Bianchi Porro G, Parente F, Cernuschi M
Department of Infectious Diseases, L. Sacco Hospital, Milan, Italy.
Am J Gastroenterol. 1989 Feb;84(2):143-6.
Oral and esophageal candidiasis represents a common infection in patients with acquired immune deficiency syndrome (AIDS). Because the relationship between the infection in both sites is not well known, we submitted to routine upper digestive endoscopy 57 patients with AIDS. Furthermore, we evaluated the diagnostic accuracy of oral candidiasis and esophageal symptoms as markers of Candida esophagitis. Oral and esophageal candidiasis were found in 52% and 48% of patients, respectively, whereas symptoms of esophageal origin were referred to by 60% of patients successively documented to have an esophageal infection. The sensitivity of esophageal symptoms and oral candidiasis alone, as indexes of an esophageal infection, was 60% and 88%, and their specificity was 100% and 81%, respectively. The combination of these two parameters improved their degree of diagnostic accuracy (sensitivity 93%, and specificity 100%), whereas the predictive value of their simultaneous presence or absence was 100% and 96%, respectively. These results document that routine endoscopy to verify the presence of esophageal candidiasis in all of the patients with AIDS is unnecessary; it could be reserved for selected subgroups such as those with esophageal symptoms despite systemic antifungal treatment, and for patients with AIDS-related complex presenting oral candidiasis without symptoms of esophageal origin.
口腔和食管念珠菌病是获得性免疫缺陷综合征（AIDS）患者常见的感染。由于这两个部位感染之间的关系尚不清楚，我们对57例艾滋病患者进行了常规上消化道内镜检查。此外，我们评估了口腔念珠菌病和食管症状作为念珠菌食管炎标志物的诊断准确性。分别在52%和48%的患者中发现了口腔和食管念珠菌病，而60%先后被记录有食管感染的患者出现了食管源性症状。单独将食管症状和口腔念珠菌病作为食管感染指标的敏感性分别为60%和88%，特异性分别为100%和81%。这两个参数的组合提高了诊断准确性（敏感性93%，特异性100%），而它们同时出现或不出现的预测价值分别为100%和96%。这些结果表明，对所有艾滋病患者进行常规内镜检查以证实食管念珠菌病的存在是不必要的；它可保留用于特定亚组，如那些尽管接受了全身抗真菌治疗仍有食管症状的患者，以及患有艾滋病相关综合征且有口腔念珠菌病但无食管源性症状的患者。
