Esophageal thrush, also called Candida esophagitis, is a fungal infection of the esophagus. This infection characteristically occurs in people with a weakened immune system, including persons with leukemia or lymphoma, those receiving chemotherapy or immunosuppressive drugs, and people infected with HIV. The Centers for Disease Control and Prevention identifies esophageal thrush as an AIDS-defining illness. Anyone with HIV who develops this opportunistic infection is thereafter considered to have AIDS. Candida esophagitis may be asymptomatic or present with local esophageal symptoms.
Painful Swallowing
The University of California, San Francisco reports that painful swallowing is a typical presenting symptom of esophageal thrush. Severe pain may limit food and fluid intake. In a 2004 article published in "Clinical Microbiology Reviews," Dr. Louis de Repentigny and colleagues reported that the risk for development of esophageal thrush among those with HIV infection increases substantially when the CD4+ cell count drops to less than 200. Johns Hopkins HIV Guide reports 85 to 90 percent of patients respond to antifungal treatment within one to two weeks.
Difficulty Swallowing
People with Candida esophagitis may have difficulty swallowing, reports the University of Maryland Medical Center. Patients may report a sensation of something being caught in the esophagus. Candida forms plaques along the lining of the esophagus, which may lead to ulcers or open sores in the esophageal wall. Severe, untreated esophagitis may lead to perforation--a hole in the esophagus. This complication is a medical emergency.
Chest Pain
Esophageal thrush can cause burning pain in the chest, behind the breastbone. While Candida is the most common cause of esophagitis among HIV-positive persons, other infectious agents may also causes esophagitis in this population. In the article, "Candidiasis and HIV" published electronically by the University of California, San Francisco, Drs. C. Fichtenbaum and J. Aberg state cytomegalovirus and herpes simplex virus are possible causes of HIV-associated esophagitis. Notably, the esophageal symptoms are the same regardless of the underlying causative agent.
Mouth Lesions
The University of Maryland Medical Center notes many people with Candida esophagitis also have oral thrush. Characteristic symptoms of oral thrush include off-white plaques on the tongue, inside of the cheek, or on roof of the mouth; decreased taste; easy bleeding of the gums; and nonhealing cracks at the corners of the mouth. The onset of esophageal symptoms in the presence of oral thrush is sufficient to make a presumptive diagnosis of Candida esophagitis, notes Johns Hopkins HIV Guide.
References
- AIDS.gov: Opportunistic Infections
- Clinical Microbiology Reviews: Immunopathogenesis of Oropharyngeal Candidiasis in Human Immunodeficiency Virus Infection
- AIDS Education & Training Centers: Candidiasis, Oral and Esophageal
- University of California, San Francisco, HIV InSite: Candidiasis and HIV
- University of California, San Francisco, HIV InSite: Otolaryngologic Manifestations of HIV
