In immunocompromised hosts, or those with malignancy, diabetes, hypoparathyroidism, hemoglobinopathy, systemic lupus erythematosus, corrosive esophageal injury, candidal esophageal infection may present with odynophagia, dysphagia, and oral thrush (50%). Diagnosis is made on endoscopy by identifying yellow-white plaques or nodules on friable red mucosa. Characteristic hyphae are seen on KOH stain. In pts with AIDS, the development of symptoms may prompt an empirical therapeutic trial.
Treatment: Candida Esophagitis In immunocompromised hosts, fluconazole, 200 mg PO on day 1 followed by 100 mg daily for 2-3 weeks, is treatment of choice; alternatives include itraconazole, 200 mg PO bid, or ketoconazole, 200-400 mg PO daily; long-term maintenance therapy is often required. Poorly responsive pts or those who cannot swallow may respond to caspofungin 50 mg IV qd for 7-21 days. |
Section 3. Common Patient Presentations