Merkmale der Candida‐Ösophagitis bei Tumor‐ und AIDS‐Patienten: Histopathologische Studie an 23 Patienten

Abstract

Candida oesophagitis is a common concomitant disease in neutropenic cancer patients after chemotherapie as well as in HIV-patients. In order to characterize the features of oesophagitis in each population, we reviewed the medical history and pathology records of 23 patients (18 cancer-patients, 5 HIV-patients) with culture and autopsy-proven Candida oesophagitis. Histopathological patterns of morphology, invasion, angioinvasion and inflammation were evaluated. Virtually all patients, 17/18 cancer- and 5/5 HIV-patients, had a history of previous mucosal candidosis or candidemia. There was a significant difference histopathologically in depth of invasion of the Candida-organisms between cancer and HIV-patients. Only in HIV-patients organisms were observed within the muscularis propria and the adventitia (2/5 vs 0/18; p = 0.04). The frequency of angioinvasion (12/18 vs 3/5) was similar in both groups. Neutropenia (< 500/microliter) was present in 12 (68%) of 18 cancer patients vs 0/5 HIV-patients (p = 0.01). Correspondingly there was a significant higher PMN/MN ratio in the oesophageal inflammatory infiltrate in HIV-patients, reflecting chemotherapy-induced neutropenia in cancer patients (p = 0.02). Oesophageal candidosis in HIV-patients may be highly invasive despite the presence of neutrophils. These findings suggest an impaired inflammatory response of HIV-patients to invasive candidosis, leading to impaired mucosal host defence.

Morphological changes in the digestive system of 93 human immunodeficiency virus positive patients: an autopsy study

“…Mucosal ulcers caused by CMV may have superinfection by fungi and bacteria, justifying this association. Candidiasis is usually seen in mucosal surfaces, occasionally invading deep tissues and producing systemic disease 16 . In our study, one patient with oral candidiasis developed pulmonary involvement that caused death.…”

The expression of the β-defensins hBD-2 and hBD-3 is differentially regulated by NF-κB and MAPK/AP-1 pathways in an in vitro model of Candida esophagitis

“…Candida albicans colonize distinct microanatomical regions such as the oro-gastointestinal tract as a commensal, but also accounts for more than 50% of all fungal systemic infections [ 1 ]. Candida esophagitis represents a severe threat to an immunocompromised body and, especially in neutropenic patients, often is the first manifestation before Candida sepsis develops [ 2 , 3 ]. Host defense mechanisms preventing mucosal (e.g.…”

Morphological changes in the digestive system of 322 necropsies of patients with acquired immune deficiency syndrome: comparison of findings pre- and post-HAART (Highly Active Antiretroviral Therapy)

“…In only two of these cases there was concomitant lung disease that caused death; neither of them were on HAART. In a study of esophageal biopsies of patients with HIV infection 23 , the invasion of fungi of the muscular and esophageal adventitia was observed, in addition to vascular invasion, which would allow the development of disseminated infections by Candida sp. These changes were not observed in this study.…”