title: Antifungal Treatment is Not Required for Immunocompetent Individuals With Asymptomatic Esophageal Candidiasis.
abstract: Although esophageal candidiasis (EC) is an opportunistic infection, asymptomatic EC (AEC) is occasionally encountered in otherwise healthy individuals. This study evaluates the impact of antifungal treatment in immunocompetent individuals with AEC and investigates risk factors for persistent or recurrent EC. The authors identified patients with biopsy-proven AEC from the database of individuals receiving screening endoscopy (n = 99,255). After excluding patients receiving immunosuppressive therapy, being positive for human immunodeficiency virus, receiving no follow-up endoscopy, or having no antifungal treatment data, a total of 142 patients were divided into remission and nonremission groups. Remission was defined when EC was not detectable on follow-up endoscopy. On baseline comparison, nonremission group was older (57.5 ± 10.3 versus 52.5 ± 10.5 years, P = 0.017) and more likely to have cardiovascular disease (12.9% versus 1.8%, P = 0.021) and history of pulmonary tuberculosis (PTB) (22.6% versus 4.5%, P = 0.004) and exhibited a lower triglyceride level (101.4 ± 37.4 versus 122.6 ± 79.6 mg/dL, P = 0.039) than remission group, whereas grade of EC and concomitant endoscopic findings did not differ between 2 groups. Antifungal treatment was also similarly performed between 2 groups. Multivariate analysis revealed that history of PTB is independently associated with nonremission (odds ratio 4.495, 95% confidence interval 1.023-19.762, P = 0.047). No patients demonstrated EC-related complications during a mean follow-up of 28.0 ± 12.0 months. In conclusion, our results suggested that antifungal treatment is not required for immunocompetent individuals with AEC and past history of PTB is an independent predictor for persistent or recurrent EC.
authors.affiliation: Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (HJS); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Yang Won
authors.initials: YW
authors.lastname: Min
authors.forename: Eun
authors.initials: E
authors.lastname: Kim
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Son
authors.forename: Jae J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Poong-Lyul
authors.initials: PL
authors.lastname: Rhee
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D058345:Asymptomatic Infections / Q000628:therapy*; D002177:Candidiasis / Q000188:drug therapy*; D004935:Esophageal Diseases / Q000188:drug therapy*; D005260:Female; D005773:Gastroscopy; D006801:Humans; D007121:Immunocompetence; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents