Diagnosis and Treatment of Esophageal Candidiasis: Current Updates

Abstract

Esophageal candidiasis (EC) is the most common type of infectious esophagitis. In the gastrointestinal tract, the esophagus is the second most susceptible to candida infection, only after the oropharynx. Immunocompromised patients are most at risk, including patients with HIV/AIDS, leukemia, diabetics, and those who are receiving corticosteroids, radiation, and chemotherapy. Another group includes those who used antibiotics frequently and those who have esophageal motility disorder (cardiac achalasia and scleroderma). Patients complained of pain on swallowing, difficulty swallowing, and pain behind the sternum. On physical examination, there is a plaque that often occurs together with oral thrush. Endoscopic examination is the best approach to diagnose this disease by directly observing the white mucosal plaque-like lesions and exudates adherent to the mucosa. These adherent lesions cannot be washed off with water from irrigation. This disease is confirmed histologically by taking the biopsy or brushings of yeast and pseudohyphae invading mucosal cells. The treatment is by systemic antifungal drugs given orally in a defined course. It is important to differentiate esophageal candidiasis from other forms of infectious esophagitis such as cytomegalovirus, herpes simplex virus, gastroesophageal reflux disease, medication-induced esophagitis, radiation-induced esophageal injury, and inflammatory conditions such as eosinophilic esophagitis. Except for a few complications such as necrotizing esophageal candidiasis, fistula, and sepsis, the prognosis of esophageal candidiasis has been good.

Structural Insights into the Interactions of Candidal Enolase with Human Vitronectin, Fibronectin and Plasminogen

“…Recent proteomic studies have repeatedly demonstrated the presence of enolase at the cell surface of yeast-like fungi from the Candida genus [25][26][27][28], a major group of fungal pathogens in humans. Commensally inhabiting the skin and mucosal membranes of healthy individuals, these fungi can cause severe infections in hospitalized patients with impaired immune mechanisms [29]. Although Candida albicans is still the main fungal species isolated from the bloodstream, the incidence of infections caused by species other than C. albicans, which are an increasingly emerging cause of systemic and poorly curable candidiases, has been growing in recent decades [30,31].…”

Prevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysis

“…OC is the most common cause of infectious esophagitis in patients with advanced HIV disease, mainly caused by the yeast Candida albicans but also other non- albicans Candida species such as C. glabrata, C. tropicalis, and C. dubliniensis [ 8 ]. OC is associated with substantial morbidity and adversely affects the quality of life of the affected persons owing to the dysphagia, odynophagia, retrosternal chest pain, and extreme weight loss attributed to the disease [ 9 ]. On endoscopic examination, white mucosal plaque-like lesions, erythema, and exudates adherent to the mucosa are frequently observed [ 9 ].…”

“…OC is associated with substantial morbidity and adversely affects the quality of life of the affected persons owing to the dysphagia, odynophagia, retrosternal chest pain, and extreme weight loss attributed to the disease [ 9 ]. On endoscopic examination, white mucosal plaque-like lesions, erythema, and exudates adherent to the mucosa are frequently observed [ 9 ]. Biopsy or mucosal brushing samples reveals pseudohyphae of the Candida species and is the preferred method of diagnosis of OC [ 9 ].…”

“…On endoscopic examination, white mucosal plaque-like lesions, erythema, and exudates adherent to the mucosa are frequently observed [ 9 ]. Biopsy or mucosal brushing samples reveals pseudohyphae of the Candida species and is the preferred method of diagnosis of OC [ 9 ]. Microbiological confirmation, speciation, and antifungal susceptibility are achieved through a culture of the endoscopically acquired samples.…”

Aflatoxin influences achalasia symptomatology

“…The predominant symptoms of achalasia are dysphagia and regurgitation. in addition, persistent esophageal distension due to food and fluid retention can lead to fungal and bacterial overgrowth, and impaired clearance of gastric contents (8). Acid regurgitation can cause chronic inflammation, dysplasia and even cancer.…”