One of the main clinical features of Candida esophagitis is the presence of odynophagia and dysphagia that may be quite severe. Passage of food and saliva may be significantly impaired, which can be accompanied with nausea, vomiting and substernal pain. Concomitant presence of oral candidiasis may not be observed as frequently as expected [10]. A prolonged course of disease is characterized by weight loss, weakness and poor general condition.

• Inflammation

  Allergies Corticosteroids: These oral medications can reduce allergy-related inflammation, resulting in less inflammation in the esophagus, allowing it to heal. [medicalnewstoday.com]

  In six of eight instances, the esophagram was nondiagnostic or markedly underestimated the extent of inflammation. Intravenous amphotericin B or miconazole resulted in the resolution of these infections for variable periods of time. [pediatrics.aappublications.org]

  Discuss symptoms with your physician early and start treatment promptly to prevent more severe inflammation. [emedicinehealth.com]

  They are formed by cells, released, and then bound to other cells that participate in inflammation. It is the binding to these other cells that stimulates the cells and promotes inflammation. [medicinenet.com]

• Fatigue

  Many who are ultimately diagnosed with the condition by complementary practitioners have spent years bogged down by illness and fatigue. [telegraph.co.uk]

  The symptoms include: muscle aches, sore/stiff joints, fatigue, problems with particular organs, recurrent urinary tract infections, serious illnesses ( Asthma, ADHD, Diabetes, MS, Arthritis, CFS, Fibromyalgia ). [diagnose-me.com]

  When Candida Albicans moves from the gastrointestinal tract to the bloodstream, you may start noticing symptoms like a white coating on the back of your throat, more frequent yeast infections, fatigue, irritability, weight gain, and eventually more serious [naturalsociety.com]

  FACTORS C andida can affect various organ systems and cause various symptoms such as: Digestive system Bloating, gas cramps Alternating diarrhea with constipation Multiple food allergies, or allergic to all foods (pan allergic) Nervous system Abnormal fatigue [naturesintentionsnaturopathy.com]

• Malaise

  Fever occurred approximately 1-2 weeks apart, and febrile periods were associated with chills and malaise. His fever would last for no longer than 1 day. The patient also complained of intermittent nocturnal cough. [journals.lww.com]

  Large solitary, shallow ulcers or multiple discrete lesions at the distal end of the esophagus are often present Human immuno-deficiency virus (HIV) Early lesions are small and aphthoid (thrush-like) and occur during a period of transient fever, chills, malaise [atsu.edu]

• Hoarseness

  Symptoms included hoarseness (8/12), dysphagia (6/12), and hemoptysis (1/12). There was poor correlation between oral lesions and esophageal or laryngeal involvement. [pediatrics.aappublications.org]

  Symptoms of esophagitis include: difficulty swallowing (dysphagia) pain when you swallow ( odynophagia ) sore throat hoarse voice heartburn acid reflux chest pain (worse with eating) nausea vomiting epigastric abdominal pain decrease in appetite cough [healthline.com]

• Dysphagia

  Patients with esophagitis will describe odynophagia, or pain with swallowing, however they may report esophageal dysphagia as well. [shmabstracts.com]

  Typical whitish macules were seen proximally (left), with more severe inflammation and ulceration distally (right). 73 year-old woman with dysphagia and odynophagia. [endoatlas.com]

  None of the upper GI symptoms predict candida esophagitis in HIV-infected patients, but dysphagia and odynophagia predict candida esophagitis in non-HIV-infected patients. [ncbi.nlm.nih.gov]

  Group Stratification Patients were stratified further as follows: asymptomatic, symptomatic without an underlying esophagogastric cause for odynophagia or dysphagia, and symptomatic with underlying esophagogastric abnormalities. [cghjournal.org]

• Odynophagia

  She also reported odynophagia, nausea immediately after eating, and reports that she has lost ten pounds. [shmabstracts.com]

  […] in size, usually < 1 cm Longitudinally oriented plaques 90% sensitivity in detecting Candida esophagitis PATHOLOGY • Most common cause of infectious esophagitis Only 50% of patients with Candida esophagitis are found to have thrush CLINICAL ISSUES • Odynophagia [radiologykey.com]

