Esophageal candidiasis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | [[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | ||
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | [[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | ||
[[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]] | [[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]] | ||
*Most commonly seen in [[HIV]] patients with CD4 count < 100 (AIDS-defining illness) or chronic inhaled glucocorticoid use | *Most commonly seen in [[Special:MyLanguage/HIV|HIV]] patients with CD4 count < 100 (AIDS-defining illness) or chronic inhaled glucocorticoid use | ||
==Clinical Features<ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>== | ==Clinical Features<ref name=candida>Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.</ref>== | ||
*Odynophagia | *Odynophagia | ||
*[[Dysphagia]] | *[[Special:MyLanguage/Dysphagia|Dysphagia]] | ||
*[[Chest pain|Retrosternal pain]] | *[[Special:MyLanguage/Chest pain|Retrosternal pain]] | ||
*[[Nausea/vomiting]] | *[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Esophagitis types}} | {{Esophagitis types}} | ||
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{{HIV associated conditions}} | {{HIV associated conditions}} | ||
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==Evaluation== | ==Evaluation== | ||
[[File:Oral Candidiasis.jpg|thumb|Esophageal candidiasis]] | [[File:Oral Candidiasis.jpg|thumb|Esophageal candidiasis]] | ||
*Thick, white, linear esophageal plaques on endoscopy | *Thick, white, linear esophageal plaques on endoscopy | ||
==Management== | ==Management== | ||
*[[Fluconazole]] 400mg PO loading dose, followed by 200mg PO Qdaily x 2 weeks | |||
*[[Itraconazole]] 200mg PO Qdaily for 2 weeks | *[[Special:MyLanguage/Fluconazole|Fluconazole]] 400mg PO loading dose, followed by 200mg PO Qdaily x 2 weeks | ||
*[[Special:MyLanguage/Itraconazole|Itraconazole]] 200mg PO Qdaily for 2 weeks | |||
**has more nausea side-effects and drug interactions compared to fluconazole | **has more nausea side-effects and drug interactions compared to fluconazole | ||
==Disposition== | ==Disposition== | ||
*Depends on ability to tolerate oral solids and liquids. Most patients will be dispositioned home with outpatient followup. | *Depends on ability to tolerate oral solids and liquids. Most patients will be dispositioned home with outpatient followup. | ||
==See Also== | ==See Also== | ||
*[[AIDS]] | |||
*[[Special:MyLanguage/AIDS|AIDS]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] [[Category:GI]] | [[Category:ID]] [[Category:GI]] | ||
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Latest revision as of 22:52, 4 January 2026
Background
- Most commonly seen in HIV patients with CD4 count < 100 (AIDS-defining illness) or chronic inhaled glucocorticoid use
Clinical Features[1]
- Odynophagia
- Dysphagia
- Retrosternal pain
- Nausea/vomiting
Differential Diagnosis
Esophagitis Types
- Inflammatory
- GERD
- Allergic (eosinophilic)
- Infectious Mainly seen in patients w/ immunosuppression (HIV/AIDS, cancer, steroids)
- Esophageal candidiasis: often an AIDS defining lesion
- HSV
- CMV esophagitis
- aphthous ulceration
- Medication-induced (i.e. "pill") esophagitis, common culprits:
- Doxycycline
- Tetracycline
- Clindamycin
- NSAIDs
- ASA
- Bisphosphonates
- Ferrous sulfate
- Potassium chloride
- Ascorbic acid
HIV associated conditions
- HIV neurologic complications
- HIV pulmonary complications
- Ophthalmologic complications
- Other
- HAART medication side effects[2]
- HAART-induced lactic acidosis
- Neuropyschiatric effects
- Hepatic toxicity
- Renal toxicity
- Steven-Johnson's
- Cytopenias
- GI symptoms
- Endocrine abnormalities
Evaluation
- Thick, white, linear esophageal plaques on endoscopy
Management
- Fluconazole 400mg PO loading dose, followed by 200mg PO Qdaily x 2 weeks
- Itraconazole 200mg PO Qdaily for 2 weeks
- has more nausea side-effects and drug interactions compared to fluconazole
Disposition
- Depends on ability to tolerate oral solids and liquids. Most patients will be dispositioned home with outpatient followup.
See Also
External Links
References
- ↑ Kauffmann CA. Overview of Candida Infections. UptoDate. 2016.
- ↑ Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.