title: The resistance to fluconazole in patients with esophageal candidiasis.
abstract: 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.
authors.affiliation: Department of Internal Medicine, School of Medical Sciences, University of Pernambuco, Recife, PE, Brazil. abotler@terra.com.br
authors.forename: Ana Botler
authors.initials: AB
authors.lastname: Wilheim
authors.forename: Demócrito de Barros
authors.initials: Dde B
authors.lastname: Miranda-Filho
authors.forename: Rodrigo Albuquerque
authors.initials: RA
authors.lastname: Nogueira
authors.forename: Rossana Sette de Melo
authors.initials: RS
authors.lastname: Rêgo
authors.forename: Kedma de Magalhães
authors.initials: Kde M
authors.lastname: Lima
authors.forename: Leila Maria Moreira Beltrão
authors.initials: LM
authors.lastname: Pereira
mesh_terms: 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
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole