The resistance to fluconazole in patients with esophageal candidiasis.
BACKGROUND
Esophageal candidiasis is often observed in patients with risk factors for its development and fluconazole is the therapeutic choice for the treatment of this disease.


OBJECTIVE
To determine its frequency, by performing upper digestive endoscopy; to determine Candida species involved in its pathogenesis and verify their distribution according with the predisposing factors and to determine susceptibility to fluconazole in the samples.


METHODS
From March 2006 to April 2007, all patients submitted to esophagogastroduodenoscopy at the Digestive Endoscopy Unit in the Oswaldo Cruz University Hospital, Recife, PE, Brazil, were eligible for the study. Samples were collected from patients who presented lesions consistent with esophageal candidiasis in order to identify Candida species and verify their susceptibility to fluconazole. The predisposing factors for the occurrence of esophageal candidiasis were described.


RESULTS
Of 2,672 patients referred to upper endoscopy at the Digestive Endoscopy Unit, 40 (1.5%) had endoscopic findings compatible with esophageal candidiasis. The average age was 49.1 years. Twenty one patients (52.5%) were less than 50 years old, of which 82.6% were infected with HIV. Most of them (52.5%) were males and 65.0% were inpatients. Diseases were identified in 90% of the patients and 21 (52.5%) were HIV positive. Concerning endoscopic findings, severe forms of esophagitis were found in 50% of the patients with CD4 count <200. Non-albicans Candida species were isolated in 22.7% of HIV positive and in 45% HIV negative patients. A total of 6 (14.28%) samples were resistant to fluconazole, while 2 (4.76%) samples had dose depending susceptibility to this drug.


CONCLUSIONS
Esophageal candidiasis prevalence was low, although within the results described by other authors. Male and inpatients were the most affected. The species isolated varied according to the characteristics of each group studied. Both, resistance and dose-depending susceptibility to fluconazole were considered high.
Wilheim
Ana Botler
AB
Department of Internal Medicine, School of Medical Sciences, University of Pernambuco, Recife, PE, Brazil. abotler@terra.com.br
Miranda-Filho
Demócrito de Barros
Dde B
Nogueira
Rodrigo Albuquerque
RA
Rêgo
Rossana Sette de Melo
RS
Lima
Kedma de Magalhães
Kde M
Pereira
Leila Maria Moreira Beltrão
LM
D000935:Antifungal Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D002175:Candida / Q000187:drug effects; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D004935:Esophageal Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged
D000935:Antifungal Agents; D015725:Fluconazole