Wilcox C M, Schwartz D A
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Dig Dis Sci. 1996 Jul;41(7):1337-45. doi: 10.1007/BF02088557.
Although Candida esophagitis is one of the most common opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS), there has been no systematic study of the endoscopic and pathologic manifestations of this disease. During a 53-month period, 141 patients with AIDS and Candida esophagitis were studied. All patients had the severity of esophagitis graded prospectively and esophageal mucosal biopsies performed. Tissue biopsies were evaluated for histologic evidence of ulceration, extent of candidiasis, and presence of viral cytopathic effect. Follow-up was obtained. There appeared to be a uniform endoscopic appearance; with increasing severity, the scattered mucosal plaques coalesced, resulting in circumferential disease and luminal impingement. The pathologic pattern of Candida esophagitis was homogenous. Plaque material was composed primarily of desquamated superficial hyperplastic hyperkeratotic squamous epithelium and inflammatory cells, with infiltration by fungal elements and bacteria consistent with superinfection. Although endoscopic and histopathologic ulcer was commonly seen in these patients (32%), only four patients had ulcer believed secondary to Candida esophagitis alone. In conclusion, in patients with AIDS, Candida esophagitis is a superficial mucosal infection resulting in characteristic endoscopic and histopathologic patterns.
尽管念珠菌食管炎是获得性免疫缺陷综合征（AIDS）患者中最常见的机会性感染之一，但尚未对该疾病的内镜和病理表现进行系统研究。在53个月的时间里，对141例患有AIDS和念珠菌食管炎的患者进行了研究。所有患者均对食管炎的严重程度进行了前瞻性分级，并进行了食管黏膜活检。对组织活检进行评估，以寻找溃疡的组织学证据、念珠菌病的范围以及病毒细胞病变效应的存在情况。进行了随访。念珠菌食管炎似乎有一致的内镜表现；随着病情加重，散在的黏膜斑块融合，导致食管周径受累和管腔狭窄。念珠菌食管炎的病理模式是一致的。斑块物质主要由脱落的浅表增生性角化过度鳞状上皮和炎性细胞组成，伴有真菌成分浸润和与重叠感染一致的细菌感染。尽管这些患者中常见内镜和组织病理学溃疡（32%），但只有4例患者的溃疡被认为仅继发于念珠菌食管炎。总之，在AIDS患者中，念珠菌食管炎是一种浅表黏膜感染，可导致特征性的内镜和组织病理学表现。
