Özofagusun fungal enfeksiyonları; tek merkez deneyimi

Yıl 2019, Cilt: 27 Sayı: 1, 7 - 11, 15.04.2019

Enver Akbaş

https://doi.org/10.17940/endoskopi.570941

Cited By: 1

Öz

Giriş ve Amaç: Araştırmamızda hastanemizde çeşitli endikasyonlar
ile üst
gastrointestinal sistem endoskopisi yapılan hastalarda özofagus fungal enfeksiyonlarının
sıklığını, başvuru semptomlarının dağılımını, buna zemin hazırlayan durumları
değerlendirmeye çalıştık. Gereç ve Yöntem: 2015-2019 yılları arasında hastanemize başvuran ve üst gastrointestinal
sistem endoskopisi yapılan 2862 hastadan endoskopik olarak özofagusta fungal
enfeksiyon tespit edilen ve mikrobiyolojik olarak bu tanısı doğrulanan 33 hasta
değerlendirmeye alındı. Bulgular:
Toplam 2862 hastanın 33 (%1,2) tanesinde özofagusta fungal enfeksiyon
tespit edildi. Eşlik eden hastalık olarak en sık %71 ile reflü özofajit
zemininde fungal enfeksiyon gelişmişti. Hiçbir hastada insan bağışıklık
yetmezliği virüsü pozitifliği tespit edilemedi. Hastaların %27,3’ünde immünsupresyona
neden olan bir patoloji ya da ilaç kullanımı mevcut iken %72,7’sinde böyle bir
neden tespit edilemedi. Hastaların başvuru şikayeti olguların %21.2’sinde disfaji, %6.1’inde hıçkırık, %21.2’sinde reflü semptomları, %6.1’inde ses kısıklığı, %6.1’inde kilo kaybı, %15.2’sinde
bulantı-kusma iken %42.4 ile hastaların çoğunluğunda mide ağrısı gibi klasik
bir dispeptik yakınma şeklindeydi. Sonuç: Dünyada Kandida özofajitinin en sık nedeni insan bağışıklık
yetmezliği virüsü enfeksiyonu, maligniteler ve immünsüpresyon yaratan durumlardır.
Bizim hastalarımızda Kandida enfeksiyonuna daha çok reflü özofajit eşlik
etmekte iken sadece %15 hastada enfeksiyon immünsüpresyon yaratan bir durumda
gelişmişti. Bulgularımız insan bağışıklık yetmezliği virüsü negatif
hasta profilindeki dünya literatür verileri ile uyumu bulundu.

Anahtar Kelimeler

Özofagusun fungal enfeksiyonları, kandida özofajiti, kandidiyazis

Fungal infections of the esophagus: Single center experience

Öz

Background and Aims: Our study investigated the prevalence of esophageal
fungal infections, distribution of presenting symptoms, and predisposing
conditions in the patients undergoing upper gastrointestinal endoscopy for
various reasons at our hospital. Materials
and Methods: Overall, 2862 patients presented to our hospital and
underwent upper gastrointestinal endoscopy between 2015 and 2019. Thirty-three of these patients who were endoscopically determined and
microbiologically confirmed to have esophageal fungal infections were included.
Results: Esophageal fungal infection
was found in 33 (1.2%) of 2862 patients. Fungal infections developed most
frequently as a comorbid disease in the setting of reflux esophagitis, with a
rate of 71%. No
patient was found to have human immunodeficiency virus seropositivity. Even
though 27.3% of patients had pathological or drug-induced immune suppression,
no such findings were noted  in
72.7% of patients. The presenting complaint was dysphagia in 21.2% of patients,
hiccough in 6.1%, reflux symptoms in 21.2%, hoarseness in 6.1%, weight loss in
6.1%, and nausea or vomiting in 15.2%; however, in most patients,
the presenting complaint was a classical dyspeptic complaint, such as stomach ache
(42.4%). Conclusion: The most common causes of Candida esophagitis
worldwide are human immunodeficiency virus infection, malignancies,
and conditions that result in immune suppression. Even though Candida
esophagitis was more commonly associated with reflux esophagitis in our
patients, fungal infection was also observed in 15% of patients along with
diseases that rendered them immunocompromized. Our results were concordant with
the literature data regarding the clinical profile of patients who are human
immunodeficiency virus negative.

Anahtar Kelimeler

Fungal infections of the esophagus, Candida esophagitis, candidiasis

Kaynakça

• 1. Polis MA: Esophagitis. In: Mandell GL, Bennett JE, Dolin RD (Eds.). Principles and Practice of Infectious Diseases. New York, Churchill. Livingstone: 1995;962-5. 2. Sangeorzan JA, Bradley SF, He X, et al. Epidemiology of oral candidiasis in HIV-infected patients: colonization, infection, treatment, and emergence of fluconazole resistance. Am J Med 1994;97:339-46. 3. Barchiesi F, Morbiducci V, Ancarani F, Scalise G. Emergence of oropharyngeal candidiasis caused by non-albicans species of Candida in HIV-infected patients. Eur J Epidemiol 1993;9:455-6. 4. Bonacini M, Young T, Laine L. The causes of esophageal symptoms in human immunodeficiency virus infection. A prospective study of 110 patients. Arch Intern Med 1991;151:1567-72. 5. Darouiche RO. Oropharyngeal and esophageal candidiasis in immunocompromised patients: treatment issues. Clin Infect Dis 1998;26:259-72. 6. Chocarro Martinez A, Galindo Tobal F, Ruiz-Irastorza G, et al. Risk factors for esophageal candidiasis. Eur J Clin Microbiol Infect Dis 2000;19:96-100. 7. Weerasuriya N, Snape J. A study of candida esophagitis in elderly patients attending a district general hospital in the UK. Dis Esophagus 2006;19:189-92. 8. Yakoob J, Jafri W, Abid S, et al. Candida esophagitis: risk factors in non-HIV population in Pakistan. World J Gastroenterol 2003;9:2328-31. 9. Choi JH, Lee CG, Lim YJ, Kang HW, Lim CY, Choi JS. Prevalence and risk factors of esophageal candidiasis in healthy individuals: a single center experience in Korea. Yonsei Med J 2013;54:160-5. 10. Takahashi Y, Nagata N, Shimbo T, et al. Long-term trends in esophageal candidiasis prevalence and associated risk factors with or without HIV infection: lessons from an endoscopic study of 80,219 patients. PLoS One 2015;10:e0133589. 11. Alsomali MI, Arnold MA, Frankel WL, et al. Challenges to "Classic" esophageal candidiasis: Looks are usually deceiving. Am J Clin Pathol 2017;147:33-42. 12. Walsh TJ, Hamilton SR, Belitsos N. Esophageal candidiasis. Managing an increasingly prevalent infection. Postgrad Med 1988;84:193-6, 201-5. 13. Arendrup MC. Epidemiology of invasive candidiasis. Curr Opin Crit Care 2010;16:445-52. 14. Jarvis WR. Epidemiology of nosocomial fungal infections, with emphasis on Candida species. Clin Infect Dis 1995;20:1526-30. 15. Hoversten P, Otaki F, Katzka DA. Course of esophageal Candidiasis and outcomes of patients at a single center. Clin Gastroenterol Hepatol 2019;17:200-2. 16. Takahashi Y, Nagata N, Shimbo T, et al. Upper gastrointestinal symptoms predictive of Candida esophagitis and erosive esophagitis in HIV and non-HIV patients. Medicine (Baltimore) 2015;94:e2138.