Sandbox: esophageal candida
Overview
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 hyphae that are characteristic of Candida species.
Therapy
A variety of medications may be used to treat esophageal candidiasis. They include:
- nystatin
- oral triazoles, such as fluconazole
- caspofungin, used in refractory or systemic cases
- amphotericin, used in refractory or systemic cases