Esophageal candidiasis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Esophageal candidiasis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Esophageal_candidiasis]]
{{CMG}};{{AE}}{{AY}}
{{CMG}};{{AE}}{{AY}}


==Overview==
==Overview==
Esophageal candidiasis should be differentiated from other diseases causing dysphagia especially in immunocompromised patients.
Esophageal candidiasis should be differentiated from other diseases causing [[dysphagia]] especially in [[Immunocompromised|immunocompromised patients]] (e.g. [[Herpes simplex|herpes simplex esophagitis]], [[CMV esophagitis (patient information)|CMV esophagitis]])


==Differentiating esophageal candidiasis from other diseases==
==Differentiating esophageal candidiasis from other diseases==
Esophageal candidiasis should be differentiated from other diseases causing [[dysphagia]] especially in [[Immunocompromised|immunocompromised patients]].
{| class="wikitable"
{| class="wikitable"
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!Prominent clinical featurs
!Prominent clinical features
!Endoscopy findings
!Endoscopy findings
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|Candida esophagitis
|Candida esophagitis
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* [[Odynophagia]] is the most prominent symptom
* May be accompanied by [[oropharyngeal candidiasis]]


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* [[Endoscopy]] shows characteristic white yellowish lesions over the [[Mucous membrane|mucosa.]]
|[[Image:Esophageal candidiasis (1).jpg|center|300px|thumb|Endoscopic image of '''esophageal candidiasis''' in a patient after [[chemotherapy]] - arrows indicating the candida lesions]]
|-
|[[HSV|HSV esophagitis]]
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* [[HSV|HSV esophagitis]] is due to reactivation of [[HSV]] usually in [[Immunocompromised|immunocompromised patients]].
* [[HSV|HSV esophagitis]] usually presents acutely as [[dysphagia]], [[odynophagia]] accompanied by [[fever]] and other constitutional symptoms.
* [[Vesicles|Oropharyngeal vesicles]] and [[ulcers]] may accompany [[HSV|HSV esophagitis]].<ref name="pmid8686361">{{cite journal |vauthors=Becker K, Lübke HJ, Borchard F, Häussinger D |title=[Inflammatory esophageal diseases caused by herpes simplex virus infections--overview and report of 15 personal cases] |language=German |journal=Z Gastroenterol |volume=34 |issue=5 |pages=286–95 |year=1996 |pmid=8686361 |doi= |url=}}</ref>
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* [[HSV]] lesions are usually present in the distal esophagus. Lesions start as [[vesicles]] but later on coalesce and form large [[ulcers]].
* [[Ulcers]] are 8-10 mm in size, has a volcano like appearance and covered with a white exudate.
|[[Image:Herpes esophagitis - By Donald E. Mansell, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=9666173 (22).jpg|center|300px|thumb|Herpes esophagitis - arrows indicating herpetic ulcers -
By Donald E. Mansell, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=9666173]]
|-
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|HSV esophagitis
|[[CMV esophagitis (patient information)|CMV esophagitis]]
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* HSV esophagitis is due to reactivation of HSV usually in immunocompromised patients.
* [[CMV esophagitis (patient information)|CMV esophagitis]] is characterized by more insidious onset of [[nausea]], [[vomiting]], [[dysphagia]] and consequent [[weight loss]].
* HSV esophagitis usually presents acutely as dysphagia, odynophagia accompanied by fever and other constitutional symptoms.
* [[CMV esophagitis (patient information)|CMV esophagitis]] occurs more commonly in [[organ transplant]] patients more than in [[Human Immunodeficiency Virus (HIV)|HIV]] patients.
* Oropharyngeal vesicles and ulcers may accompany HSV esophagitis.
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* HSV lesions are usually present in the distal esophagus. Lesions start as vesicles but later on coalesce and form large ulcers.
* As in [[HSV|HSV esophagitis]], [[CMV]] lesions are usually in the distal esophagus.
* Ulcers are 8-10 mm in size, has a volcano like appearance and covered with a white exudate.
* Lesions can be  multiple small [[ulcers]] or large single shallow ulcer.
* [[CMV]] esophagitis can present as [[Necrosis|esophageal necrosis]] with no ulcers.<ref name="pmid2823585">{{cite journal |vauthors=Balthazar EJ, Megibow AJ, Hulnick D, Cho KC, Beranbaum E |title=Cytomegalovirus esophagitis in AIDS: radiographic features in 16 patients |journal=AJR Am J Roentgenol |volume=149 |issue=5 |pages=919–23 |year=1987 |pmid=2823585 |doi=10.2214/ajr.149.5.919 |url=}}</ref>
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|CMV esophagitis
|[[Lymphoma|Esophageal lymphoma]]
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* CMV esophagitis is characterized by more insidious onset of nausea, vomiting, dysphagia and consequent weight loss.
* CMV esophagitis occurs more commonly in organ transplant patients more than in HIV patients.
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* As in HSV esophagitis, CMV lesions are usually in the distal esophagus.
* [[Lymphoma|Esophageal lymphoma]] has nonspecific symptoms of [[dysphagia]], [[hoarseness]] and  [[Chest pain|retrosternal chest pain]].
* Lesions can be  multiple small ulcers or large single shallow ulcer.
* CMV esophagitis can present as esophageal necrosis with no ulcers.
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* [[Endoscopy]] is useful in obtaining [[biopsies]] as visual findings are not specific as [[lymphoma]] can be accompanied by [[candidiasis]] or [[HSV|HSV esophagitis]].<ref name="pmid21160688">{{cite journal |vauthors=Ghimire P, Wu GY, Zhu L |title=Primary esophageal lymphoma in immunocompetent patients: Two case reports and literature review |journal=World J Radiol |volume=2 |issue=8 |pages=334–8 |year=2010 |pmid=21160688 |pmc=2999330 |doi=10.4329/wjr.v2.i8.334 |url=}}</ref>
|Esophageal lymphoma
|Esophageal lymphoma has nonspecific symptoms of dysphagia, hoarseness and  retrosternal chest pain.
|Endoscopy is useful in obtaining biopsies as visual findings are not specific as lymphoma can be accompanied by candidiasis or HSV esophagitis.
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|}