  Symptoms are odynophagia and chest pain. Diagnosis is by endoscopic visualization and culture. Treatment is with antifungal or antiviral drugs. Esophageal infection is rare in patients with normal host defenses. [merckmanuals.com]

  Patients may present with odynophagia, chest pain, or dysphagia. Radiologically, contrast studies will show ulcers, plaques, fistulas, and mucosal irregularity. [med-ed.virginia.edu]

• Diarrhea

  Carcinoid syndrome causes redness or a feeling of warmth in your face and neck (skin flushing), chronic diarrhea, and difficulty breathing, among other signs and symptoms. Carcinoid heart disease. [mayoclinic.org]

  효과 저자 : 고한라, 박창환, 명은, 정민우, 박선영, 홍영준, 안영근, 정명호, 김현수, 최성규, 류종선 발행기관 : 대한내과학회 간행물 : 대한내과학회 추계학술발표논문집 2012권 1호 발행 연도 : 2012 페이지 : pp. 42-42 (1 pages) 다운로드 (기관인증 필요) 키워드 보기 초록보기 7Is it necessary to do the endoscopy for all patients with hospital acquired diarrhea [kiss.kstudy.com]

  Diarrhea may be controlled with loperamide, codeine, tincture of opium, diphenoxylate, or cyproheptadine. Pellagra may be prevented by ensuring adequate protein in the diet and by taking niacin. [merckmanuals.com]

  The syndrome causes flushing of the face and upper chest, diarrhea, and trouble breathing. Surgery is the main treatment for carcinoid tumors. If they haven't spread to other parts of the body, surgery can cure the cancer. [medlineplus.gov]

  The tumor may produce hormone -like substances that spread to the body and cause symptoms of carcinoid syndrome, such as flushing of the face and chest, diarrhea, and trouble breathing. [rarediseases.info.nih.gov]

• Choking

  However, since she was introduced to textured foods at age 7 months, she had been gagging, coughing, and choking with them each time. [journals.lww.com]

  A 59-year-old Caucasian female with long-standing history of AD successfully treated with MMF presented to the dermatology clinic for follow-up appointment with 3 months' history of projectile vomiting, choking, and trouble swallowing. [ncbi.nlm.nih.gov]

  Symptoms • Feeding aversion/intolerance • Vomiting • Food refusal • Choking with meals • Failure to thrive • Dysphagia • Choking/gagging with coarse textures • Food impactions • Abdominal/chest pain • Vomiting/regurgitation • Dysphagia (predominant) • [aacijournal.biomedcentral.com]

  She had no history of vomiting, dysphagia, abdominal pain, regurgitation or choking. The stools were normal. Physical examination: Weight: 40 kg (97% percentile). Height: 142 cm (90% percentile). T: 36.9°C. HR: 84 bpm. RR: 20 rpm. Sat O2: 92%. [alliedacademies.org]

  Medical Care for Esophagitis If you are experiencing chest pain that lasts more than a few minutes, especially if accompanied with shortness of breath or sweating, or if reflux symptoms are accompanied with fever, shortness of breath, excessive coughing, choking [emedicinehealth.com]

• Gagging

  However, since she was introduced to textured foods at age 7 months, she had been gagging, coughing, and choking with them each time. [journals.lww.com]

  Predominant symptoms in school-aged children and adolescents include dysphagia (difficulty swallowing), food impactions, and choking/gagging with meals, particularly when comprised of foods with coarse textures. [aacijournal.biomedcentral.com]

• Chest Pain

  Patients typically present with acute odynophagia with severe substernal chest pain during swallowing. Dysphagia, chest pain, and upper gastrointestinal bleeding are less often observed. [med-ed.virginia.edu]

  He tried to relieve the impaction with self-induced vomiting without relief followed by multiple episodes of hematemesis associated with dysphagia, odynophagia and severe chest pain. [omicsonline.org]

  […] in your chest that lasts more than a few minutes Suspect you have food lodged in your esophagus Have a history of heart disease and experience chest pain Experience pain in your mouth or throat when you eat Have shortness of breath or chest pain that [mayoclinic.org]

  Symptoms of esophagitis include: difficulty swallowing (dysphagia) pain when you swallow ( odynophagia ) sore throat hoarse voice heartburn acid reflux chest pain (worse with eating) nausea vomiting epigastric abdominal pain decrease in appetite cough [healthline.com]

