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Candidiasis
Published in Rebecca A. Cox, Immunology of the Fungal Diseases, 2020
Judith E. Domer, Emily W. Carrow
Candidiasis is a prototypic opportunistic disease of the compromised host caused by yeasts of the genus Candida. The various species of Candida capable of initiating disease normally live commensally with their human or animal hosts as part of the endogenous flora of mucocutaneous regions,1,2 although they can also be isolated on occasion from exogenous sources.3,4 Conditions which predispose the individual to the development of candidiasis vary, but can be broadly categorized as nonimmunologic, e.g., diabetes, trauma, pregnancy, antibiotic therapy, and hyperalimentation5–9 or immunologic, e.g., malignancies of the immune system,10–13 or immunosuppressive therapy administered to prolong allografts14,15 or to kill malignant cells.16 Of particular interest currently is the association of oral and esophageal candidiasis with the recently described acquired immunodeficiency syndrome (AIDS).17
Care of Critically Ill Patients with HIV
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Joseph Metmowlee Garland, Andrew Levinson, Edward Wing
Esophageal candidiasis is characterized by pain on swallowing and is usually accompanied by oral-pharyngeal white plaques. Candida albicans is the usual cause and treatment is indicated with systemic fluconazole for esophageal disease.
Fungal infections causing emergencies
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
R. Madhu, Pradeesh Arumugam, V. Hari Pankaj
Oropharyngeal candidiasis is characterized by painless, creamy white, plaque-like lesions of the buccal or oropharyngeal mucosa, or tongue surface. Lesions can be easily scraped off with a tongue depressor or other instrument. Esophageal candidiasis is occasionally asymptomatic but often presents with fever, retrosternal burning pain or discomfort, and odynophagia. Candidal pneumonia presenting with fever, cough, chest pain, dyspnea, rales, or rhonchi and other signs of consolidation may occur.
Efficacy and acceptability of different anti-fungal interventions in oropharyngeal or esophageal candidiasis in HIV co-infected adults: a pilot network meta-analysis
Published in Expert Review of Anti-infective Therapy, 2021
Bing-Syuan Zeng, Bing-Yan Zeng, Chao-Ming Hung, Tien-Yu Chen, Yi-Cheng Wu, Yu-Kang Tu, Pao-Yen Lin, Kuan-Pin Su, Brendon Stubbs, Cheuk-Kwan Sun, Yu-Shian Cheng, Dian-Jeng Li, Chih-Sung Liang, Chih-Wei Hsu, Yen-Wen Chen, Ping-Tao Tseng, Chang-Hua Chen
While the commonly recommended treatment to oropharyngeal/esophageal candidiasis is fluconazole, relapse of oropharyngeal or esophageal candidiasis has been gradually increasing in recent decades. To find a new evidence about the advantages of different anti-fungal interventions for managing oropharyngeal or esophageal candidiasis in adults with HIV had become an important issue. Based on network meta-analysis of twenty-seven randomized controlled trials (6277 participants), this work revealed that photosensitizer-based antimicrobial photodynamic therapy (aPDT) with laser irradiation plus methylene blue was associated with the highest cure rate and the lowest relapse rate among the investigated interventions for oropharyngeal candidiasis. However, none of the investigated anti-fungal interventions were superior to fluconazole for esophageal candidiasis in respect of cure rates/relapse rates. In addition, all investigated anti-fungal interventions were well-accepted.
The safety of ixekizumab in psoriasis drug therapy
Published in Expert Opinion on Drug Safety, 2020
Mucocutaneous Candida infections are a well-known class effect of IL-17A antagonism; for the most part, they are minor and easily managed, and rarely require treatment discontinuation, but their impact in real world might be higher than in the selected populations of RCTs. This would probably apply to patients with obesity, diabetes mellitus or a history of recurrent oral or genital candidiasis. Esophageal candidiasis is an uncommon occurrence but must be taken into consideration in patients with chest pain or dysphagia. There might be a dose effect, with frequency and severity of mucocutaneous candidiasis increasing with the extent of IL-17 blockade [103]; phase III clinical trials with bimekizumab will probably provide additional evidence of this hypothesis. Since IL-17A plays little role in systemic immunity, unlike TNFα, it is not surprising that a safety signal for opportunistic infections have not been detected with IL-17A antagonists; on the other hand, S. aureus and dermatophyte infections could be expected to occur and might be underreported.
Esophageal lichen planus: towards diagnosis of an underdiagnosed disease
Published in Scandinavian Journal of Gastroenterology, 2019
Franziska Schauer, Carmen Monasterio, Kristin Technau-Hafsi, Johannes Steffen Kern, Adhara Lazaro, Peter Deibert, Peter Hasselblatt, Henning Schwacha, Steffen Heeg, Volker Brass, Armin Küllmer, Arthur Robert Schmidt, Annette Schmitt-Graeff, Wolfgang Kreisel
After diagnosis of ELP therapy was modified accordingly (see Supplementary Tables 2 and 3): in very severe or refractory cases systemic prednisolone (dosage 0.3–0.5 mg/kg body weight) was administered for a short period. Thereafter, 12/16 patients with severe ELP received oral topical corticosteroids. Ten patients were treated with swallowed topical budesonide (0.5 mg budesonide in 5 ml gel two to three times a day postprandial). In nine patients an improvement in endoscopic findings within four weeks was observed (Table 2, last row). In patient three an inflammatory stenosis completely resolved. In patients 11 and 14 the inflammatory/scarring stenosis almost completely resolved and did not cause further symptoms. Severe esophageal hyperkeratosis and dyskeratosis was influenced neither by therapy with budesonide nor with retinoids. In three patients relapsing esophageal candidiasis was treated with local amphotericin-B. The ELP of patient four was refractory to systemic steroids and adalimumab, while it responded only partially to topical budesonide and mycophenolate.