Candida esophagitis should also be differentiated from other causes of dysphagia as:
===Candida esophagitis should also be differentiated from other less common causes of dysphagia as===


*[[Gastroesophageal reflux disease]] (GERD)
*[[Gastroesophageal reflux disease]] (GERD)
*[[Barrett's esophagus]]  
*[[Barrett's esophagus]]  
*[[Esophageal achalasia]]
*[[Esophageal achalasia]]
*Pill esophagitis
*[[Esophagitis|Pill esophagitis]]
*Eosinophilic esophagitis
*[[Eosinophilic esophagitis]]


==References==
==References==
{{reflist|2}}
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Gastroenterology]]
[[Category:Otolaryngology]]
[[Category:Immunology]]

Latest revision as of 21:40, 29 July 2020

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 should be differentiated from other diseases causing dysphagia especially in immunocompromised patients (e.g. herpes simplex esophagitis, CMV esophagitis)

Differentiating esophageal candidiasis from other diseases

Esophageal candidiasis should be differentiated from other diseases causing dysphagia especially in immunocompromised patients.

Prominent clinical features Endoscopy findings
Candida esophagitis
Endoscopic image of esophageal candidiasis in a patient after chemotherapy - arrows indicating the candida lesions
HSV esophagitis
  • HSV lesions are usually present in the distal esophagus. Lesions start as vesicles but later on coalesce and form large ulcers.
  • Ulcers are 8-10 mm in size, has a volcano like appearance and covered with a white exudate.
Herpes esophagitis - arrows indicating herpetic ulcers - By Donald E. Mansell, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=9666173
CMV esophagitis
Esophageal lymphoma

Candida esophagitis should also be differentiated from other less common causes of dysphagia as

References

  1. ↑ Becker K, Lübke HJ, Borchard F, Häussinger D (1996). "[Inflammatory esophageal diseases caused by herpes simplex virus infections--overview and report of 15 personal cases]". Z Gastroenterol (in German). 34 (5): 286–95. PMID 8686361.
  2. ↑ Balthazar EJ, Megibow AJ, Hulnick D, Cho KC, Beranbaum E (1987). "Cytomegalovirus esophagitis in AIDS: radiographic features in 16 patients". AJR Am J Roentgenol. 149 (5): 919–23. doi:10.2214/ajr.149.5.919. PMID 2823585.
  3. ↑ Ghimire P, Wu GY, Zhu L (2010). "Primary esophageal lymphoma in immunocompetent patients: Two case reports and literature review". World J Radiol. 2 (8): 334–8. doi:10.4329/wjr.v2.i8.334. PMC 2999330. PMID 21160688.
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