Esophageal candidiasis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
Esophageal candidiasis is an opportunistic infection of the esophagus by Candida albicans. The disease occurs in patients in immunocompromised states, including post-chemotherapy and in AIDS. It is also known as candidal esophagitis or monilial esophagitis.
Historical Perspective
In 1839, B. Lagenbeck from Germany described a yeast-like fungus for the first time in the human oral infection thrush and its ability to cause it.
Classification
Esophageal candidiasis is classified according to the severity of lesions seen during endoscopy into 6 grades.
Pathophysiology
Candida is a normal commensal of the skin and mucous membranes. The balance between the virulence of the fungus and the host immune defense is responsible avoiding opportunistic infection of candida. Deficiency of cell-mediated immunity or poor general status are the main risk factors for having opportunistic candidiasis. Candidiasis is usually localized to skin and mucous membranes. In rare cases, candidiasis can spread causing candidemia and distant infection. These cases are usually associated with deficient immunity . C. albicans is the main species causing infection in humans more than any other candida species.
Causes
C. albicans is the main species causing infection in humans more than any other candida species.
Differentiating esophageal candidiasis from other diseases
Esophageal candidiasis should be differentiated from other diseases causing dysphagia especially in immunocompromised patients (e.g. herpes simplex esophagitis, CMV esophagitis).
Epidemiology and Demographics
Candidiasis is the most common cause of infectious esophagitis followed by HSV esophagitis.
Risk Factors
Immunodeficiency is the most important risk factor for candida esophagitis.
Natural History, Complications and Prognosis
Candida esophagitis is very responsive to antifungal therapy. Complications can be systemic due to the spread of infection to the blood stream or local as esophageal stricture and obstruction.
Symptoms and Physical Examination
The underlying predisposing factors are usually clear on obtaining history (HIV, chemotherapy, etc ..). Odynophagia is the most common encountered symptom of esophageal candidiasis. Examination reveals signs of immunocompromisation that was the primary cause of developing esophageal thrush.
Diagnostic tests
Although the appearance of the patches during endoscopy is diagnostic for esophageal candidiasis, biopsies should be obtained to confirm the diagnosis. If the patient is not already diagnosed with HIV or another immunocompromising disease, screening should be done.
Medical therapy
Esophageal candidiasis is almost always treated with systemic antifungals (either parentral or oral). A trial of antifungal therapy is done before performing endoscopy in HIV patients with esophagitis.
Surgery
Surgical intervention is not recommended for the management of esophageal candidiasis unless complications ensue.
Primary Prevention
There is no established method for prevention of candida esophagitis.
Secondary prevention
There are no secondary preventive measures available for candida esophagitis.