Risk Factors And Clinical Features Analysis Of Candida Esophagitis

Aim:To study the risk factors, clinical features.drug resistance of candida esophagitist and the relationships between other upper gastrointestinal Candida infections for more evidence in treatment.Method:Samples were continuous taken from examined patient in Department of Gastroscopy in The First Affiliated Hospital of Kunming medical College for 6-month period (from January to June,2010). Of the 58 candida esophagitis patients conformed by gastroscopy,38 were male and 20 were female, aged 22-81 years, average age was 49.88±15.31 years.59 control cases excluded candida esophagitis by gastroscopy were collected in the same period, of the 59 control case,35 were male and 24 were female, aged 18-78 years, average age was 51.15±14.36 years. All samples were sampled from the pharynx\esophagus\juice\antrum samples. The fungi collected from upper gastrointestinal tract were examined by Susceptibility testing. The clinical data was collected for risk factor research. All data were compared by use of SPSS 18.0 software pack.Result:(1) The Rate that candida esophagitis patients combined with diabetes or taken antibiotics within 2 weeks was 29.3% and 46.6%, which was significantly higher than the control group 3.4% and 18.6%, the probability was 0.0001 and 0.02, the odds ratio were 11.8 and 3.8; While 3.4% candida esophagitis patients combined with duodenal ulcer it was significantly lower than the control group (25.5%), P=0.0003, odds ratio not combined with duodenal ulcer was 10.2. It can be concluded that of the 11 candidate risk factors, diabetes and taken antibiotics was identified risk factors. However, duodenal ulcer maybe a protective factors. Other factors, such as their background and eating habits, oral hygienehabits, taking drugs other than antibiotics etc, were no direct relationship between incidence of this disease. (2) Fungal esophagitis common symptoms were areabdominal pain, chest pain or discomfort, swallowing a sense of obstruction, acid reflux,nausea, anorexia, abdominal distension, of which only symptoms of chest pain or discomfort were Significant difference between the candida esophagitis patients(31.0%) and the control group(10.2%) P=0.006. (3) Of the candida esophagitis patients group, the lesion smear microscopy and culture positive rates were 60.34% and 91.4%,55 patients with culture-positive results.52 cases (94.5%) got Candida albicans infection, 2 cases (3.6%) were smooth Candida,1 case (1.8%) were mixed Candida albicans and Candida glabrata infection. Between grading wilcox the different culture and smear positive rate was not statistically significant. (4)53 patients with fungal esophagitis(91.4%) accompanied by the throat, stomach and gastric antrum pathogenic materials culture in the positive results. Culture positive rate of other parts of the upper digestive tract between the two groups was statistically significant difference in infection rates(61.5% and 11.9%, P<0.05). (5)The susceptibility to 7 common antifungal agents of Candida albicans in Upper gastrointestinal was different to each other(most of the probability was less than 0.05). The order of outpatient of upper gastrointestinal Candida albicans sensitivity to antibiotics was ketoconazole= fluconazole=miconazole>amphotericin>itraconazole=econazole>nystatin.Conclusion:(1)This study shows that the main risk factors for fungal esophagitis is significantly lower immunity, followed by the local flora, while high acid on the disease is a protective factor. Mucosal injury, or a variety of other factors that affect the immune risk factors were not risk factors, but could only be based on two factors to promote or slow down the diseases. (2) In its many symptoms of fungal esophagitis, only chest discomfort or pain had a certain specificity, combined with positive throat culture suggest the possible presence of fungal esophagitis. Endoscopy required inspection Attention to the case of the esophagus. Biopsy check in the esophagus brush simultaneously culture can improve physical diagnosis, Biospy check was a useful complement. (3) Candida albicans is still the main pathogen of out-patients with fungal esophagitis, and no significant increase in drug-resistant strain infections, most of the patients untreated were sensitive to triazole antifungal. Of commonly used antifungal agents, the most sensitivity is Ketoconazole, followed by fluconazole and miconazole, amphotericin and itraconazoleless were less sensitive, the sensitive of nystatin was minimum...