  Its most frequent symptoms are: diarrhea vomiting heartburn chest pain food sticking difficulty swallowing Many who suffer from eosinophili esophagitis also have seasonal allergies, rhinitis, asthma or eczema. [healthblurbs.com]

• Retrosternal Chest Pain

  The most common symptomatology consists in odynophagia, dysphagia and retrosternal chest pain, but epigastralgia, vomiting and gastrointestinal bleeding can also occur. [alliedacademies.org]

  Dysphagia and odynophagia are the two main complaints, while accompanying symptoms may include obstruction, nausea, vomiting and retrosternal chest pain. [symptoma.com]

  The most common symptoms associated with esophageal candidiasis are dysphagia, odynophagia, and retrosternal chest pain. Odynophagia is considered to be the hallmark of esophageal candidiasis. [ncbi.nlm.nih.gov]

• Hypotension

  Oregon grape has no associated adverse effects except if taken at very high doses (due to the berberine), which may cause lethargy, nosebleeds, skin and eye irritation, kidney irritation, dyspnea, hypotension, cardiac damage, nausea, vomiting, diarrhea [mysticmedicine.com]

  Rapid heartbeat (tachycardia) and decreased blood pressure (hypotension): Dilation of blood vessels can lead to a rapid heartbeat and a drop in blood pressure. [oncolink.org]

  […] nausea, vomiting, infusion-related reaction, fever and thrombophlebitis Micafungin iv. 150 mg Rash, hepatotoxicity, leukopenia, hemolysis, nausea, vomiting, thrombophlebitis, infusion-related reactions and fever Anidulafungin iv. 50 mg Rash, hypokalemia, hypotension [futuremedicine.com]

• Eye Pain

  Candida Endophthalmitis Candia species may infect the eye as well. This may occur after eye surgery or after injury of the eye or spread via blood stream in invasive candidiasis. [news-medical.net]

• Dermatitis

  To describe a case in which a patient developed Candida esophagitis (CE) after treatment of atopic dermatitis (AD) with mycophenolate mofetil (MMF) for 22 months. [ncbi.nlm.nih.gov]

  […] membranes and the most common Candidal infection Terminology Cutaneous candidal infections include: Oral candidasis Candidal intertrigo (affects body folds): acute (wet and red), subacute (red +/- maceration), or chronic (red and dry) Candidal diaper dermatitis [pathologyoutlines.com]

  Skin: Acne Anal itch Athlete's foot Dandruff Dermatitis Dermatitis Diaper rash Dry skin Eczema Excessive perspiration Facial rash Fungal infection of the nails Hives Impetigo Jock itch Lupus Psoriasis Tingling and numbness. [diagnose-me.com]

  Usually associated with pain while eating and while wearing dentures Skin and nail infections : erythematous patches and satellite lesions Intertriginous areas Digital web spaces (erosio interdigitalis blastomycetica) Paronychia and onychomycosis Diaper dermatitis [amboss.com]

  Garlic and onions Chocolate Mint-flavored foods Eosinophilic esophagitis Risk factors for eosinophilic esophagitis, or allergy-related esophagitis, may include: A history of certain allergic reactions, including allergic rhinitis, asthma and atopic dermatitis [mayoclinic.org]

• Flushing

  A drug called octreotide can relieve flushing symptoms. Other treatments for flushing include phenothiazines (such as prochlorperazine) and histamine-blocking drugs such as ranitidine. [merckmanuals.com]

  Carcinoid syndrome causes redness or a feeling of warmth in your face and neck (skin flushing), chronic diarrhea, and difficulty breathing, among other signs and symptoms. Carcinoid heart disease. [mayoclinic.org]

  We found Ketoconazole to be well tolerated except for one patient who developed nausea, vomiting, and facial flushing while on the drug, which seemed to have been precipitated by alcohol intake. No changes in liver function tests were noted. [ncbi.nlm.nih.gov]

  The syndrome causes flushing of the face and upper chest, diarrhea, and trouble breathing. Surgery is the main treatment for carcinoid tumors. If they haven't spread to other parts of the body, surgery can cure the cancer. [medlineplus.gov]

