Walsh T J, Hamilton S R, Belitsos N
Infectious Diseases Section, National Cancer Institute, Bethesda, MD 20892.
Postgrad Med. 1988 Aug;84(2):193-6, 201-5. doi: 10.1080/00325481.1988.11700377.
Esophageal candidiasis is an opportunistic infection that is being recognized increasingly often in certain patients, including those who have a neoplastic disease, are undergoing protracted antibiotic therapy, or hae acquired immunodeficiency syndrome (AIDS). Impaired cell-mediated immunity may predispose the patient to esophageal mucosal colonization, whereas chemotherapy-induced granulocytopenia may predispose to disseminated candidiasis. Esophageal candidiasis should be suspected in susceptible patients with complaints of substernal odynophagia or dysphagia. The diagnosis is confirmed by endoscopically directed mucosal biopsy. Esophagitis from other causes (eg. herpes simplex virus, cytomegalovirus, or bacterial infection) may develop concomitantly with esophageal candidiasis. Treatment is determined by the clinical and immune status of the patient. Amphotericin B (Fungizone) is administered to immunocompromised patients at risk for disseminated or deeply invasive candidiasis and is indicated in nongranulocytopenic patients whose symptoms prevent reliable administration of oral antifungal agents. Ketoconazole (Nizoral) may be administered to clinically stable nongranulocytopenic patients with esophageal candidiasis limited to the mucosa. Patients with AIDS and a history of esophageal candidiasis usually benefit from long-term suppression with an oral antifungal agent.
食管念珠菌病是一种机会性感染，在某些患者中越来越常见，包括患有肿瘤疾病、正在接受长期抗生素治疗或患有获得性免疫缺陷综合征（艾滋病）的患者。细胞介导的免疫功能受损可能使患者易发生食管黏膜定植，而化疗引起的粒细胞减少可能易发生播散性念珠菌病。对于出现胸骨后疼痛性吞咽困难或吞咽困难主诉的易感患者，应怀疑食管念珠菌病。通过内镜引导下的黏膜活检可确诊。其他原因引起的食管炎（如单纯疱疹病毒、巨细胞病毒或细菌感染）可能与食管念珠菌病同时发生。治疗取决于患者的临床和免疫状况。两性霉素B（氟康唑）用于有播散性或深部侵袭性念珠菌病风险的免疫功能低下患者，适用于症状妨碍可靠口服抗真菌药物给药的非粒细胞减少患者。酮康唑（ Nizoral）可用于临床稳定的非粒细胞减少且食管念珠菌病局限于黏膜的患者。有艾滋病且有食管念珠菌病病史的患者通常受益于口服抗真菌药物的长期抑制治疗。
