What are the presenting signs and symptoms of Candida esophagitis and how is it diagnosed?
The most common manifestations of Candida esophagitis are fever, anorexia, odynophagia, and retrosternal pain. Occasionally, nausea and rarely UGI bleeding from ulceration may occur. Esophagoscopy reveals adherent whitish plaques with shallow ulcers surrounded by erythematous borders. Invasive esophageal candidiasis can occur in the absence of oral candidiasis and must be distinguished from esophagitis due to CMV, herpes simplex virus, and aphthous esophagitis, all of which may be seen in patients with HIV infection. Isolation of Candida species in culture from a specimen obtained from the mucosal surface or the base of an ulcer provides supportive information but is not diagnostic, as colonization of mucosal surfaces with Candida is common in immunosuppressed individuals, particularly those who are receiving antibacterial therapies such as TMP-SMX for prophylaxis of PCP. The diagnosis can be confirmed by a biopsy of the ulcer and demonstration of yeast forms in tissue. The finding of