• Sweating

  Ampho B has many more side effects than the other drugs, such as fevers, chills, sweats, nausea, and kidney dysfunction. A new preparation of Ampho B is being tried which mixes the drug in a solution of lipids or fats, instead of sugar. [thebody.com]

  […] fatigue Anxiety, mood swings Drowsiness Memory loss Depression Insomnia and mental fogginess In extreme cases: hallucinations and violent behavior Symptoms of ADD, hyperactivity and learning disabilities in children Skin Hives Psoriasis Eczema Excessive sweating [naturesintentionsnaturopathy.com]

  […] associated with swallowing or soon after a meal Bad breath ( halitosis ) Excessive belching When to Seek Medical Care for Esophagitis If you are experiencing chest pain that lasts more than a few minutes, especially if accompanied with shortness of breath or sweating [emedicinehealth.com]

• Eczema

  Its most frequent symptoms are: diarrhea vomiting heartburn chest pain food sticking difficulty swallowing Many who suffer from eosinophili esophagitis also have seasonal allergies, rhinitis, asthma or eczema. [healthblurbs.com]

  […] system Abnormal fatigue Anxiety, mood swings Drowsiness Memory loss Depression Insomnia and mental fogginess In extreme cases: hallucinations and violent behavior Symptoms of ADD, hyperactivity and learning disabilities in children Skin Hives Psoriasis Eczema [naturesintentionsnaturopathy.com]

  Patients with EoE should be referred to an allergist for evaluation due to high association with food allergies, asthma, rhinitis and eczema. The allergist may perform food allern skin tests and IgE levels. [pedclerk.bsd.uchicago.edu]

  Since then, there have been over 65,000 studies on Candida and the list of diseases and conditions that it is associated with – allergies, asthma, arthritis, multiple sclerosis, psoriasis, eczema, rosacea, cancers, yeast infections, heart conditions, [candidaplan.com]

  Skin: Acne Anal itch Athlete's foot Dandruff Dermatitis Dermatitis Diaper rash Dry skin Eczema Excessive perspiration Facial rash Fungal infection of the nails Hives Impetigo Jock itch Lupus Psoriasis Tingling and numbness. [diagnose-me.com]

• Pruritus

  Generalised cutaneous candidiasis (rare): a widespread rash, worse in skin folds and extremities, with pruritus. Skin lesions in patients with invasive candidiasis - see 'Invasive candidal infections', below. [patient.info]

  […] tract candidiasis The types of genitourinary tract candidiasis are as follows: Vulvovaginal candidiasis (VVC) - Erythematous vagina and labia; a thick, curdlike discharge; and a normal cervix upon speculum examination [1] Candida balanitis - Penile pruritus [emedicine.medscape.com]

  Specific additional risk factors for recurrent vulvovaginal candidiasis have not been identified.(48) Female-to-male transmission remains questionable, although male sexual partners may experience a transient rash, erythema, pruritus, or burning sensation [hivinsite.ucsf.edu]

• Irritability

  Irritation of the inner lining of the esophagus may be the cause of esophagitis. Reflux of stomach acid into the esophagus is a common cause of esophageal irritation. [emedicinehealth.com]

  Local adverse effects include oropharyngeal candidiasis, dysphonia and coughing from upper airway irritation. Mouth washing, eat after drug administration, new formulations and devices that reduce oropharyngeal deposition may minimize such effects. [jacionline.org]

  One of the main causes of esophageal irritation is reflux of stomach acid. [medicinenet.com]

  Esophagitis is when the lining of your esophagus becomes irritated and inflamed. The esophagus is the tube that connects the back of your throat to your stomach. Food and liquid go down the tube when you swallow. [urmc.rochester.edu]

• Headache

  […] behavior Symptoms of ADD, hyperactivity and learning disabilities in children Skin Hives Psoriasis Eczema Excessive sweating Acne and nail infections Genitourinary tract PMS (depression, mood swings, bloating, fluid retention, cramps, craving for sweets, headaches [naturesintentionsnaturopathy.com]

  Soon, an individual might find that eating gluten causes digestive issues, fatigue, headaches, and many other symptoms of a gluten sensitivity. Avoiding gluten is usually a good idea if you suffer from Candida Related Complex. [thecandidadiet.com]

