<i>Candida</i>esophagitis: Risk factors in non-HIV population in Pakistan

Yakoob, Javed; Jafri, Wasim; Abid, Shahab; Jafri, Nadim; Islam, Muhammad; Hamid, Saeed; Shah, Hasnain Ali; Hussainy, Akbar Shah

doi:10.3748/wjg.v9.i10.2328

Cited by 35 publications

(49 citation statements)

References 12 publications

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“…Although oral candidiasis is considered an important associated factor for the diagnosis of CE [7], [9], [13], this finding was not observed in all patients in the present study, and some patients were missing relevant oral candidiasis data. Second, we did not evaluate the clinical factors of diabetes and malignancy, or the use of oral antibiotics and antacids as associated factors for CE in non-HIV patients [15], [20]–[22]. Third, selection bias was present, for although subjects were patients who underwent endoscopy, those who had severe clinical conditions such as unstable circulatory or respiratory dynamics or bleeding tendency may have been more likely to be excluded.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Esophageal Candidiasis and Its Endoscopic Severity in the Era of Antiretroviral Therapy

et al. 2013

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BackgroundCandidia esophagitis (CE) is an AIDS-defining condition, usually occurring in individuals with low CD4 counts of <200 cells/µL. Endoscopy is a valuable definitive diagnostic method for CE but may not be indicated for asymptomatic patients or for those with high CD4 counts or without oral candidiasis. This study assessed such patients to clarify the factors associated with CE and its severity on endoscopy in the highly active antiretroviral therapy (HAART) era.Methodology/ Principal FindingsA total of 733 HIV-infected patients who underwent upper gastrointestinal (GI) endoscopy were analyzed. Sexual behavior, CD4+ count, HIV-RNA viral load (VL), history of HAART, GI symptoms, GI diseases, and oral candidiasis were assessed. Endoscopic severity of CE was classified as mild (Kodsi's grade I/II) or severe (grade III/IV). Of the 733 subjects, 62 (8.46%) were diagnosed with CE (mild, n = 33; severe, n = 29). Of them, 56.5% (35/62) had no GI symptoms, 30.6% (19/62) had CD4 + ≥200 cells/μL, and 55.3% (21/38) had no oral candidiasis. Univariate analysis found lower CD4+ counts, higher HIV VL, and no history of HAART to be significantly associated with CE. With lower CD4+ counts and higher HIV VL, CE occurrence increased significantly (P<0.01 for trend in odds). Multivariate analysis showed low CD4+ counts and high HIV VL to be independently associated with CE. Of the severe CE patients, 55.2% (16/29) had no GI symptoms and 44.4% (8/18) had no oral candidiasis. Median CD4+ counts in severe cases were significantly lower than in mild cases (27 vs. 80; P = 0.04).ConclusionsLow CD4+ counts and high HIV VL were found to be factors associated with CE, and advanced immunosuppression was associated with the development of severity. Endoscopy is useful as it can detect CE, even severe CE, in patients without GI symptoms, those with high CD4 counts, and those without oral candidiasis.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with Esophageal Candidiasis and Its Endoscopic Severity in the Era of Antiretroviral Therapy

et al. 2013

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“…Endoscopic findings correlate neither with clinical manifestations nor with the presence of risk factors [12]. The lack of correlation between clinic symptoms and endoscopic findings was also shown by another retrospective study [23].…”

Section: Discussionmentioning

confidence: 97%

“…The association of DM with EC was further shown by a retrospective study including 51 patients [23]. The same study described uncontrolled DM, along with carcinoma, corticosteroid and antibiotic use as the most common risk factors for EC [23]. The association of DM with EC is often described when it is poorly controlled [23,24].…”

Section: Discussionmentioning

confidence: 99%

“…The same study described uncontrolled DM, along with carcinoma, corticosteroid and antibiotic use as the most common risk factors for EC [23]. The association of DM with EC is often described when it is poorly controlled [23,24]. Another retrospective study from Korea involving 281 HIV-negative patients with EC found that there was no underlying disease in 69.8% of patients, while DM (8.2%) and malignancy (7.8%) were the two most common concomitant diseases [4].…”

Section: Discussionmentioning

confidence: 99%

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Esophageal Candidiasis in a Patient With Uncontrolled Diabetes Mellitus and Recurrent Abdominal Pain, Symptomatic Or Incidental? A Case Report and Brief Literature Review

2015

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Esophageal candidiasis (EC) is a common opportunistic infection in patients with impaired cellular immunity, such as human immunodeficiency virus (HIV) infection. However, it can also be found in individuals with certain predisposing conditions like uncontrolled diabetes mellitus (DM) and the use of certain medications. We report a 54-year-old female with past medical history of DM, hypertension and hyperlipidemia who presented to the ER with worsening periumbilical and epigastric pain for 2 days. She had multiple similar presentations requiring admissions to different hospitals and had undergone extensive workup over the past year. She only had transient improvement from these hospitalizations. Esophagogastroduodenoscopy (EGD) performed on day 2 of admission revealed extensive creamy pseudomembranous exudate through the entire length of esophagus confirmed as Candida albicans by brush scraping analysis. She received oral fluconazole with significant relief of her symptoms over the next couple of weeks. Although EC remains asymptomatic in the majority of patients and is only detected incidentally on EGD, its diagnosis and treatment can provide significant symptomatic relief in many patients. EC should be considered as a potential diagnosis in the appropriate clinical setting even in patients with no evidence of overt immunodeficiency.

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“…In summary, both cases of CE by C. glabrata failed to develop fluconazole resistance. Thus, this emerging species may be underestimated due to lack of proper identification and may occur, in part, because of the impact of fluconazole therapy on the ecology of oral yeast species (8,17).…”

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confidence: 99%

Candida Glabrata Esophagitis: new case reports and management

Macêdo¹,

Silva²,

Farias³

et al. 2008

Braz. J. Microbiol.

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Candida esophagitis (CE) is a common opportunistic infection in the immunocompromised host. C. glabrata is rarely cited as agent of CE and has been underestimated due to lack of proper identification. In this study, two cases of C. glabrata esophagitis in AIDS and chagasic patients are reported. Diagnosis of Candida species should be considered an important key for the ideal choice of antifungal therapy against this mycosis.

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Candidaesophagitis: Risk factors in non-HIV population in Pakistan

Abstract: Carcinomas, diabetes mellitus, corticosteroid and antibiotic therapy are major risk factors for candida esophagitis in Pakistan. It is an easily managed complication that responds to treatment with nystatin.

Cited by 35 publications

References 12 publications

Factors Associated with Esophageal Candidiasis and Its Endoscopic Severity in the Era of Antiretroviral Therapy

Factors Associated with Esophageal Candidiasis and Its Endoscopic Severity in the Era of Antiretroviral Therapy

Esophageal Candidiasis in a Patient With Uncontrolled Diabetes Mellitus and Recurrent Abdominal Pain, Symptomatic Or Incidental? A Case Report and Brief Literature Review

Candida Glabrata Esophagitis: new case reports and management

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