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INFECTIOUS ESOPHAGITIS: Causes Symptoms Treatment

INFECTIOUS ESOPHAGITIS: The three most common causes of infectious esophagitis are candida, cytomegalovirus (CMV) and herpes simplex virus (HSV).

Aetiology of Infectious Esophagitis

„ Candida albicans: It is the most common form and usually associated with HIV.

„ Herpes simplex virus.

„ Cytomegalovirus.

„ Varicella-zoster virus.

„ Human immunodeficiency virus.

Usually, the patients are immunocompromised due to HIV AIDS, post-transplant treatment, or chemotherapy.

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Clinical Features of Infectious Esophagitis

„ Most common symptom: Odynophagia

„ Other: Heartburn, nausea, fever or bleeding.

Candida albicans

„ Predisposing factors: Advanced age, hypochlorhydria, motility disorders, diabetes mellitus, alcoholism, steroids, oral thrush and HIV.

„ Endoscopy with biopsy and brushing: Adherent white-pale yellow plaques are seen on endoscopy. Brushing of plaques will show hyphae and budding yeast.

Cytomegalovirus

Cytomegalovirus infects submucosal fibroblasts and endothelial cells and not squamous epithelium.

„ GI symptoms: Abdominal pain, nausea, and vomiting.

„ Endoscopy findings: Serpiginous erosions and ulcers that may coalesce and form deep and larger ulcers.

„ Biopsy: It should be taken from the base of ulcer. Biopsy shows intranuclear and cytoplasmic inclusions and a halo, which surrounds nucleus.

„ Viral culture: More sensitive than histology alone.

Herpes simplex

Herpes simplex virus infection can be either primary or secondary (reactivation of latent viral infection).

„ Esophagoscopy: Vesicles, which rupture and form ulcers with raised edges.

„ Biopsy: It is taken from ulcer margin and shows multinucleated giant cells and ground glass intranuclear inclusion bodies.

„ Viral culture: More sensitive.

Treatment of Infectious Esophagitis

„ Management of immunocompromised condition.

„ Antifungal

 Fluconazole: 100–200 mg/day for 10–14 days.

 Clotrimazole and nystatin: Topical 4–5 times a day.

 Amphotericin B: In cases of granulocytopenia to prevent disseminated disease.

„ Antiviral

 Acyclovir for HSV: Intravenous 5–10 mg/kg every 8 hours till patient tolerate oral therapy.

 Gancyclovir and foscarnet for CMV: Two-week full dose regimen followed by maintenance therapy for several weeks.

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