Esophageal candidiasis: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:Oral Candidiasis.jpg|thumb|Esophageal | [[File:Oral Candidiasis.jpg|thumb|Esophageal candidiasis]] | ||
*Thick, white, linear esophageal plaques on endoscopy | *Thick, white, linear esophageal plaques on endoscopy | ||
==Management== | ==Management== | ||
Revision as of 20:37, 16 November 2022
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.