Oropharyngeal and esophageal candidiasis in immunocompromised patients: treatment issues.

Abstract

The incidence of fungal infections, particularly those caused by Candida species, has increased markedly over the past 15 years [1]. Although the recent use of combination antiretroviral therapy that includes protease inhibitors may help reverse this pattern, candidal infections are currently by far the most common fungal infections in patients with HIV infection and AIDS [1]. While most cases of candidiasis are still caused by C. albicans, there has been a striking increase in the frequency with which non-albicans Candida species (primarily C. tropicalis, C. krusei, C. parapsilosis, and C. glabrata) are isolated [2]. For example, non-albicans strains of Candida accounted for only 3.4% of oropharyngeal isolates from HIV-infected patients in the late 1980s, as compared with 16.8% of isolates by the beginning of 1990-a fourfold increase in 3 years [3]. A recent review of 37 publications revealed that almost half (46%) of all candidal infections in patients with cancer were caused by non-albicans species of Candida [4]. Oropharyngeal candidiasis is the most common opportunistic infection in patients with HIV infection, occurring in as many as 90% of HIV-positive patients at some point during the course of HIV disease [5]. Consistent with the overall pattern of fungal infections in general, the incidence of oropharyngeal candidiasis has reportedly risen steadily over time. A recent analysis of hospital discharge data from 1980 to 1989 by the National Center for Health Statistics, National Hospital Discharge Survey, and two commercially-generated hospital discharge data sources (PAS [Professional Activity Survey] and McAuto [McDonnell Douglas Automation Company Medical Records System]) revealed that the rate of oropharyngeal candidiasis increased almost fivefold (from 0.34 cases per 1,000 admissions per year to 1.6 cases per 1,000 admissions per year) from 1980 to 1989 [6]. The typical manifestations of oropharyngeal candidiasis are pseudomembranous, erythematous, and angular cheilitis. Although oropharyngeal candidiasis is easily treated, it often recurs and can be quite painful. As a result, it may prevent the intake