An Observational Study of Clinical and Microbiological Profile of Esophageal Candidiasis in a Tertiary Care Center, Madras City, India

Background: Esophageal candidiasis, previously believed to be limited to immunocompromised individuals, is now on the rise among those with healthy immune systems. This condition can be severely debilitating, and if not managed effectively, it can lead to persistent and enduring infections.The clinical spectrum,predisposing factors and microbiological profile of esophageal candidiasis has not been evaluated previously in our hospital.

Aim: To analyze the clinical and microbiological profile of patients with esophageal candidiasis.

Methods: The study conducted at Madras Medical College in Chennai during 2021-2022 is an observational study centered at a single institution. It involved a cohort of 100 patients diagnosed with candida esophagitis who met the specified inclusion criteria. The diagnosis of candida esophagitis (EC) in the study was established through the identification of characteristic candidal plaques during endoscopy. Biopsies were taken using standard biopsy forceps, and the diagnosis was confirmed through pathological examination, which revealed the presence of yeast forms typical for candida invading the esophageal mucosa.

Results: During the study period, around 16,000 upper endoscopies were performed in our endoscopy unit. The main findings of our study was that the prevalence of EC was less observed (0.62%, 100/16000).One fourth (26%) of our cases were presented with dysphagia followed by nausea (15%), dyspepsia (15%), asymptomatic (11%), regurgitation (9%), chest discomfort (8%), vomiting (6%), odynophagia (5%) and hiccups (5%). More than half (59%) of cases during endoscopy were grade 1 esophageal candidiasis followed by grade 2 EC (32%), grade 3 EC (8%) & oropharyngeal candidiasis observed in (1%). More than one third (39%) of cases candida lesions observed in distal esophagus followed by entire esophagus in (27%), mid esophagus in (24%) and upper esophagus in (10%). KOH mount positive in 56% cases and more than 2/3rd (67%) of EC were due to candida albicans species & one fifth (20%) showed resistance to fluconazole.

Conclusion: In conclusion, Candida esophagitis may be more common than previously suspected. Neither the presenting symptoms nor the endoscopy findings are always classic for this disease. Large-size prospective studies are needed to further identify the clinical & microbiological profile of esophageal candidiasis.