Candida Esophagitis : Introduction
Fungal esophagitis occurs both in immunocompromised as well as immunocompetent hosts. Candida spp. are the most common cause of fungal infections. The most commonly implicated species are C. albicans followed by C. glabrata and C. parapsilosis. Others include C. tropicalis, C. dublenis, and Candida guilliermondii. Candida is a normal inhabitant of skin, oral cavity, gastrointestinal tract, and genitourinary tract in many individuals.
Immunocompromised situations include: HIV infection, patients on chemotherapy (for hematolymphoid malignancies) or immunosuppressive therapy (following organ transplantation). In immunosuppressed individuals, candida infection can occur by itself or concurrent with herpes, CMV, or bacterial esophagitis. Other medical conditions that impair immune responses predisposing to fungal esophagitis include: diabetes mellitus, adrenal insufficiency, alcoholism, and old age.
In immunocompetent individuals, there is usually an underlying esophageal disease that prolongs stasis of luminal contents, predisposing them to candida infection. Examples include achalasia and scleroderma. In achalasia, the individuals with long-standing disease and marked esophageal dilation are most at risk.
In some immunocompetent individuals, the predisposing factor is a localized area of compromised immune response, usually caused by topical steroids. For example, the use of inhaled glucocorticoids for the treatment of asthma may lead to oropharyngeal or esophageal candidiasis in otherwise healthy individuals. Similarly, the treatment of eosinophilic esophagitis by swallowed fluticasone may be complicated by superimposed candida infection. In rare cases of candida esophagitis, there is no obvious underlying predisposing factor.
At endoscopy, the esophagus shows white pseudomembranous exudate or plaques distributed along its length. When plaques are exuberant, they can block the esophageal lumen. Ulcers are uncommon.
Image courtesy of: @PatholWalker