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Candida glabrata Esophagitis: Are We Seeing the Emergence of a New Azole-Resistant Pathogen?

Wilson A, Delport J, Ponich T - Int J Microbiol (2014)

Bottom Line: Conclusion.C. glabrata infections were associated with at least one risk factor for candidal infection.Given its resistance to azole-based therapy, this may have treatment implications for how candidal esophagitis is approached by the clinician.

View Article: PubMed Central - PubMed

Affiliation: Division of Clinical Pharmacology and Division of Gastroenterology, Department of Medicine, London Health Sciences Centre, Western University, University Campus, 339 Windermere Road, Room C9-101, London, ON, Canada N6A 5W9.

ABSTRACT
Background. Candida glabrata (C. glabrata) has become a recognized pathogen in fungal esophagitis. A proportion of these isolates are azole-resistant which may have treatment implications. Variability in the prevalence of this organism exists in the limited data available. Objective. To determine the incidence of C. glabrata esophagitis in a North American hospital setting and to highlight factors that may predispose patients to this condition. Methods. Patient charts were collected from January 1, 2009 to July 30, 2011. Any charts of patients identified as having esophagitis with a positive fungal culture were reviewed for the species of Candida and the presence of factors that would predispose them to esophageal candidiasis. Results. The prevalence of Candida esophagitis based on culture was 2.2% (37 subjects). C. glabrata was the 2nd most prevalent pathogen identified (24.3% or 9 subjects). Of the C. glabrata cohort, all patients had at least one factor predisposing them to candidiasis. Conclusion. C. glabrata esophagitis makes up a large portion of the candidal esophagitis seen in hospital. C. glabrata infections were associated with at least one risk factor for candidal infection. Given its resistance to azole-based therapy, this may have treatment implications for how candidal esophagitis is approached by the clinician.

No MeSH data available.


Related in: MedlinePlus

Distribution of Candida species in an adult gastroenterology cohort endoscopically and histologically identified as having Candida esophagitis. C.: Candida.
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Related In: Results  -  Collection


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fig2: Distribution of Candida species in an adult gastroenterology cohort endoscopically and histologically identified as having Candida esophagitis. C.: Candida.

Mentions: 1701 charts were identified as meeting the inclusion criteria. Fifty-five subjects (3.2%) were recognized as having endoscopic findings consistent with Candida esophagitis (any species). However, the true prevalence of Candida esophagitis (any species) based on microbiologic culture was 2.2% (37 subjects) (Figure 1). C. albicans was implicated in the vast majority of infections (27 subjects or 73%) while C. glabrata was the next most prevalent (9 subjects or 24.3%), followed by C. tropicalis (1 subject or 2.7%) (Figure 2). Sixteen men (53%) and 14 women (47%) were affected. There were 6 cases where the subject had a mixed infection (5 mixed C. glabrata/albicans and 1 mixed C. tropicalis/albicans). With respect to the glabrata-infected subjects, ages ranged from 29 to 87, with a slightly younger mean age of 63 compared to the albicans-infected subjects, whose ages ranged from 23 to 99, with a mean age of 67 (P = 0.63). In the C. glabrata population, the majority of individuals were inpatients, while the C. albicans population were relatively equally distributed between in- and outpatients (Table 1).


Candida glabrata Esophagitis: Are We Seeing the Emergence of a New Azole-Resistant Pathogen?

Wilson A, Delport J, Ponich T - Int J Microbiol (2014)

Distribution of Candida species in an adult gastroenterology cohort endoscopically and histologically identified as having Candida esophagitis. C.: Candida.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4269082&req=5

fig2: Distribution of Candida species in an adult gastroenterology cohort endoscopically and histologically identified as having Candida esophagitis. C.: Candida.
Mentions: 1701 charts were identified as meeting the inclusion criteria. Fifty-five subjects (3.2%) were recognized as having endoscopic findings consistent with Candida esophagitis (any species). However, the true prevalence of Candida esophagitis (any species) based on microbiologic culture was 2.2% (37 subjects) (Figure 1). C. albicans was implicated in the vast majority of infections (27 subjects or 73%) while C. glabrata was the next most prevalent (9 subjects or 24.3%), followed by C. tropicalis (1 subject or 2.7%) (Figure 2). Sixteen men (53%) and 14 women (47%) were affected. There were 6 cases where the subject had a mixed infection (5 mixed C. glabrata/albicans and 1 mixed C. tropicalis/albicans). With respect to the glabrata-infected subjects, ages ranged from 29 to 87, with a slightly younger mean age of 63 compared to the albicans-infected subjects, whose ages ranged from 23 to 99, with a mean age of 67 (P = 0.63). In the C. glabrata population, the majority of individuals were inpatients, while the C. albicans population were relatively equally distributed between in- and outpatients (Table 1).

Bottom Line: Conclusion.C. glabrata infections were associated with at least one risk factor for candidal infection.Given its resistance to azole-based therapy, this may have treatment implications for how candidal esophagitis is approached by the clinician.

View Article: PubMed Central - PubMed

Affiliation: Division of Clinical Pharmacology and Division of Gastroenterology, Department of Medicine, London Health Sciences Centre, Western University, University Campus, 339 Windermere Road, Room C9-101, London, ON, Canada N6A 5W9.

ABSTRACT
Background. Candida glabrata (C. glabrata) has become a recognized pathogen in fungal esophagitis. A proportion of these isolates are azole-resistant which may have treatment implications. Variability in the prevalence of this organism exists in the limited data available. Objective. To determine the incidence of C. glabrata esophagitis in a North American hospital setting and to highlight factors that may predispose patients to this condition. Methods. Patient charts were collected from January 1, 2009 to July 30, 2011. Any charts of patients identified as having esophagitis with a positive fungal culture were reviewed for the species of Candida and the presence of factors that would predispose them to esophageal candidiasis. Results. The prevalence of Candida esophagitis based on culture was 2.2% (37 subjects). C. glabrata was the 2nd most prevalent pathogen identified (24.3% or 9 subjects). Of the C. glabrata cohort, all patients had at least one factor predisposing them to candidiasis. Conclusion. C. glabrata esophagitis makes up a large portion of the candidal esophagitis seen in hospital. C. glabrata infections were associated with at least one risk factor for candidal infection. Given its resistance to azole-based therapy, this may have treatment implications for how candidal esophagitis is approached by the clinician.

No MeSH data available.


Related in: MedlinePlus