WordNet

an infection caused by fungi of the genus Monilia or Candida (especially Candida albicans) (同)moniliasis, monilia disease
relating to the esophagus

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/06/12 15:25:24」(JST)

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Esophageal candidiasis is an opportunistic infection of the esophagus by Candida albicans. The disease usually occurs in patients in immunocompromised states, including post-chemotherapy and in AIDS. However, it can also occur in patients with no predisposing risk factors, and is more likely to be asymptomatic in those patients.^[1] It is also known as candidal esophagitis or monilial esophagitis.

Clinical presentation

Patients with esophageal candidiasis present with odynophagia, or painful swallowing. Longstanding esophageal candidiasis can result in weight loss. There is often concomittant thrush.

Some patients present with esophageal candidiasis as a first presentation of systemic candidiasis.

Diagnosis

In most cases the diagnosis is established based on response to therapy. Patients in whom esophageal candidiasis is suspected should receive a brief course of antifungal therapy with fluconazole. If the infection resolves after treatment with fluconazole, then the diagnosis of esophageal candidiasis is made and no further investigation is needed. However, if the infection persists or if there are other factors involved which may warrant further investigation, then patient will undergo an esophagogastroduodenoscopy if it is safe to do so. Endoscopy often reveals classic diffuse raised plaques that characteristically can be removed from the mucosa by the endsocope. Brushing or biopsy of the plaques shows yeast and pseudohyphae by histology that are characteristic of Candida species.

A severe case of candidiasis
H&E stain of esophagus showing Candida hyphae within the lamina propria

Therapy

The current first-line treatment is fluconazole, 200 mg. on the first day, followed by daily dosing of 100 mg. for at least 21 days total. Treatment should continue for 14 days after relief of symptoms. [Note: this page previously listed first-line treatment using a single dose of fluconazole (750 mg), but that is actually treatment for oropharyngeal, not esophageal Candidiasis.^[2]] Other therapy options include:

nystatin
other oral triazoles, such as itraconazole
caspofungin, used in refractory or systemic cases
amphotericin, used in refractory or systemic cases

References

^ Mimidis, K; Papadopoulos, V; Margaritis, V; Thomopoulos, K; Gatopoulou, A; Nikolopoulou, V; Kartalis, G (February 2005). "Predisposing factors and clinical symptoms in HIV-negative patients with Candida oesophagitis: are they always present?". International journal of clinical practice 59 (2): 210–3. doi:10.1111/j.1742-1241.2004.00249.x. PMID 15854199.
^ Hamza OJ, Matee MI, Brüggemann RJ, et al. (2008). "Single-dose fluconazole versus standard 2-week therapy for oropharyngeal candidiasis in HIV-infected patients: A randomized, double-blind, double-dummy trial". Clin Infect Dis 47 (10): 1270–1276. doi:10.1086/592578. PMID 18840077.

UpToDate Contents

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1. 口腔咽頭および食道カンジダ症の治療 treatment of oropharyngeal and esophageal candidiasis
2. 口腔咽頭および食道カンジダ症の臨床症状 clinical manifestations of oropharyngeal and esophageal candidiasis
3. カンジダ感染症の概要 overview of candida infections
4. 小児におけるカンジダ感染症：概要 candida infections in children an overview
5. Pediatric HIV infection: Classification, clinical manifestations, and outcome

English Journal

Clinical Pharmacodynamic Index Identification for Micafungin in Esophageal Candidiasis: Dosing Strategy Optimization.

Andes DR, Reynolds DK, Van Wart SA, Lepak AJ, Kovanda LL, Bhavnani SM.Source1685 Highland Ave, Department of Medicine, University of Wisconsin, Madison, WI 53711.
Antimicrobial agents and chemotherapy.Antimicrob Agents Chemother.2013 Aug 19. [Epub ahead of print]
Echinocandins exhibit concentration dependent effects against Candida species and preclinical studies support large, infrequent dosing. The current study examines the pharmacokinetics/pharmacodynamics of two multicenter, randomized trials of micafungin dosing regimens that varied in both dose level
PMID 23959319

Opportunistic Infections With Anti-Tumor Necrosis Factor-α Therapy in Inflammatory Bowel Disease: Meta-Analysis of Randomized Controlled Trials.

Ford AC, Peyrin-Biroulet L.Source1] Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK [2] Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
The American journal of gastroenterology.Am J Gastroenterol.2013 Aug;108(8):1268-76. doi: 10.1038/ajg.2013.138. Epub 2013 May 7.
OBJECTIVES: Several anti-tumor necrosis factor-α (TNFα) antibodies have demonstrated efficacy in Crohn's disease (CD) and ulcerative colitis (UC). These drugs carry the theoretical risk of opportunistic infection, but no systematic review and meta-analysis has examined this issue specifically.METH
PMID 23649185

Relationship between clinical factors and severity of esophageal candidiasis according to Kodsi's classification.

Asayama N, Nagata N, Shimbo T, Nishimura S, Igari T, Akiyama J, Ohmagari N, Hamada Y, Nishijima T, Yazaki H, Teruya K, Oka S, Uemura N.SourceDepartment of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus / I.S.D.E.Dis Esophagus.2013 Jul 4. doi: 10.1111/dote.12102. [Epub ahead of print]
Severe Candida esophagitis (CE) may lead to development of strictures, hemorrhage, esophagotracheal fistula, and a consequent decrease in quality of life. Although the severity of CE has been classified based on macroscopic findings on endoscopy, the clinical significance remains unknown. The aim of
PMID 23826847

Japanese Journal

アルゴンプラズマ凝固療法が奏功した難治性食道カンジダ症の1例

留置辰治,松中秀之,西川泉,井畑裕三子,田伏弘行,森良幸,篠永卓郎,東克彦,岡政志,一瀬雅夫
日本消化器内視鏡学会雑誌 = Gastroenterological endoscopy 52(4), 1250-1256, 2010-04-20
症例は74歳，男性．平成10年に下部食道に厚い白苔を伴う食道カンジダ症を認め，数年にわたり種々の抗真菌剤を繰り返し投与されたが白苔は残存したままであった．平成18年2月に食物の通過障害がひどくなり，内視鏡検査で咽頭部より食道胃粘膜接合部に広がるカンジダ病変を認め，特に下部食道は以前と同様に厚い白苔に覆われていた．抗真菌剤の投与とアルゴンプラズマ凝固療法（APC）を併用することで白苔は消失した．各種 …
NAID 10026910002

Isolation of Candida Species is an Important Clue for Suspecting Gastrointestinal Tract Perforation as a Cause of Empyema

Ishiguro Takashi,Takayanagi Noboru,Ikeya Tomohiko,Yoshioka Hiroaki,Yanagisawa Tsutomu,Hoshi Eishin,Hoshi Toshiko,Sugita Yutaka,Kawabata Yoshinori
Internal Medicine 49(18), 1957-1964, 2010
… Primary diseases of these 5 patients were spontaneous esophageal rupture in 3 patients, esophageal rupture due to lung cancer invasion in 1 patient, and gastric ulcer perforation in 1 patient. … None of these 5 patients had esophageal candidiasis. …
NAID 130000336883

睡眠前の点鼻ステロイド剤長期投与が原因と思われた食道カンジダ症の1例

周東寛,野口久,西片光,滝沢健司,周東千鶴,永田眞,寺師義典,山口道也,滝沢敬夫,渡辺建介,登坂薫,岡野昌彦,小泉昭
アレルギー 56(7), 714-720, 2007-07-30
吸入ステロイドの副作用の一つとして,口腔・食道カンジダ症の報告がある.点鼻ステロイド長期投与により出現した「嚥下による口腔・食道通過時に不快感」の症状を呈した症例に口腔・食道カンジダ症を発見した.そして点鼻ステロイドを中止したことにより著明に改善した症例を経験したので報告する.症例は69歳女性.嚥下時上胸部に通過障害の違和感を主訴にて来院した.数年前より通年性アレルギー性鼻炎と診断され, 2年前よ …
NAID 110006367818

Related Pictures

★リンクテーブル★

リンク元	「食道カンジダ症」
関連記事	「esophageal」「candidiasis」

「食道カンジダ症」

Esophageal candidiasis
	Endoscopic image of esophageal candidiasis in a patient after chemotherapy. Brushings confirmed the presence of hyphae
Classification and external resources
ICD-9-CM	112.84
	[edit on Wikidata]

　　[★]

英: esophageal candidiasis
関: 食道炎

概念

正常人の約半数に口腔内や胃内にカンジダが存在するが、何らかの原因により食道粘膜を主座にカンジダが増殖した疾患。
全身の重症疾患や抗生剤、ステロイド剤、抗癌薬などの使用例、胃切除例など全身的免疫機構(特に細胞性免疫)低下時に発症頻度が増す。

原因

全身的要因

悪性腫瘍、膠原病、AIDS、糖尿病、腎不全、肝硬変、高用量ステロイドの長期投与、広域抗菌薬長期投与

局所的要因

食道炎
食物・異物の停留にともなう機械的な食道粘膜傷害
吸入ステロイド
プロトンポンプ阻害薬

症状

軽症例ではほとんどが無症状時

嚥下困難、嚥下時痛、胸骨後部、悪心、嘔吐、吐血

身体所見

口腔内：(AIDSの場合)鵞口瘡を伴う

検査

上部消化管内視鏡：数mm前後で光沢のない小隆起性の白色付着物(白苔)がびまん性、縦列状に存在。白苔は水洗しでも落ちにくい。重症例では白苔が増大癒合し、縦列融合や地図状白苔を形成する。
培養検査：サブロー培地(Sabouraud培地)で培養。検鏡ではHE染色、PAS染色、グラム染色にて菌体を同定する。

鑑別診断

glycogenic acanthosis、へルペスウイルス感染症、サイトメガロウイルス感染症

治療

以前はアムホテリシンBの投与が行われていたが、抗真菌薬のゼリー剤で治療できるようになってきている。

「esophageal」

　　[★]

adj.

食道性の、食道の

関: esophagus、oesophageal、oesophagus

「candidiasis」

　　[★]

(pl.)candidiase

カンジダ症

[1] Mimidis, K; Papadopoulos, V; Margaritis, V; Thomopoulos, K; Gatopoulou, A; Nikolopoulou, V; Kartalis, G (February 2005). "Predisposing factors and clinical symptoms in HIV-negative patients with Candida oesophagitis: are they always present?". International journal of clinical practice 59 (2): 210–3. doi:10.1111/j.1742-1241.2004.00249.x. PMID 15854199.

[2] Hamza OJ, Matee MI, Brüggemann RJ, et al. (2008). "Single-dose fluconazole versus standard 2-week therapy for oropharyngeal candidiasis in HIV-infected patients: A randomized, double-blind, double-dummy trial". Clin Infect Dis 47 (10): 1270–1276. doi:10.1086/592578. PMID 18840077.

匿名

検索

案内

案内

esophageal candidiasis