Esophagitis Candida

Sable CA, Villanueva A, Arathon E, Gotuzzo E, Turcato G, Uip D, Noriega L, Rivera C, Rojas E, Taylor V, Berman R, Calandra GB, Chodakewitz J. A randomized, double-blind, multicenter trial of MK-991 (L-743,872) vs. amphotericin B (AMB) in the treatment of Candida esophagitis in admts. Abstracts of the 37th Interscience Comerence on Antimicrobial Agents and Chemotherapy, 1997 LB-33. 

Isolated reports of Candida esophagitis or Pneumocystis proved Pneumocystis carinii) infections in immunocompetent patients and the possible decrease in CD4-I- T cells with or without opportunistic infections in several HIV-infected patients (SED-13,1097) (379) suggest that unexpected immunosuppressive effects of interferon alfa can occur. An autoimmune destruction of CD4 cells in patients with a particular HLA haplotype has been proposed as a possible mechanism (380). One patient also had an acute and fatal acute precipitation of infection with Entamoeba histolytica (SEDA-22, 403). However, the available evidence is still very limited and no firm conclusion can be drawn on a possible association between interferon alfa treatment and a fall in CD4 cell count or an immunosuppressive effect. 

Barbaro G, Barbarini G, Calderon W, Grisorio B, Alcini P, Di Lorenzo G. Fluconazole versus itraconazole for Candida esophagitis in acquired immunodeficiency syndrome. Candida esophagitis. Gastroenterology 1996 lll(5) 1169-77. 

Most likely diagnosis Candida esophagitis secondary to hnman immnnodeficiency virns (HIV). 

The usual dose of C-AMB is 0.5-0.6 mg/kg, administered in 5% glucose over 4 hours. Candida esophagitis in adults responds to 0.15-0.2 mg/kg daily. Rapidly progressive mucormycosis or invasive aspergillosis is treated with doses of 1-1.2 mg/kg daily until progression is arrested. 

Fazio RA, Wickremesinghe PC, Arsura EL. Ketoconazole treatment of Candida esophagitis— a prospective study of 12 czsqs. Am J Gastroenterol (1983) 78, 261-4. 

Candida albicans accounts for 80% of cases of OPC and esophageal candidiasis. Over the last 20 years, an increasing incidence of C. albicans resistance has been accompanied by an increased incidence of non-albicans species infections, including Candida glabrata, Candida tropicalis, Candida krusei, and Candida parapsilosis. In patients with cancer, non-albicans Candida species account for almost half of all cases.29... 

Twenty percent of HIV-infected patients develop fluconazole-resistant Candida albicans isolates after repeated exposure to fluconazole.33 To treat fluconazole-resistant oropharyngeal candidiasis, daily itraconazole for 2 to 4 weeks may be used. Oral itraconazole solution exhibits a mycological cure rate of 88% and a clinical cure rate of 97% in immunocompromised patients.34 Fluconazole-resistant esophageal candidiasis should be treated with intravenous amphotericin B or caspofungin. 

For the treatment of patients with esophageal candidiasis, and for prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation (HSCT). 

Treatment of esophageal candidiasis-Prophylaxis of Candida infections in HSCT recipients-... 

Fluconazole is very effective in the treatment of infections with most Candida spp. Thrush in the end-stage AIDS patient, often refractory to nystatin, clotrimazole, and ketoconazole, can usually be suppressed with oral fluconazole. AIDS patients with esophageal candidiasis also usually respond to fluconazole. A single 150-mg dose has been shown to be effective treatment for vaginal candidiasis. A 3-day course of oral fluconazole is effective treatment for Candida urinary tract infection and is more convenient than amphotericin B bladder irrigation. Preliminary findings suggest that Candida endophthalmitis can be successfully treated with fluconazole. Stable nonneutropenic patients with candidemia can be adequately treated with fluconazole, but unstable, immunosuppressed patients should initially receive... 

Editors Notes Commonly affects cyclosporine level. May be useful for Candida UTI and esophageal candidiasis. Coadministration of terfenadine or cisapride is contraindicated due to an increased risk of prolonged QT intervals and torsade de pointes. However, both drugs have now been removed from the market. ... 

Candida Inflammatory lesions in oropharyngeal region and esophagitis Oral infections clotrimazole, fluconazole, or nystatin Esophageal infections fluconazole or ketoconazole... 

Candida albicans is the predominant species causing all forms of mucosal candidiasis. A number of host and exogenous factors have been identified as important risk factors predisposing an individual to the development of mucosal candidiasis. In oropharyngeal and esophageal candidiasis, the key risk factor is impaired host immune system. 

The best test is upper Gl endoscopy (more useful than barium swallow) helps exclude other causes of esophagitis (e.g., viral, aphthous ulcers). Diagnosis is confirmed by the histologic presence of Candida in biopsy lesions taken during endoscopy. 

---