title: Esophageal candidiasis--an adverse effect of inhaled corticosteroids therapy.
abstract: Over the last few decades, inhaled corticosteroids (ICs) became the cornerstone in the treatment of persistent asthma. Their use improved asthma control, decreased mortality and also minimized adverse reactions associated with systemic steroid. Esophageal candidiasis is a rare complication resulting from the use of ICs. Although, in recent years, as their prescriptions has increased, more cases have been reported, especially in Japan. Listed are 4 case reports regarding esophageal candidiasis in asthmatic patients associated with inhaled budesonide administration. In the cases reported herein, the use of a different device of dry powder budesonide might have favored esophageal drug deposition and Candida infection. Patients denied using systemic corticosteroids in the previous 6 months. Furthermore, none of the patients presented Diabetes mellitus, malignant disease, HIV infection, or other immunosuppressive conditions. We conclude that patients treated with high doses of ICs are at higher risk of developing esophageal candidiasis. These patients should undergo upper gastrointestinal endoscopy whenever they present symptoms. Nevertheless, we must keep in mind that infection might also be asymptomatic and esophageal candidiasis prevalence may be higher than that reported thus far.
authors.affiliation: Clinical Immunology and Allergy Division, Sao Paulo University, Sao Paulo, Brazil.
authors.forename: Marcelo Vivolo
authors.initials: MV
authors.lastname: Aun
authors.forename: Marisa Rosimeire
authors.initials: MR
authors.lastname: Ribeiro
authors.forename: Cláudia Leite
authors.initials: CL
authors.lastname: Costa Garcia
authors.forename: Rosana Câmara
authors.initials: RC
authors.lastname: Agondi
authors.forename: Jorge
authors.initials: J
authors.lastname: Kalil
authors.forename: Pedro
authors.initials: P
authors.lastname: Giavina-Bianchi
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000368:Aged; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects*; D002177:Candidiasis / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004935:Esophageal Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D004983:Ethanolamines / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D000068759:Formoterol Fumarate; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012494:Sampling Studies
chemical_list: D000305:Adrenal Cortex Hormones; D004983:Ethanolamines; D019819:Budesonide; D000068759:Formoterol Fumarate