Fungal esophagitis

Introduction to fungal esophagitis The fungal esophagitis (fungousesophagitis) is the most common pathogen, Candida albicans, the most common is Candida albicans, followed by Candida tropicalis and Candida krusei, other rare actinomycetes, mucor and some plants Fungi, etc., these bacteria are obtained from the external environment, rather than endogenous flora, and the primary esophageal infection caused by it is only found in patients with severe immunocompromised. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: esophageal stricture upper gastrointestinal bleeding esophageal perforation sepsis

Cause of fungal esophagitis

(1) Causes of the disease

Candida is present in the skin and mucous membranes of normal humans. When the body's whole body and local resistance are reduced or a large number of broad-spectrum antibiotics are used to inhibit the growth of other microorganisms, Candida will grow in large numbers and cause disease. Therefore, Candida esophagus More common in:

1. Patients with cancer, especially advanced tumors, who are treated with radiation therapy or anti-tumor drugs.

2. Long-term treatment with antibiotics or steroids.

3. Some chronic diseases such as diabetes or aplastic anemia.

4. Reflux esophagitis, the esophageal mucosa has obvious erosion or ulceration.

5. Patients with immunodeficiency diseases such as HIV or HIV carriers.

(two) pathogenesis

Candida in the normal oral cavity is under the control of the competing bacteria. Only when the host's resistance is weakened or the bacteria are killed by antibiotics, the fungus invades the esophageal epithelium to produce a necrotic, rotten-like pseudomembrane. The membrane contains fibrin, debris of necrotic tissue and mycelium of Candida, pseudomembrane shedding, mucosal congestion, ulcers, in short, ulcers and pseudomembranes are characteristic.

Fungal esophagitis prevention

The iatrogenic infection of esophageal fungi is not uncommon in clinical practice. Broad-spectrum antibiotics, H2 receptor antagonists, and proton pump inhibitors can destroy the biological balance between the normal flora of the human body, leading to excessive hyperplasia and epithelial infection of the fungus. Steroids and other immunosuppressive drugs can cause the body's immune function to be low, leading to fungal infections of the esophagus and viscera. In addition, scleroderma, achalasia, and esophageal cancer can also cause fungal migration and infection due to esophageal stasis, so it is correct. The use of antibiotics and other drugs is the most effective way to prevent fungal esophagitis.

Fungal esophagitis complications Complications esophageal stricture upper gastrointestinal bleeding esophageal perforation sepsis

Complications include esophageal stricture, obstruction caused by fungal mass, upper gastrointestinal bleeding, perforation of esophagus, esophageal-tracheal fistula, fungal spread, and sepsis caused by secondary bacterial infection.

Fungal esophageal inflammatory symptoms Common symptoms Swallowing pain, anorexia, dysphagia, sore throat, esophageal malignant lesions

The main symptoms are sore throat, swallowing pain and difficulty in swallowing. The severity of the symptoms is related to the severity and degree of inflammation. There may be anorexia, hematemesis and even bleeding. Infants are often accompanied by oral thrush. Adult candidiasis esophagitis can be Occurs without candida stomatitis.

Fungal esophagitis examination

1. Blood routine neutropenia can often be found.

2. Serological test to determine the serum agglutination titer of infected patients is 2/3 patients higher than 1:160; serum mannan antigen (polysaccharide on Candida cell wall) is detected by radioimmunoassay and enzyme-linked method; agarose gelation Glue diffusion and reverse immunoelectrophoresis were used to detect Candida antibodies; one third of the antigen and its antibody titers increased rapidly in the serum of infected individuals.

3. Esophageal X-ray barium examination is helpful for diagnosis. The main lesion is 2/3 of the esophagus. It can be weakened or diffuse, and the esophageal mucosa is rough, irregular or granular, just like the tincture. Mixed with most tiny bubbles, in advanced cases, the mucosa is nodular, resulting in the appearance of the sacral column like a pebbles, similar to varicose veins, sometimes showing deep ulcers. In chronic cases, inflammatory lesions develop deep into the wall, which can cause Segmental stenosis, even like esophageal cancer, but esophageal X-ray sputum angiography can not rule out the existence of esophageal candidiasis.

4. Esophagoscopy is the only way to diagnose the disease. The esophageal mucosa under the microscope presents edema, congestion, erosion, ulceration, easy bleeding, and the surface of the mucous membrane is covered with white spots or pseudomembranes. Biopsy and smear and culture are performed. If the culture is positive, it is not enough for diagnosis. Because Candida is a symbiotic bacterium of the gastrointestinal tract, it must be smear to see fungal hyphae. The biopsy tissue can be diagnosed by hyphal invasion of the epithelium.

In view of the fact that patients with candidal esophagitis are often secondary to severe or even fatal primary diseases, timely examinations have found that early diagnosis and treatment are necessary to save the lives of patients.

Diagnosis and diagnosis of fungal esophagitis

Mainly rely on endoscopy, combined with fungal examination, the above-mentioned serious primary disease, long-term treatment of antibiotics or steroids and immunodeficiency patients, with varying degrees of swallowing pain and dysphagia, should be performed early endoscopy.

Differential diagnosis

1. Esophageal varices Most of the disease has a history of liver disease, physical examination of portal hypertension, such as splenomegaly, ascites, abdominal varicose veins, etc., no swallowing pain, rarely dysphagia, gastroscope visible esophageal mucosa grayish blue Beaded, braided or agglomerated varicose veins.

2. Esophageal cancer This disease occurs mostly in middle-aged and elderly people. The main clinical manifestations include progressive dysphagia, weight loss, anemia, etc., which can be confirmed by fiberoptic gastroscopy and pathological biopsy.

3. Other types of esophagitis purulent esophagitis; herpes esophagus; esophageal tuberculosis: most esophageal tuberculosis patients are young, angiographic findings of esophageal dilatation is good, even if the stenosis is smooth, fiber endoscopic esophageal mucosa itself is inflammation Infiltration and ulceration, caseous granuloma can be found in biopsy pathology, and acid-fast bacilli can be found by acid-fast staining.

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