Esophageal infections are encountered frequently in clinical practice, particularly in patients with impaired host defenses, and are an important contributor to morbidity and mortality. The acquired immunodeficiency syndrome (AIDS) epidemic and the increasing use of organ transplantation with its attendant immunosuppresive therapy have precipitated an increased incidence of esophageal infections. Although Candida albicans is typically the etiologic agent in mildy immunosuppressed patients with infectious esophagitis, a variety of fungal, viral, and bacterial pathogens are capable of causing infection (see Table 47.1). Regardless of the organism, infection causes mucosal inflammation resulting in the hallmark clinical complaint of odynophagia and potentially resulting in erosions, ulcers, or fistulae. Rapid identification and treatment of the infecting organism is of paramount importance because, in contrast to underlying clinical states that predispose to their occurrence, esophageal infections generally respond rapidly and completely to appropriate treatment.

FUNGAL INFECTIONS OF THE ESOPHAGUS

Candida Species

Candida albicans is the fungal organism most frequently implicated in infectious esophagitis. Other Candida species (Candida tropicalis, Candida parapsilosis, Candida krusei, and Candida glabrata) are less commonly involved. Candida organisms are normal components of the oral flora, and colonization of the esophagus is not unusual. A population-based study revealed esophageal colonization in approximately 20% of healthy, ambulatory adults. Colonization involves adherence and proliferation of Candida organisms within the superficial mucosa.