The modern face of esophageal candidiasis in an oncology center: Correlating clinical manifestations, endoscopic grade, and pathological data in 323 contemporary cancer patients

Takahiro Matsuo; Ben S Singh; Sebastian Wurster; Ying Jiang; Manoop S Bhutani; Deyali Chatterjee; Dimitrios P Kontoyiannis

doi:10.1016/j.jinf.2024.106172

The modern face of esophageal candidiasis in an oncology center: Correlating clinical manifestations, endoscopic grade, and pathological data in 323 contemporary cancer patients

J Infect. 2024 May 10;89(1):106172. doi: 10.1016/j.jinf.2024.106172. Online ahead of print.

Authors

Takahiro Matsuo¹, Ben S Singh², Sebastian Wurster¹, Ying Jiang¹, Manoop S Bhutani², Deyali Chatterjee³, Dimitrios P Kontoyiannis⁴

Affiliations

¹ Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1460 Houston, TX 77030, USA.
² Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1466 Houston, TX 77030, USA.
³ Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 085 Houston, TX 77030, USA.
⁴ Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1460 Houston, TX 77030, USA. Electronic address: dkontoyi@mdanderson.org.

PMID: 38735485
DOI: 10.1016/j.jinf.2024.106172

Abstract

Objectives: Clinical presentation and outcomes of esophageal candidiasis (EC) in cancer patients are scarcely studied in the azole era, as is the correlation between clinical, endoscopic, and histopathological EC manifestations.

Methods: We retrospectively reviewed the risk factors, clinical features, and outcomes of pathology-documented EC cases at MD Anderson Cancer Center. We further assessed associations between presence of symptoms, standardized 4-stage endoscopic grade (Kodsi classification), histopathological data, and fluconazole treatment failure.

Results: Among 323 cancer patients with EC, 89% had solid tumors, most commonly esophageal cancer (29%). Thirty-three percent of EC patients were asymptomatic. The proportion of symptomatic EC patients significantly increased with endoscopic grade (P = 0.005). Among 202 patients receiving oral fluconazole, 27 (13%) had treatment failure. Underlying esophageal disease was the only independent predictor of fluconazole treatment failure (odds ratio: 3.88, P = 0.005). Endoscopic grade correlated significantly with Candida organism burden (Correlation coefficient [ρ] = 0.21, P < 0.01) and neutrophilic inflammation (ρ = 0.18, P < 0.01). Candida invasion of the squamous mucosal layer was associated with treatment failure (P = 0.049).

Conclusions: EC was predominantly encountered in patients with solid tumors. One-third of EC patients were asymptomatic, challenging traditional symptom-based diagnosis. The development of integrated clinicopathological scoring systems could further guide the therapeutic management of cancer patients with EC.

Keywords: Cancer; Candida esophagitis; Esophageal candidiasis.