Prevalence and risk factors for Candida esophagitis among human immunodeficiency virus-negative individuals

Yan-Hua Chen; Tzu-Ming Jao; Yow-Ling Shiue; I-Jung Feng; Ping-I Hsu

doi:10.12998/wjcc.v10.i30.10896

Prevalence and risk factors for Candida esophagitis among human immunodeficiency virus-negative individuals

World J Clin Cases. 2022 Oct 26;10(30):10896-10905. doi: 10.12998/wjcc.v10.i30.10896.

Authors

Yan-Hua Chen^{1

2

3}, Tzu-Ming Jao^{4

5}, Yow-Ling Shiue^{2

6}, I-Jung Feng⁶, Ping-I Hsu⁷

Affiliations

¹ Department of Internal Medicine, Kaohsiung Veterans General Hospital Pingtung Branch, Pingtung 91245, Taiwan.
² Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 80424, Taiwan.
³ Department of Nursing, Meiho University, Pingtung 91202, Taiwan.
⁴ Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan.
⁵ Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei 10617, Taiwan.
⁶ Institute for Precision Medicine, National Sun Yat-sen University, Kaohsiung 80424, Taiwan.
⁷ Division of Gastroenterology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan 709204, Taiwan. williamhsup@yahoo.com.tw.

Abstract

Background: Candida esophagitis (CE) is among the commonest esophageal infections and is known as an opportunistic fungal infection mostly affecting people living with the human immunodeficiency virus (HIV). However, some medical conditions might predispose HIV-negative individuals to esophageal candidiasis. The epidemiology and associated endoscopic findings of CE among people without HIV have rarely been reported.

Aim: To investigate the prevalence of CE among HIV-negative persons, and determine risk factors predicting CE.

Methods: Between January 2015 and December 2018, all consecutive outpatients who underwent routine esophagogastroduodenoscopy as part of health check-ups at their own expense at the Health Check-up Center of the Kaohsiung Veterans General Hospital, Taiwan, were recruited in this study. Those with positive HIV serology results were excluded. Sociodemographic and clinical characteristics including age, gender, economic status, smoking history, alcohol consumption, tea and coffee consumption, underlying diseases, body fat percentage, body mass index, endoscopic findings, and Helicobacter pylori infection status were carefully reviewed. CE was confirmed by endoscopic biopsy and pathological assessment with hematoxylin and eosin and periodic acid-Schiff staining. To evaluate independent factors predicting the development of CE, we conducted a univariate analysis of clinical characteristics. The variables found to be significant via univariate analysis were subsequently included in a multivariable analysis of potential risk factors for CE development.

Results: A total of 11802 participants were included in this study. Forty-seven (0.4%) were confirmed as having CE by pathological examination. Univariate analysis identified older age, the presence of chronic kidney disease, alcohol consumption, and steroid use (P = 0.023, < 0.001, 0.033, and 0.004, respectively) as significantly associated with CE. Multivariable analysis revealed older age [adjusted odds ratio (OR) = 1.027; 95%CI: 1.001-1.053; P = 0.045], chronic kidney disease (adjusted OR = 13.470; 95%CI: 4.574-39.673; P < 0.001), alcohol consumption (adjusted OR = 2.103; 95%CI: 1.151-3.844; P = 0.016), and steroid use (adjusted OR = 24.255; 95%CI: 5.343-110.115; P < 0.001) as independent risk factors for CE development. The presence of dysphagia was associated with severe CE (P = 0.021).

Conclusion: The prevalence of CE among HIV-negative persons was 0.4% in Taiwan. Independent risk factors for CE were older age, chronic kidney disease, alcohol consumption, and steroid use.

Keywords: Candida esophagitis; Human immunodeficiency virus; Prevalence; Risk factors.