Abstract
Background. Candida glabrata (C. glabrata) has become a recognized pathogen in fungal esophagitis. A proportion of these isolates are azole-resistant which may have treatment implications. Variability in the prevalence of this organism exists in the limited data available. Objective. To determine the incidence of C. glabrata esophagitis in a North American hospital setting and to highlight factors that may predispose patients to this condition. Methods. Patient charts were collected from January 1, 2009 to July 30, 2011. Any charts of patients identified as having esophagitis with a positive fungal culture were reviewed for the species of Candida and the presence of factors that would predispose them to esophageal candidiasis. Results. The prevalence of Candida esophagitis based on culture was 2.2% (37 subjects). C. glabrata was the 2nd most prevalent pathogen identified (24.3% or 9 subjects). Of the C. glabrata cohort, all patients had at least one factor predisposing them to candidiasis. Conclusion. C. glabrata esophagitis makes up a large portion of the candidal esophagitis seen in hospital. C. glabrata infections were associated with at least one risk factor for candidal infection. Given its resistance to azole-based therapy, this may have treatment implications for how candidal esophagitis is approached by the clinician.
Highlights
Infections of the esophagus occur most commonly in immunocompromised patients such as those infected with human immunodeficiency virus and those receiving chemotherapy or immunosuppressive medications [1]
Any charts identified as having a positive fungal culture were further reviewed for the presence or absence of any risk factors that would predispose that patient to esophageal candidiasis as well as for the specific species of Candida
C. albicans was implicated in the vast majority of infections (27 subjects or 73%) while C. glabrata was the most prevalent (9 subjects or 24.3%), followed by C. tropicalis (1 subject or 2.7%) (Figure 2)
Summary
Infections of the esophagus occur most commonly in immunocompromised patients such as those infected with human immunodeficiency virus and those receiving chemotherapy or immunosuppressive medications [1]. Candida species are one of the most commonly detected organisms in the setting of an esophageal infection [2]. Candida albicans (C. albicans) remains the most common cause of fungal esophagitis at many institutions, non-albicans species are increasingly associated with esophageal candidiasis [3]. To determine the incidence of C. glabrata esophagitis in a North American hospital setting and to highlight factors that may predispose patients to this condition. Any charts of patients identified as having esophagitis with a positive fungal culture were reviewed for the species of Candida and the presence of factors that would predispose them to esophageal candidiasis. The prevalence of Candida esophagitis based on culture was 2.2% (37 subjects). Given its resistance to azole-based therapy, this may have treatment implications for how candidal esophagitis is approached by the clinician
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