Esophageal candidiasis

Esophageal candidiasis
Endoscopic image of esophageal candidiasis in a patient after chemotherapy. Brushings confirmed the presence of hyphae
Classification and external resources
Specialty	infectious disease
ICD-9-CM	112.84

Esophageal candidiasis is an opportunistic infection of the esophagus by Candida albicans. The disease usually occurs in patients in immunocompromised states, including post-chemotherapy and in AIDS. However, it can also occur in patients with no predisposing risk factors, and is more likely to be asymptomatic in those ppatients.^[1] It is also known as candidal esophagitis or monilial esophagitis.

Clinical presentation

Patients with esophageal candidiasis present with odynophagia, or painful swallowing. Longstanding esophageal candidiasis can result in weight loss. There is often concomittant thrush.

Some patients present with esophageal candidiasis as a first presentation of systemic candidiasis.

Diagnosis

In most cases the diagnosis is established based on response to therapy. Patients in whom esophageal candidiasis is suspected should receive a brief course of antifungal therapy with fluconazole. If the infection resolves after treatment with fluconazole, then the diagnosis of esophageal candidiasis is made and no further investigation is needed. However, if the infection persists or if there are other factors involved which may warrant further investigation, then patient will undergo an esophagogastroduodenoscopy if it is safe to do so. Endoscopy often reveals classic diffuse raised plaques that characteristically can be removed from the mucosa by the endsocope. Brushing or biopsy of the plaques shows yeast and pseudohyphae by histology that are characteristic of Candida species.

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  A severe case of candidiasis
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  H&E stain of esophagus showing Candida hyphae within the lamina propria

Therapy

The current first-line treatment is fluconazole, 200 mg. on the first day, followed by daily dosing of 100 mg. for at least 21 days total. Treatment should continue for 14 days after relief of symptoms. [Note: this page previously listed first-line treatment using a single dose of fluconazole (750 mg), but that is actually treatment for oropharyngeal, not esophageal Candidiasis.^[2]] Other therapy options include:

• nystatin
• other oral triazoles, such as itraconazole
• caspofungin, used in refractory or systemic cases
• amphotericin, used in refractory or systemic cases

References

1. ↑ Mimidis, K; Papadopoulos, V; Margaritis, V; Thomopoulos, K; Gatopoulou, A; Nikolopoulou, V; Kartalis, G (February 2005). "Predisposing factors and clinical symptoms in HIV-negative patients with Candida oesophagitis: are they always present?". International journal of clinical practice. 59 (2): 210–3. doi:10.1111/j.1742-1241.2004.00249.x. PMID 15854199. 
2. ↑ Hamza OJ, Matee MI, Brüggemann RJ, et al. (2008). "Single-dose fluconazole versus standard 2-week therapy for oropharyngeal candidiasis in HIV-infected patients: A randomized, double-blind, double-dummy trial". Clin Infect Dis. 47 (10): 1270–1276. doi:10.1086/592578. PMID 18840077.