Archive for January, 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.



January 31, 2009 at 2:24 am Leave a comment

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:, 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.


January 31, 2009 at 2:23 am Leave a comment

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.

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January 31, 2009 at 1:51 am Leave a comment

Vancomycin Ototoxicity: a Reevaluation in an Era of Increasing Doses

Antimicrobial Agents and Chemotherapy 1 Feb 2009 V.53 N.2 p.483-486

Avisheh Forouzesh,1 Pamela A. Moise,2 and George Sakoulas1,3*

Division of Infectious Diseases, New York Medical College, Valhalla, New York,1 University of the Pacific School of Pharmacy, Stockton,2 Department of Medicine, Sharp Memorial Hospital, San Diego, California3

Nephrotoxicity and ototoxicity have historically been documented as relatively rare complications of vancomycin monotherapy. Recent reports have linked aggressive vancomycin dosing strategies to significant risks of nephrotoxicity. We evaluated the rate of high-frequency hearing loss detected by audiometry for patients on vancomycin therapy. For this purpose, we used retrospective case-control analysis of audiometry results for patients on vancomycin therapy for whom baseline and follow-up exams were available. Analysis of 89 patients for whom audiograms were performed after an average of 27 days of vancomycin therapy showed a 12% rate of high-frequency hearing loss, with a trend in univariate analysis toward a higher rate with advanced age. The mean of the highest vancomycin trough levels for both patients with worsening audiograms and those without worsening audiograms was 19 mg/liter. Regression tree modeling demonstrated that for patients <53 years old, the rate of high-frequency hearing loss detected by audiogram was 0%, while for patients >53 years old, the incidence was 19% (P = 0.008). We conclude that a significant rate of high-frequency hearing loss in older patients receiving vancomycin monotherapy was detected by audiometry. While these data urge caution against continued indiscriminate vancomycin dose escalation to treat infections caused by Staphylococcus aureus strains for which vancomycin MICs are 2 mg/liter, further prospective studies are needed to determine the clinical significance and reversibility of these effects.


January 29, 2009 at 4:35 pm Leave a comment

Reassessment of Recommended Imipenem Doses in Febrile Neutropenic Patients with Hematological Malignancies

Antimicrobial Agents and Chemotherapy 1 Feb 2009 V.53 N.2 p.785-787

F. Lamoth,1, T. Buclin,2, C. Csajka,2 A. Pascual,1 T. Calandra,1 and O. Marchetti1*

Infectious Diseases Service,1 Division of Clinical Pharmacology and Toxicology, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland2

Imipenem plasma concentrations were analyzed in 57 febrile neutropenic patients using the NONMEM program. The recommended 2-g/day regimen achieved coverage of the most common bacteria (MIC90 = 1 mg/liter) during the whole dosing interval in only 53% of patients. This goal was achieved in 90% of patients with 3 g/day.


January 29, 2009 at 4:33 pm Leave a comment

Changing Challenges of Bacterial Enteric Infection in the United States

The Journal of Infectious Diseases 15 February 2009 V.199 N.4 p.465-466


Timothy F. Jones

Tennessee Department of Health, Nashville



January 28, 2009 at 5:43 pm Leave a comment

Tri-County Comprehensive Assessment of Risk Factors for Sporadic Reportable Bacterial Enteric Infection in Children

The Journal of Infectious Diseases 15 February 2009 V.199 N.4 p.467–476

Donna M. Denno,1 William E. Keene,9 Carolyn M. Hutter,2 Jennifer K. Koepsell,4 Marianne Patnode,6

Denny Flodin-Hursh,6 Laurie K. Stewart,4 Jeffrey S. Duchin,3,4 Laurette Rasmussen,7 Robert Jones,5 and Phillip I. Tarr8

Departments of 1Pediatrics and Global Health and 2Epidemiology and Biostatistics and 3Division of Allergy and Infectious Diseases, University of Washington, 4Public Health—Seattle and King County, and 5Craic Computing, Seattle, 6Yakima Health District, Union Gap, 7Whatcom County Health Department, Bellingham, Washington; 8Departments of Pediatrics and Molecular Microbiology, Washington University, St. Louis, Missouri; 9State of Oregon Public Health Division, Portland

Background.The aim of this study was to determine risk factors for childhood sporadic reportable enteric infection (REI) caused by bacteria, specifically Campylobacter, Salmonella, Escherichia coli O157, or Shigella (REI-B).

Methods.Matched case-control study. Case patients aged <19 years who were reported to 3 Washington State county health departments and matched control subjects were interviewed from November 2003-November 2005. Matched odds ratios (ORs) were calculated by using conditional logistic regression. Population attributable risk percentages were calculated for exposures associated with infection.

Results.Two hundred ninety-six case patients were matched to 580 control subjects. Aquatic recreation was the most important factor associated with all REI-Bs studied (beach water exposure [OR for Salmonella infection, 28.3 {CI, 7.2–112.2}; OR for Shigella infection, 14.5 {CI 1.5–141.0} or any recreational water exposure [OR for Campylobacter infection, 2.7 {CI, 1.5–4.8}; OR for Escherichia coli O157 infection, 7.4 {CI, 2.1–26.1}]). Suboptimal kitchen hygiene after preparation of raw meat or chicken (OR, 7.1 [CI, 2.1–24.1]) and consumption of food from restaurants were additional risks for Campylobacter infection. Infection with Salmonella was associated with the use of private wells as sources of drinking water (OR, 6.5 [CI, 1.4–29.7]), and the use of residential septic systems was a risk for both Salmonella (OR, 3.2 [CI, 1.3–7.8]) and E. coli (OR, 5.7 [CI, 1.2–27.2]) O157 infection.

Conclusions.Overall, non-food exposures were as important as food-related exposures with regard to their contributions to the proportion of cases. Infection prevention efforts should address kitchen hygiene practices and non-food exposures, such as recreational water exposure, in addition to food-consumption risks.



January 28, 2009 at 5:42 pm Leave a comment

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