ESOPHAGEAL CANDIDIASIS IN HIV-NEGATIVE PATIENTS

Candida esophagitis is the most frequent esophageal infection in HIV s eropositive as well as in seronegative patients. Aim: this retrospecti ve study was designed to determine the characteristics of this disease in HIV negative patients in a general hospital. Design: clinical reco rds of all HIV negative patients with Candida esophagitis, which was e ndoscopically diagnosed and microscopically confirmed (biopsy and/or c ytology of esophageal mucosa), were studied. Results: thirty-one patie nts (23 men, 8 women, mean age: 65.4 +/- 14.3 years, median 71) fulfil led the criteria (0.56% of the diagnostic esophagogastroduodenal endos copies). The most common clinical symptoms were dysphagia with or with out odynophagia and pain (retrosternal, epigastric or xiphoid). Fourte en patients (45%) had no esophageal signs; in nine of them (29%) the d isease was diagnosed in the course of an endoscopic exam to investigat e the sources of acute or chronic anaemia. The most frequent predispos ing factors were diabetes mellitus, oral or aerosolized corticotherapy , malignancies, treatment with broad-spectrum antibiotics and liver ci rrhosis. Nine patients (29%) presented no known predisposing factors, The most common endoscopic appearance was grade II (51%). Sixty-one pe r cent of the patients exhibited at least one other esophagogastroduod enal endoscopic lesion associated with the mycosis. Three patients die d of their underlying diseases within one week of the diagnosis of the candidiasis. Only one patient presented persistence of candidiasis on e week after initiating treatment with oral nystatine. Conclusions: es ophageal candidiasis is infrequent and does not always present with su spicious symptoms or known predisposing factors. Aerosolized corticoth erapy may be a risk factor for the development of esophageal candidias is.