An Observational Study of Clinical and Microbiological Profile of Esophageal Candidiasis in a Tertiary Care Center, Madras City, India
Paila Ramesh *
Medical Gastroenterology, Madras Medical College, Near Park Town Station, Park Town, Chennai, 600 003, India.
Muthu Kumaran
Medical Gastroenterology, Madras Medical College, Near Park Town Station, Park Town, Chennai, 600 003, India.
Rajeevan
Medical Gastroenterology, Madras Medical College, Near Park Town Station, Park Town, Chennai, 600 003, India.
Ramani
Medical Gastroenterology, Madras Medical College, Near Park Town Station, Park Town, Chennai, 600 003, India.
Prem Kumar
Medical Gastroenterology, Madras Medical College, Near Park Town Station, Park Town, Chennai, 600 003, India.
I. Shubha
Medical Gastroenterology, Madras Medical College, Near Park Town Station, Park Town, Chennai, 600 003, India.
P. Ratnakar Kini
Medical Gastroenterology, Madras Medical College, Near Park Town Station, Park Town, Chennai, 600 003, India.
Murali
Medical Gastroenterology, Madras Medical College, Near Park Town Station, Park Town, Chennai, 600 003, India.
A. Chezhian
Medical Gastroenterology, Madras Medical College, Near Park Town Station, Park Town, Chennai, 600 003, India.
Caroline Selvi
Medical Gastroenterology, Madras Medical College, Near Park Town Station, Park Town, Chennai, 600 003, India.
Aravind
Medical Gastroenterology, Madras Medical College, Near Park Town Station, Park Town, Chennai, 600 003, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Esophageal candidiasis, previously believed to be limited to immunocompromised individuals, is now on the rise among those with healthy immune systems. This condition can be severely debilitating, and if not managed effectively, it can lead to persistent and enduring infections.The clinical spectrum,predisposing factors and microbiological profile of esophageal candidiasis has not been evaluated previously in our hospital.
Aim: To analyze the clinical and microbiological profile of patients with esophageal candidiasis.
Methods: The study conducted at Madras Medical College in Chennai during 2021-2022 is an observational study centered at a single institution. It involved a cohort of 100 patients diagnosed with candida esophagitis who met the specified inclusion criteria. The diagnosis of candida esophagitis (EC) in the study was established through the identification of characteristic candidal plaques during endoscopy. Biopsies were taken using standard biopsy forceps, and the diagnosis was confirmed through pathological examination, which revealed the presence of yeast forms typical for candida invading the esophageal mucosa.
Results: During the study period, around 16,000 upper endoscopies were performed in our endoscopy unit. The main findings of our study was that the prevalence of EC was less observed (0.62%, 100/16000).One fourth (26%) of our cases were presented with dysphagia followed by nausea (15%), dyspepsia (15%), asymptomatic (11%), regurgitation (9%), chest discomfort (8%), vomiting (6%), odynophagia (5%) and hiccups (5%). More than half (59%) of cases during endoscopy were grade 1 esophageal candidiasis followed by grade 2 EC (32%), grade 3 EC (8%) & oropharyngeal candidiasis observed in (1%). More than one third (39%) of cases candida lesions observed in distal esophagus followed by entire esophagus in (27%), mid esophagus in (24%) and upper esophagus in (10%). KOH mount positive in 56% cases and more than 2/3rd (67%) of EC were due to candida albicans species & one fifth (20%) showed resistance to fluconazole.
Conclusion: In conclusion, Candida esophagitis may be more common than previously suspected. Neither the presenting symptoms nor the endoscopy findings are always classic for this disease. Large-size prospective studies are needed to further identify the clinical & microbiological profile of esophageal candidiasis.
Keywords: Esophageal candidiasis, dysphagia, Fluconazole, antimicrobial, endoscopy
How to Cite
References
Shrijana Gurung, Tara Devi Sharma, A six-year hospital-based surveillance study on burden of esophageal candidiasis in Gangtok, Sikkim, Iran J Microbiol. 2022; 14(4):598–605.
Laine L, Bonacini M. Esophageal disease in human immunodeficiency virus infection. Arch Intern Med 1994;154:1577-82.
Thapa BR, Kumar L. Candida esophagitis after antibiotic use. Indian J Pediatr.1989;56:296-9.
Kochhar R, Talwar P, Singh S, Mehta SK. Invasive candidiasis following cimetidine therapy. Am J Gastroenterol. 1988;83: 102-3.
Karmeli Y, Stalnikowitz R, Eliakim R, Rahav G. Conventional dose of omeprazole alters gastric flora. Dig Dis Sci. 1995;40:2070-3.
Çiğdem Arabacı, Serkan Aydemir, Epidemiology, antifungal susceptibility, and risk factors of invasive candidiasis in a tertiary hospital during a four-year period, Jundishapur Journal of Microbiology. 2022;15(11);e132098.
Hoshika K, Iida M, Mine H. Esophageal Candida infection and adherence mechanisms in the nonimmunocompromised rabbit. J Gastroenterol. 1996;31:307-13.
Vermeersch B, Rysselaere M, Dekeyser K, Rasquin K, De Vos M, Elewaut A, et al. Fungal colonization of the esophagus. Am J Gastroenterol 1989;84:1079-83.
Phaosawasdi K, Rice P, Lee B. Primary and secondary Candida esophagitis. IMJ Ill Med J1986;169:361-5.
Baehr PH, McDonald GB. Esophageal infections: risk factors, presentation, diagnosis, and treatment. Gastroenterology. 1994;106:509-32.
Simon MR, Houser WL, Smith KA, Long PM. Esophageal candidiasis as a complication of inhaled corticosteroids. Ann Allergy Asthma Immunol. 1997; 79:333-8.
Mathieson R, Dutta SK. Candida esophagitis. Dig Dis Sci. 1983;28:365-70.
Mohammad Zulfiqar Ali, Speciation of candida species isolated from patients with esophageal candidiasis and their antifungal susceptibility test to fluconazole”, IP International Journal of Medical Microbiology and Tropical Diseases. 2022;8(1):46–50.
Weerasuriya N, Snape J. Oesophageal candidiasis in elderly patients: risk factors, prevention and management. Drugs Aging 2008;25:119-30.
Underwood JA, Williams JW, Keate RF. Clinical findings and risk factors for Candida esophagitis in outpatients. Dis Esophagus. 2003;16:66-9.