  See your doctor if signs or symptoms: Last more than a few days Don't improve or go away with over-the-counter antacids Are severe enough to make eating difficult Are accompanied by flu signs and symptoms, such as headache, fever and muscle aches Get [mayoclinic.org]

  "The immune system is triggered into action, causing inflammation, excess mucous production and many of the symptoms associated with candida, such as food intolerance, fatigue, hormonal irregularities, headaches and arthritis. [telegraph.co.uk]

• Confusion

  Some doctors use a questionnaire only because of lab test confusion. [diagnose-me.com]

  There may be stiffness of the neck (nuichal rigidioty), confusion and even coma. Candida arthritis and Candida infections of bones and joints Invasive candidiasis may affect bones, joints and muscles as well. [news-medical.net]

  It is this close similarity that confuses your immune system. When Candida albicans attaches to the walls of your intestine and begins to spread, your immune system responds. [thecandidadiet.com]

  Adverse reactions may occur if administered orally, resulting in confusion, inability to walk, disorientation, ataxia, and systemic contact dermatitis. [mysticmedicine.com]

  Oral candidiasis is not to be confused with oral hairy leukoplakia (OHL). In contrast to candidiasis, the whitish, hairy plaques of OHL, on the sides of the tongue, cannot be scraped off. [hivbook.com]

• Stroke

  Case study : This study describes a case of candida esophagitis with fever alone in the patient with stroke. After a stroke attack, a 53-year-old man was hospitalized for rehabilitation. [tandfonline.com]

  This study describes a case of candida esophagitis with fever alone in the patient with stroke. After a stroke attack, a 53-year-old man was hospitalized for rehabilitation. He had a fever unexpectedly, but the cause could not be found for 2 weeks. [ncbi.nlm.nih.gov]

  Ocansey BK...Denning DW 31083531 2019 9 Eosinophilic esophagitis: Pathophysiology, diagnosis, and management. 61 Vinit C...Dupont C 30827775 2019 10 Acute hemiparesis and status epilepticus following endoscopic esophageal balloon dilation: is it really a stroke [malacards.org]

The initial diagnosis of Candida esophagitis can be made by a thorough physical examination and patient history. Presence of Candida in the oropharynx, characteristic symptoms and discovery of risk factors that prone patients to this infection may narrow the differential diagnosis significantly. To make a definite diagnosis, laboratory and diagnostic studies can be performed. Blood workup should include a complete blood count (CBC), with an emphasis on leukocyte count. If there is credible suspicion toward HIV infection as a risk factor, CD4+ cell count should be performed as well. In fact, this condition is termed to be an AIDS-defining illness [10], which is why all individuals with Candida esophagitis should undergo HIV testing. Further laboratory studies depend on the accompanying symptoms and risk factors, which are used to determine the underlying disease, if there is any. Endoscopy is the method of choice for obtaining a direct view into the esophagus [11], and can confirm macroscopic identification of white plaques lining the esophagus. A microbial confirmation can be obtained through cultivation of observed material. Candida readily grows on standard antifungal media but results may take up to several days.

• Esophageal Motility Disorder

  […] mellitus, esophageal motility disorders, gastric surgery, HIV, rheumatic disease, elderly and debilitated patients ( Dis Esophagus 2003;16:66 ) Associated with CMV or HSV esophagitis in immunocompromised (see case reports below); also esophageal stricture [pathologyoutlines.com]

  Other possible predisposing risk factors were acid suppressive therapy (14 patients), prior gastric surgery (five), mucosal barrier injury (four), inhaled steroid use (four), oral steroid use (three), esophageal motility disorders (three), rheumatologic [onlinelibrary.wiley.com]

  Thus, at-risk patients include those with AIDS, organ transplants, alcoholism, diabetes, undernutrition, cancer, and esophageal motility disorders. Candida infection may occur in any of these patients. [merckmanuals.com]

Once the diagnosis of Candida esophagitis is made, antifungal treatment is used. Various antifungal regimens exist [4] [12]. First-line therapy includes administration of fluconazole, belonging to the group of azole agents, for 200-400 mg either PO or IV q24h. Echinocandins, such as caspofungin in doses of 50 mg IV q24h, micafungin 150 mg IV q24h or anidulafungin 200 mg IV q24h as a loading dose followed by 100 mg IV q24h, are all effective alternative drugs and are used in the setting of Candida esophagitis not responding well to fluconazole. Additionally, itraconazole 200 mg PO q24h or posaconazole 400 mg q12h for three days, followed by 400 mg q24h can be highly effective as well. Although considered as a third-line drug, Amphotericin B is also used in managing Candida esophagitis and is given in doses of 0.5 mg/kg IV q24h. Regardless of the regimen, the duration of therapy ranges between 14-21 days [4] [12]. For patients with recurrent esophagitis, chronic administration of fluconazole in doses of 100-200 mg 3x per week as long as necessary is recommended [12].

