Esophageal candidiasis physical examination

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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

Examination reveals signs of immunocompromisation that was the primary cause of developing esophageal thrush.

Physical Examination

Upper GI endoscopy

On endoscopy, esophageal candidiasis appears as white mucosal patches that are confirmed through biopsy.

Upper GI endoscopy showing esophageal candidiasis

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Appearance of the patient

• Patients with esophageal candidiasis are usually ill-appearing.
• They may later become apathetic and delirious.

Vital Signs

Temperature

• Hyperthermia (temperatures as high as 42° C) is a sign of infection and hypothermia (temperatures as low as 35° C) indicates septic shock.
• Hypothermia is a grave sign,seen late in the course of the disease in patients with on-going fungaemia or septic shock.

Blood Pressure

• The blood pressure is maintained within normal limits early in the disease process but as fungemia progresses, the blood pressure decreases due to shock

Pulse

• Tachycardia with weak, thready peripheral pulses represents decreased effective circulating blood volume, indicating a stage of shock later in the disease.
• May be normal or increased in rate due to infection.
• It may be low in volume due to dehydration.

Respiration

• Tachypnea due to infection and increased oxygen demand.

Skin

• Opportunistic skin conditions as Folliculitis, Kaposi sarcoma, skin candidiasis.
• HIV associated conditions may be present as Seborrheic dermatitis and Psoriasis.

Eyes

• Retinal haemorrhage and retinal infiltrates may be present.

Head

• Tenderness of sinuses may be elicited.

Nose

• Inflammation of the nasal turbinates may be present.

Ears

• Unilateral or bilateral deafness may be present.
• Discharge from the ears may be found.

Throat

• Peridontal disease may be present.
• Oral herpes and Oral thrush simplex lesions may be found.

Lungs

• Crackles and rhonchi may be found.
• Dullness to percussion can be present.
• Increased tactile fremitus can be present.

Cardiovascular system

• A heart murmur can be found.

Abdomen

• Abdominal tenderness can be found.
• Hepatomegaly and splenomegaly may be detected.

Genitourinary

• Vaginal or urethral discharge can be present.

Extremities

• Muscle weakness and joint swelling may be present.

Central Nervous System

• Focal neurological deficits may be found.

• Behavioral changes may be observed.
• Gait disturbances may be present.