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| Candida Esophagitis |
| Etiology •Most commonly Candida albicans but other endogenous commensal Candida species are occasionally found |
| Pathogenesis •Colonization of the oral cavity and esophagus is found in 20% of adults •This usually results from some disturbance in the factors that govern regulation of the normal GI flora •Surface proliferation in the absence of epithelial invasion is not considered infection •Fungal esophagitis occurs when epithelial invasion by fungi occurs accompanied by an inflammatory tissue reaction •For infection to occur there must be a further breakdown in host resistance commonly in the form of immunodeficiency or coexistent esophagitis due to another organism or peptic irritation, |
| Epidemiology •The true incidence is unknown because many patients are asymptomatic •The highest incidence of fungal esophagitis is in advanced AIDS where the prevelance approaches 50% •It is also found in other immunodeficient states such as leukemia and lymphoma particularly with chemotherapy, and with steroid therapy or hereditary immunodeficient states •Increased incidence is noted in diabetes mellitus, severe debilitation and in the elderly |
| General Gross Description •The gross findings reflect the extent and seriousness of the disease •In increasing order of severity the surface of the esophagus shows white plaques often multifocal, exudative membranes, erosions and ulcers of increasing depth •The surface may be reddened and hemorrhage can be seen as well as elevated balls of debris, fungus and granulation tissue |
| General Microscopic Description •The earliest finding is intraepithelial proliferation of organisms with pseudohyphae and budding yeast forms. •This combination is virtually pathognomonic for Candida •Acute inflammation is present and with increasing severity necrosis and ulceration occur •Transmural necrosis can be seen and is called invasive Candidiasis •By the time necrosis has occurred organisms are numerous and this helps to distinguish infection from colonization if sputum or brushing are examined •The organisms can be seen on H&E but the sensitivity of PAS or silver stained sections is higher |
| Clinical Correlation •Many patients with mild Candida esophagitis are asymptomatic •Symptoms include dysphagia, retrosternal pain, or complications such as hemorrhage or obstruction due to stricture •Treatment consists of antifungal drugs |
| References •Sleisenger MH, Fordtran JS. Gastrointestinal disease. 5th ed. Philadelphia: Saunders, 1993, pp. 427-432 |
| Candida Esophagitis |
| Synopsis by: Martin Nadel M.D. (T62000E40800)[376] |
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