In addition to managing esophagitis through appropriate antifungal therapy, management of the underlying condition will significantly reduce the chance of recurrence and development of other opportunistic infections.

The prognosis of Candida esophagitis is generally good, as the condition is usually self-limiting and responds well to antifungal treatment. Co-infection by cytomegalovirus (CMV) and herpes simplex virus (HSV) may occur, while in very rare cases, complications such as bleeding, ulceration, esophageal perforation and dissemination of the infection may take place [2]. The prognosis may significantly depend on the overall condition of the patient and the severity of the underlying disease which predisposed the individual to this infection, especially if not managed adequately.

Candida albicans is a unicellular fungal pathogen ranging from 4-6 µm in diameter and is responsible for various types of infections. Pathogenesis invariably includes immunosuppression, together with various virulence factors exhibited by this fungal pathogen. C. albicans is often mentioned to be a part of the normal oral flora, which makes immunosuppressed patients significantly vulnerable. For these reasons, esophagitis, but also other infections of internal organs caused by Candida are classified as endogenous. This yeast readily grows on standard media and is characterized by formation of white colonies made of hyphae and pseudohyphae [3]. One of the main distinguishing features of C. albicans is the ability to form germ tubes, which are small cellular projections that progress into hyphae.

C. albicans is found in all environments and is isolated from soil, animals and humans, as it often comprises normal flora of various parts of the human host, including the gastrointestinal tract [3]. When it comes to risk factors, immunosuppression of various origin is usually the single most important predisposing condition. HIV and AIDS [5], malignant diseases, particularly those of hematopoietic origin, intravenous use of corticosteroid therapy and organ transplant recipients are shown to be at a significantly increased risk [6]. However, the introduction of various drugs that alter normal gastrointestinal flora and pH has led to the fact that their use may also predispose individuals to this infection. Antibiotics, such as tetracyclines, sulfonamides and aminoglycosides significantly impair normal function of neutrophils, thus promoting growth of Candida species. Proton pump inhibitors [7], and histamine-receptor antagonists, such as cimetidine, have also proven to be involved in reducing the capability of immune defenses, presumably by interfering with pH levels. Various studies have indicated that immunocompetent individuals may develop Candida esophagitis, without an identifiable risk factor [8], which implies that some other processes may play a role in the pathogenesis of this infection, in addition to immunosuppression and iatrogenic factors.

Under physiological conditions, the immune system of the human host is able to fight off numerous pathogens. Neutrophils, monocytes and eosinophils induce lytic damage to hyphae and disrupt fungal structure, aided by respective functions of dendritic cells and lymphocytes. In general, the role of the innate immune system is considered to be more important than adaptive immune mechanisms when it comes to C. albicans [3]. In order for Candida to establish an infection, some form of immune deficiency is considered a prerequisite. In the case of HIV, downregulation of CD4+ T-helper cells occurs, which are one of the most important mediators of immune response, and infection by Candida species is rather frequently seen in these individuals, especially if HIV is not treated [9]. In addition to various leukocytic lineages, numerous cytokines and other cell types, including platelets, endothelial cells and fibroblasts have shown to be a part of the immune response against Candida [3].

