Esophageal candidiasis

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

H&E stain of esophagus showing Candida hyphae within the lamina propria

Esophageal candidiasis is an opportunistic infection of the esophagus by Candida albicans. The disease occurs in patients in immunocompromised states, including post-chemotherapy and in AIDS. 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.

Diagnostic testing

Patients where esophageal candidiasis is suspected should undergo 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.

Therapy

The current first-line treatment is a single dose of fluconazole (750mg).^[1] 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

Additional images

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  A severe case of candidiasis

See also

• candidiasis
• esophagitis
• neutropenia

References

1. ^ Hamza OJM, Matee MIN, Brüggemann RJM, 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.