candidiasis but give the patients other history, HIV is more likely. Immunocompromised patients are also at risk for CMV esophagitis but this typically appears as multiple ulcerations in the esophagus. HPV has been linked to esophageal papillomas but these are usually distinct lesions within the esophagus, and don’t appear as this diffuse yellow/white plaque. Patients with hepatitis C are not at increased risk for candida esophagitis unless co-infected with HIV.
ReplyDeleteA 36-year-old woman with acquired immunodeficiency syndrome reports persistent severe odynophagia despite a 10-day course of oral antifungal therapy. The most appropriate diagnostic test would be which of the following?
ReplyDeleteA. Barium swallow
B. Computed tomography of the chest
C. Endoscopy with brushings and biopsies
D. Cytomegalovirus titers
correct answer C
to exclude CMV, HSV, other fungal diseases and big ulcers.
I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
ReplyDeleteliver already present. I started on antiviral medications which
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