Esophageal Candida Infection
Introduction
Introduction to Esophageal Candida Infection Fungal infections of the esophagus are most common with Candida, among which Candida albicans is most common, and other rare fungi are infected with Aspergillus, Histoplasma, Cryptococcus and Bud. basic knowledge The proportion of sickness: 0.7% Susceptible people: no special people Mode of infection: non-infectious Complications: pneumonia candidiasis
Cause
Causes of Esophageal Candida Infection
(1) Causes of the disease
Candida esophagitis is the most common esophageal fungal infection caused by the yeast-like fungus Candida albicans. White Candida is not a normal pathogen in the human body. In the normal population, it is the symbiotic bacteria in the mouth, pharynx and feces. Candida esophagitis can occur in the absence of underlying disease, but is more likely to occur in people with impaired immunity.
(two) pathogenesis
Candidiasis can be seen in the following three types of patients.
Chronic disease
Candida esophagitis is a complication of the following diseases: diabetes, hypothyroidism, adrenal insufficiency, chronic leukemia, cancer, lymphoma, aplastic anemia, lupus erythematosus, chronic ulcerative colitis and hemoglobin S disease, all of which All diseases can reduce the patient's resistance to infection and reduce the phagocytosis of white blood cells.
2. Patients requiring long-term treatment
Long-term use of antibiotics, cell growth inhibition or immunosuppressive therapy, these drugs cause the body to inhibit antibody synthesis and phagocytosis, the patient's resistance to infection can be reduced to the presence of herpes infection.
3. Secondary damage to local tissue
Infection can be accompanied by gastric retention, nasal tube insertion, corrosive esophagus or subsequent radiotherapy, also occurs in patients with achalasia.
Prevention
Prevention of esophageal candida infection
Mold esophagitis should be combined with prevention and treatment. In particular, prevention of infection caused by iatrogenic factors should be prevented, and indications for the use of antibiotics and hormones should be strictly controlled to reduce the occurrence of the disease.
Protecting the skin from cleansing and drying is an important measure to prevent mold-type esophagitis caused by exogenous infections. Remove all kinds of incentives and continuously improve the body's resistance, which is more meaningful for patients with chronic diseases.
Complication
Complications of esophageal candidiasis Complications pneumonia candidiasis
There are mainly esophageal mucosal ulcers, perforation, occasional fistula access to the aorta, aspiration pneumonia and esophageal stricture, etc., esophageal stricture can be single or segmental, can also involve the whole esophagus, esophageal candidiasis must be considered with the esophagus Benign stenosis is differentiated, especially in patients with esophageal stricture in the upper thoracic.
Symptom
Esophageal candidiasis symptoms common symptoms lower esophageal sphincter tension drop swallowing pain congestion vomiting pharyngeal foreign body candida infection sternal pain dysphagia gastrointestinal bleeding
Mild patients can be asymptomatic, severe clinical manifestations of swallowing pain, swallowing foreign body sensation, swallowing discomfort, some patients with dysphagia, the most common symptoms are painful dysphagia, substernal pain, vomiting and gastrointestinal bleeding May be associated with fungal stomatitis, there are many small white spots on the mucous membrane, tablets, fragile and easy to hemorrhage, endoscopic examination of white or creamy spots or fusion into a pseudomembrane, esophageal mucosa with obvious congestion, nodules and ulcers.
Examine
Examination of esophageal candida infection
Serological tests: 40% to 50% sensitivity is determined by radioimmunoassay and enzyme-linked immunosorbent assay for the determination of mannan antigen in serum, and no mannan antigen is found in non-invasive Candida infection.
X-ray inspection
Esophageal motor function is reduced, food retention, segmental stenosis, spastic ulcer, but when severely infected, X-ray findings can also show normal.
2. Endoscopy
It is the most sensitive and specific diagnostic method. The endoscopic features are characterized by adhesion of bean dregs-like white moss to the esophageal mucosa, congestive erythema after esophageal mucosa, increased fragility, erosion, shallow ulcers, etc., due to the degree of inflammation. Different, the extent and severity of the lesion are different. The lighter is only the esophagus scattered in the spotted white moss. The mucosa under the moss is slightly reddened. It is more common in the upper middle segment of the esophagus. The heavy white moss is large or even integrated into the whole week. Thick, after the moss, the mucous membrane is erosive, ulcer, and more accompanied by hemorrhage, more common in the middle and lower part of the esophagus.
Kodsi et al (1976) classified the performance of endoscopic Candida esophagitis into 4 grades.
Level 1: A few raised white spots, <2mm in diameter, accompanied by congestion, no erosion, ulcers.
Level 2: multiple bulging leukoplakia, diameter > 2mm, accompanied by congestion, no erosion, ulcers.
Grade 3: White moss is fused into a line or a nodular ridge, accompanied by erosion and ulceration.
Grade 4: Grade 3 performance plus mucosal fragility with stenosis of the lumen.
Diagnosis
Diagnosis and diagnosis of esophageal candida infection
The sensitivity of the serological test is not high. The diagnosis depends on the endoscopic cell brush to take the white smear test. The pseudo-hyphae, hyphae and yeast are seen under the microscope. The biopsy histological examination also has the diagnostic value of the fungal component. However, patients with poor sensitivity and impaired immune mechanisms have high difficulty in dysphagia. Esophageal candidiasis is highly suspected. Oral examination reveals a small white spot on the mucosa of typical fungal stomatitis. See the patients with candida esophagitis. To the fungal stomatitis accounted for 20% to 80%, a positive diagnosis should be seen in the biopsy Candida invasion of tissue, bacteriological examination of exudate and tissue is helpful for diagnosis.
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