Fungal Infections

Disease name and synonyms

Oesophageal candidiasis (candidosis), esophageal candidiasis.

Fungi responsible (links to these)

Candida albicans (rarely Candida glabrata)

Disease description

Oesophageal candidiasis usually co-exists with oropharyngeal disease, although in 30% of cases, no oral lesions are visible. Sore throat on swallowing, or difficulty swallowing (dysphagia), nausea and vomiting are the commonest symptoms.

Frequency and global burden

Candida oesophagitis affects an estimated ~1.4 million people as ~20% of HIV/AIDS patients not on anti-retroviral therapy, and ~0.5% if on antiretroviral therapy develop it. Other patients might increase the numbers by 10-20%.

Underlying problems and at risk patients

HIV infection and AIDS when the CD4 count is below 100 x 106/l, and is itself an AIDS-defining condition. Cancer and neutropenia. Rare reports of oesophageal candidosis in immunocompetent individuals after omeprazole therapy, suggesting that hypochlorhydria favours colonization.

Diagnostic testing

Endoscopy showing white plaques on the surface of the oesphagus is the only definitive means of making the diagnosis with microscopy, culture and biopsy (often negative) confirming Candida involvement. Barium swallow is insensitive, but distinctive if abnormal.


Fluconazole 200mg daily. Alternatives include IV amphotericin B, anidulafungin, caspofungin, micafungin, and oral solutions of itraconazole and posaconazole. Topical therapy is ineffective and ketoconazole is inferior.

IDSA clinical practice guidelines 2016

Outlook and prognosis

Response rates over 90%, but relapse common in AIDS. Rare complication of perforation and stricture.

A moderately severe oesophageal candidiasis in a non-HIV infected woman

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