INFECTIOUS ESOPHAGITIS
Infectious esophagitis is most commonly diagnosed in immunosuppressed patients. Patients such as solid organ transplants, leukemia, AIDS, lymphoma, and those who taking immunosuppressive drugs. Most common pathogens who responsible for infectious esophagitis are candida albicans, CMV, herpes simplex. Candida infection occurs also in patients who treated with systemic corticosteroids, radiation therapy, uncontrolled diabetes, and systemic antibiotic therapy.
SYMPTOMS
In infectious esophagitis the common symptoms are dsyphagia and odynophagia. Patient with candida infection are sometimes asymptomatic. substernal chest pain occurs in some patients. Oral ulcers like herpes labialis are associated with herpes simplex esophagitis. Patients of esophageal CMV infection may have infection on other sites such as colon and retina.
For diagnosis of esophagitis is endoscopy with biopsy and brushing is always prefers because its accuracy is high. In CMV esophagitis shallow, large, superficial ulceration. Herpes esophagitis shows multiple small deep ulceration. In candida esophagitis linear, diffuse, yellow white plaques adherent to mucosa.
TREATMENT
In herpetic esophagitis, immunocompetent patient may be treats symptomatically and treated with acyclovir, orally or intravenously for a duration of 14-21 days. Other drugs are valacyclovir, famciclovir. Non respond of these drugs requires therapy of Foscarnet for 21 days.
In candida esophagitis antifungal therapy is administered . Initial therapy started with Fluconazole for 14-21 days. Other effective drug is Itraconazole suspension (not capsules) and voriconazole . Refractory infection treated intravenously with caspofungin.
Patients with HIV infection, immune restoration with antiretroviral drugs is effective in control of CMV disease, treatment starts with ganciclovir and once resolution of symptoms occurs then complete the course of therapy with valganciclovir. Non respond of this therapy then treatment done with foscarnet intravenously but toxicities are hypocalcemia, hypomagnesemia.
For Informational purpose only. Consult your Physician for advice.
