Archive for January 31st, 2009
Prevalence of esophageal candidiasis among patients treated with inhaled fluticasone propionate
The American Journal of Gastroenterology Mar 2004 V.98 N.10 p.2146-2148
Naoki Kanda, M.D. a , Hirotaka Yasuba, M.D., Ph.D. b , Teruko Takahashi, M.D. c , Yuka Mizuhara, M.D. c , Syuji Yamazaki, M.D. c , Yuko Imada, M.D. c , Yoshio Izumi, M.D. c , Yoshiki Kobayashi, M.D. b , Kenzo Yamashita, M.D. b , Hideo Kita, M.D., Ph.D. b , Takashi Tamada, M.D., Ph.D. c , Tsutomu Chiba, M.D., Ph.D. a *
a Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
b Department of Respiratory Medicine, Takatsuki Red Cross Hospital, Osaka, Japan
c Department of Internal Medicine, Takatsuki Red Cross Hospital, Osaka, Japan
Objectives Development of oropharyngeal candidiasis is a frequently reported adverse effect of inhaled corticosteroid use, but the prevalence of esophageal candidiasis is unknown. The aim of this study was to estimate the prevalence of esophageal candidiasis among patients treated with an inhaled corticosteroid, fluticasone propionate.
Methods Upper GI endoscopy was performed on 49 patients treated with inhaled fluticasone propionate to examine the prevalence of esophageal candidiasis. Of the patients, 36 had bronchial asthma and 13 had chronic obstructive pulmonary disease. To compare the prevalence with control patients, upper GI endoscopy was performed on 700 consecutive patients without malignancy or immunosuppression.
Results The prevalence of esophageal candidiasis was 37% among patients treated with inhaled fluticasone propionate, whereas only 0.3% of the control patients had the infection. The prevalence was especially high among patients with diabetes mellitus or those who were treated with a high dose of inhaled fluticasone propionate. Moreover, a reduction in the daily dose of inhaled fluticasone propionate eliminated the infection in four of five patients.
Conclusions Esophageal candidiasis is a common complication of inhaled corticosteroid use.
abstract
http://www3.interscience.wiley.com/journal/118862316/abstract?CRETRY=1&SRETRY=0
http://www3.interscience.wiley.com/cgi-bin/fulltext/118862316/PDFSTART
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Risk Factors for Esophageal Candidiasis
European Journal of Clinical Microbiology & Infectious Diseases Mar 2000 V.19 N.2 p.96-100
A. Chocarro Martínez1, F. Galindo Tobal1, G. Ruiz-Irastorza2, A. González López1, F. Alvarez Navia1, C. Ochoa Sangrador3 and M.I. Martín Arribas1
(1) Department of Internal Medicine, Hospital “Virgen de la Concha”, Avenida de Requejo 31-33, 49022 Zamora, Spain e-mail: achocarrom@medynet.com, ES
(2) Department of Internal Medicine, Hospital de Mendaro, Mendaro, Guipúzcoa, Spain, ES
(3) Unit of Research, Hospital “Virgen de la Concha”, Avenida de Requejo 31-33, 49022 Zamora, Spain, ES
Abstract The role of gastric acid inhibitors as predisposing factors for Candida esophagitis is unknown. A retrospective case-control study of esophageal candidiasis was conducted in human immunodeficiency virus (HIV)-negative patients diagnosed from January 1991 to December 1997. The diagnosis of esophageal candidiasis was always made on the basis of endoscopic and histological criteria. Fifty-one patients were diagnosed with esophageal candidiasis, 15 of whom had esophageal complaints and 48 of whom suffered from another previous chronic disease (17 had cancer). In addition, 20 patients had previously been treated with antibiotics, 13 with steroids and 14 with omeprazole. In the multivariate analysis, neoplasm (odds ratio, 5.50; 95% confidence interval, 1.94–15.56) and therapy with antibiotics (odds ratio, 11.97; 95% confidence interval, 3.82–37.45), steroids (odds ratio, 35.52; 95% confidence interval, 3.90–324.01) or omeprazole (odds ratio, 18.23; 95% confidence interval, 4.67–71.03) were all associated with esophageal candidiasis. These data suggest that Candida esophagitis tends to occur in patients with chronic diseases, most of whom have been previously treated with antibiotics, steroids or omeprazole. The findings support the hypothesis that treatment with omeprazole favors the development of esophageal candidiasis.
abstract
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Candidiasis esofágica en pacientes inmunocompetentes: Estudio clínico e inmunológico
Revista Médica de Chile Nov. 2004 V.132 p.1394-1389
Clinical and immunological study of 10 immunocompetent patients with esophageal candidiasis
Claudia Cortés M1, Danny Oksenberg R2, Alejandro Afani S3, Carlos Defilippi C2, Ana María Madrid S2.
1Sección Medicina Interna, Hospital Clínico Universidad de Chile, Chile.
2Centro de Gastroenterología, Hospital Clínico Universidad de Chile, Chile.
3Sección Inmunología, Hospital Clínico Universidad de Chile, Chile.
Background: Esophageal candidiasis is associated with conditions that cause an immune depression. It is a defining disease for AIDS, is observed in poorly controlled diabetics, in patients with renal or hepatic failure, in patients with cancer and in subjects using medications causing immunosuppression or broad spectrum antimicrobials.
Aim: To report the features of 10 immunocompetent patients with esophageal candidiasis.
Patients and methods: Six males and four females aged between 48 and 82 years, without conditions associated with immunosuppression, in whom an esophageal candidiasis was found on an upper gastrointestinal endoscopy. Delayed skin hypersensitivity to eight antigens, Iymphocyte subpopulations, yeast phagocytosis and neutrophil chemotaxis were measured.
Results: Six patients had a low CD4 Iymphocyte count and seven had a low CD8 count. Seven patients were anergic on skin hypersensitivity challenge. Yeast phagocytosis was abnormal in one patient and neutrophil chemotaxis was abnormal in two. Humoral immunity was normal in all subjects. All patients were treated with oral fluconazole in doses of 150 mg/day for 14 days, with complete resolution of candidiasis in all.
Conclusions: Patients with esophageal candidiasis, have frequent alterations of cellular immunity, that must be diagnosed and treated.
Full Text
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