The overall burden of Candida esophagitis and other types of infection caused by this fungal pathogen can be significantly reduced through appropriate preventive strategies that include:

• Proper management of underlying diseases
• Avoiding the use of drugs that are known to interfere with immune mechanisms that promote fungal growth as much as possible
• Adequate treatment that reduces the rates of recurrence

Candida albicans is a ubiquitous opportunistic fungal organism that can cause infections in virtually any part of the body, including the esophagus. Candida esophagitis is an infection characterized by development of numerous Candida plaques on the esophageal mucosa. Through various virulence factors, such as the ability to change its morphology (known as phenotype switching), but also increased susceptibility of the host, C. albicans is able to establish an infection in various tissues. Several patients populations are established to be of increased risk for this infection - those receiving corticosteroids, patients with acquired immunodeficiency syndrome (AIDS), usually as a result of human immunodeficiency virus (HIV) infection, cancer patients and organ transplant recipients [1]. The use of proton pump inhibitors, histamine-receptor antagonists and certain antibiotics have also been linked to increased rates of Candida esophagitis [2]. Although Candida is usually seen in immunocompromised individuals, cases of this infection in immunocompetent patients has become more frequent in recent years, presumably because of increased use of drugs that alter normal gastrointestinal flora and impair immune functions. It is assumed that the pathogenesis of Candida esophagitis requires an initial infection of the oral cavity and subsequent dissemination into the esophagus. However, many patients have esophageal involvement without obvious signs of oral cavity infection and the presumptive diagnosis remains on the presence of other symptoms [3]. Dysphagia and odynophagia are the two main complaints, while accompanying symptoms may include obstruction, nausea, vomiting and retrosternal chest pain. To confirm Candida esophagitis, endoscopy is the recommended diagnostic procedure, which can clearly show white plaques on the esophageal mucosa. Subsequent microbiological confirmation through culturing can be performed. Administration of either oral or systemic antifungals is recommended. Azoles such as fluconazole or itraconazole, echinocandins (caspofungin, micafungin or anidulafungin are all indicated) and amphotericin B can be used. More importantly, treatment must focus on management of the underlying disease as well, which is usually HIV, in which case antiretroviral therapy should be initiated or corrected appropriately [4]. This condition has a good prognosis if treated appropriately, but concomitant infections with cytomegalovirus and herpes simplex virus, as well as severity of the underlying disease, may significantly impact patient outcomes.

Candida esophagitis is one of the forms of infection caused by the fungus known as Candida albicans. It is characterized by proliferation of this microorganism throughout the esophagus, which develops due to an underlying immunodeficiency in the vast majority of cases. Candida albicans is a ubiquitously found and is considered as a part of normal skin and gastrointestinal flora of the human host. Under physiological conditions, the immune system successfully fights this microorganism through several mechanisms, but when certain diseases lower the capacity of the immune system, such as human immunodeficiency virus (HIV), cancer, or use of potent immunosuppressive therapy like corticosteroids, Candida is able to proliferate and establish an infection. Other risk factors include the use of certain antibiotics, such as tetracyclines and sulfonamides, which directly inhibit the function of certain cells of the immune system. Additionally, the use of proton pump inhibitors such as omeprazole and histamine-receptor antagonists such as cimetidine have shown to alter normal gastric flora and pH, thus creating favorable conditions for Candida infection. Recent studies have shown that this type of infection may occur in apparently healthy individuals without obvious risk factors, which implies that other mechanisms may be involved. Because Candida is located in the gastrointestinal tract and is not acquired from the external environment, Candida esophagitis is usually classified as an endogenous infection. Usually, patients complain of bad breath and swallowing difficulties that may range from mild to severe enough to reduce normal passage of food and saliva. Some individuals report nausea, vomiting and pain in the chest, while weight loss and weakness are seen in infections that have a prolonged course. The initial diagnosis of Candida esophagitis can be made during the physical examination, which may reveal Candida in the oral cavity as well (known as oral thrush), but this may not always be the case. Laboratory studies should be performed, consisting of a complete blood count and mandatory testing for HIV infection, as Candida esophagitis is often seen in patients with this condition. To make a definite diagnosis, endoscopy is performed, which includes insertion of an endoscope into the esophagus to confirm the presence of white plaques on the esophageal mucosa. A sample may be obtained during this procedure for cultivation and subsequent microbial identification, but treatment is initiated as soon as macroscopic identification is achieved. Various antifungal drugs that pose different mechanisms are recommended. Fluconazole, itraconazole caspofungin, micafungin and amphotericin B are recommended against in managing this infection. Treatment usually lasts for 2-3 weeks and is given either orally or intravenously, depending on the general conditions of the patient. Overall, the prognosis for this infection is generally good and it resolves fully if adequately treated, but the underlying predisposing condition should be determined.

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