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.