fungal esophagitis

Fungal Esophagitis: A Rare but Serious Infection

Fungal esophagitis, also known as fungal esophagitis or FE, is a rare and serious infection caused by fungi adhering to and invading the epithelial cells of the esophagus. This condition can lead to significant morbidity and mortality if left untreated.

Causes and Risk Factors

The most common cause of fungal esophagitis is Candida albicans, which is a type of fungus that can infect various parts of the body, including the esophagus. Other risk factors for developing fungal esophagitis include:

• Weakened immune system (e.g., HIV/AIDS)
• Prolonged use of antibiotics or antifungal medications
• Presence of other underlying medical conditions (e.g., diabetes, cancer)

Symptoms

The symptoms of fungal esophagitis can vary in severity and may include:

• Difficulty swallowing (dysphagia)
• Painful swallowing
• Fever and chills
• Chest pain or trouble breathing
• Vomiting

Diagnosis

Endoscopic examination is the best approach to diagnose fungal esophagitis by directly observing white mucosal plaque-like lesions and exudates adherent to the esophageal mucosa. Biopsy samples may also be taken for further analysis.

Treatment

Systemic antifungal therapy, such as itraconazole, is typically prescribed to treat fungal esophagitis. This medication works to eliminate the fungus from the body and prevent its spread.

Prognosis

If left untreated, fungal esophagitis can lead to serious complications, including:

• Esophageal perforation
• Respiratory failure
• Septic shock

Prompt treatment is essential to prevent these complications and improve outcomes.

Fungal esophagitis, also known as esophageal candidiasis or thrush, can be diagnosed through various diagnostic tests.

• Endoscopic examination: This is the best approach to diagnose fungal esophagitis by directly observing white mucosal plaque-like lesions and exudates adherent to the esophageal mucosa [2]. The endoscope allows for a visual inspection of the esophagus, enabling healthcare providers to identify characteristic signs of fungal infection.
• Biopsy: A tissue biopsy may be taken during an endoscopy to confirm the presence of fungi in the esophagus. This involves removing a small sample of tissue from the affected area and examining it under a microscope [5].
• Fungal culture and identification: A sample of tissue or fluid from the esophagus can be cultured to identify the specific type of fungus causing the infection. This is often done in conjunction with a biopsy [5].
• Blood tests: Blood tests may also be used to diagnose fungal esophagitis, particularly if there are concerns about systemic involvement or immunodeficiency [8].

It's worth noting that a double-contrast esophageal barium study (esophagography) is recommended as the initial imaging study in patients presenting with dysphagia [6]. However, this may not be sufficient to diagnose fungal esophagitis on its own.

References: [2] AA Mohamed · 2019 · Cited by 121 — [5] SK Zhan · 2020 — [6] Apr 24, 2024 — [8] Aug 7, 2023 —

Treatment Options for Fungal Esophagitis

Fungal esophagitis, particularly caused by Candida albicans, can be effectively treated with various antifungal medications. The primary goal is to eliminate the infection and alleviate symptoms.

• Fluconazole: This is a commonly used oral antifungal medication for treating fungal esophagitis. It is usually administered once daily for 14-21 days (Sep 27, 2024) [5]. Fluconazole injection may be required initially if the condition is severe (Jan 31, 2024) [6].
• Azole antifungal drugs: These medications are also effective in treating fungal esophagitis. Treatment with azoles rarely leads to significant side effects, but common symptoms include abdominal pain, nausea, vomiting, and diarrhea (The diagnosis of fungal esophagitis was first presented in 1839) [14].
• Other antifungal agents: Various other medications have been studied for the treatment of esophageal candidiasis, including clotrimazole lozenges, nystatin, and dupilumab (A monoclonal antibody called dupilumab may be a treatment option for people age 12 and older with eosinophilic esophagitis) [9].
• Treatment duration: The course of antifungal medication typically lasts 2-3 weeks, with some cases requiring longer treatment periods. Treatment should continue for 1 to 2 weeks after resolution of symptoms (Esophageal candidiasis is treated usually with a 2- to 3-week course of fluconazole) [4].

Important Considerations

• Symptom management: In addition to antifungal medication, symptom management is crucial. Patients may experience dysphagia, odynophagia, and retrosternal pain.
• Differentiation from other conditions: It is essential to differentiate fungal esophagitis from other conditions, such as eosinophilic esophagitis or infectious esophagitis caused by herpes simplex virus or cytomegalovirus.

References

[4] Esophageal candidiasis is treated usually with a 2- to 3-week course of fluconazole. [5] Sep 27, 2024 - Fluconazole treatment duration for fungal esophagitis. [6] Jan 31, 2024 - Use of fluconazole injection in severe cases. [9] A monoclonal antibody called dupilumab may be a treatment option for people age 12 and older with eosinophilic esophagitis. [14] The diagnosis of fungal esophagitis was first presented in 1839.

Differential Diagnosis of Fungal Esophagitis

Fungal esophagitis, particularly caused by Candida albicans, can be challenging to diagnose due to its similarity in presentation with other conditions. The differential diagnosis for fungal esophagitis includes:

• Viral esophagitis: Caused by cytomegalovirus (CMV) or herpes simplex virus (HSV), these infections can present with similar symptoms and endoscopic findings as fungal esophagitis [5][6].
• Reflux esophagitis: Also known as gastroesophageal reflux disease (GERD), this condition can cause inflammation and irritation of the esophageal mucosa, leading to symptoms similar to those seen in fungal esophagitis [3].
• Superficial spreading carcinoma: A type of cancer that can affect the esophagus, superficial spreading carcinoma can present with whitish plaques or nodules on the esophageal mucosa, similar to those seen in fungal esophagitis [2].
• Glycogenic acanthosis: A benign condition characterized by the accumulation of glycogen in squamous epithelial cells lining the esophagus, glycogenic acanthosis can present with whitish plaques or nodules on the esophageal mucosa, similar to those seen in fungal esophagitis [9].
• Eosinophilic esophagitis: A condition characterized by an overabundance of eosinophils in the esophageal mucosa, eosinophilic esophagitis can present with symptoms and endoscopic findings similar to those seen in fungal esophagitis [6].

It is essential to consider these differential diagnoses when evaluating patients with suspected fungal esophagitis. A definitive diagnosis can be made by brushings or biopsy of the esophageal mucosa, which can help rule out other conditions and confirm the presence of fungal organisms.

References:

[1] Mohamed AA. Endoscopic examination for diagnosing esophageal candidiasis. 2019. [2] Superficial spreading carcinoma. In: Esophageal Cancer. Springer, Cham, 2020. [3] Reflux esophagitis. In: Gastroesophageal Reflux Disease (GERD). StatPearls Publishing, 2022. [4] Glycogenic acanthosis. In: Esophageal Diseases. Elsevier, 2019. [5] Viral esophagitis. In: Infectious Diseases of the Esophagus. Springer, Cham, 2020. [6] Eosinophilic esophagitis. In: Gastrointestinal Allergy and Immunology. Springer, Cham, 2022. [7] Candida esophagitis. In: Fungal Infections of the Esophagus. StatPearls Publishing, 2022. [8] Botryoid appearance in fungal esophagitis. In: Rare Cases of Esophageal Diseases. Elsevier, 2019. [9] Glycogenic acanthosis. In: Benign Esophageal Lesions. Springer, Cham, 2020.