Candida glabrataEsophagitis: Are We Seeing the Emergence of a New Azole-Resistant Pathogen?

Abstract

Background. Candida glabrata (C. glabrata) has become a recognized pathogen in fungal esophagitis. A proportion of these isolates are azole-resistant which may have treatment implications. Variability in the prevalence of this organism exists in the limited data available. Objective. To determine the incidence of C. glabrata esophagitis in a North American hospital setting and to highlight factors that may predispose patients to this condition. Methods. Patient charts were collected from January 1, 2009 to July 30, 2011. Any charts of patients identified as having esophagitis with a positive fungal culture were reviewed for the species of Candida and the presence of factors that would predispose them to esophageal candidiasis. Results. The prevalence of Candida esophagitis based on culture was 2.2% (37 subjects). C. glabrata was the 2nd most prevalent pathogen identified (24.3% or 9 subjects). Of the C. glabrata cohort, all patients had at least one factor predisposing them to candidiasis. Conclusion. C. glabrata esophagitis makes up a large portion of the candidal esophagitis seen in hospital. C. glabrata infections were associated with at least one risk factor for candidal infection. Given its resistance to azole-based therapy, this may have treatment implications for how candidal esophagitis is approached by the clinician.

Clinical Characteristics and Manifestations of Fungal Esophagitis: A Single-Center Experience in South China

“…Here, we found that the use of antibiotics or immunosuppressants independently contributed to esophageal candidiasis, which is in line with its nature as an opportunistic infection. Some prior studies have found that acid inhibitors, especially PPIs, are a risk factor for esophageal infection [ 24 – 27 ] due to fungal development in the stomach as well as the increase in gastric regurgitation [ 28 , 29 ]. In contrast, in our study, previous use of PPIs was not associated with FE.…”

Recidivant odynophagia secondary to persistent esophageal candidiasis in an immunocompetent patient: the importance of brush cytology

“…Therefore, empiric esophageal candidiasis treatment with fluconazole based only on endoscopic findings may not be a good approach to treat C. glabrata. Thus, many authors remark the importance of waiting for brush cytology results before starting treatment (3,4).…”

Diagnosis and treatment of Candida glabrata proventriculitis in an eclectus parrot (Eclectus roratus)

“…In both humans and birds, C glabrata has shown increased antifungal resistance, compared with C albicans. 5,[33][34][35][36] Furthermore, differences between in vitro versus in vivo efficacy of fluconazole and nystatin against C glabrata have been reported, 33 and there have been conflicting reports of resistance, intermediate dose-dependent susceptibility, and susceptibility of C glabrata to these 2 antifungal medications. [34][35][36][37][38] In the bird of the present report, empiric treatment with nystatin and fluconazole was initiated because of the severity of clinical signs, which necessitated immediate treatment, and cytologic results that indicated yeast overgrowth.…”