A Retrospective Study of Esophageal Candidiasis in Jordan, a non-HIV Endemic Area

Abstract

Background: Candida albicans, which inhabits the esophagus in approximately 20% of healthy individuals, is the most common causative organism of fungal esophagitis. Although esophageal candidiasis is considered an acquired immunodeficiency syndrome (AIDS) defining illness in human immunodeficiency virus (HIV) infected patients, it is increasingly reported in healthy people. We aimed to investigate the prevalence and risk factors of esophageal candidiasis among Jordanians and increase awareness about its pathology in HIV uninfected individuals. Methods: This a retrospective study of all cases of esophageal candidiasis admitted to King Abdullah University Hospital, between June 2005 and December 2016. All patients diagnosed with esophageal candidiasis based on cytological evaluation of esophageal biopsies, were included. Patients were considered immunocompromised, if they had impaired cell mediated immunity, diabetes, active malignancy, connective tissue disease, or if they were treated with cytotoxic medicines or corticosteroids within 2 weeks of diagnosis of esophageal candidiasis. Results: Between June 2005 and December 2016, 20826 patients underwent upper endoscopy at King Abdullah University Hospital, of which 16 (0.0007%) were diagnosed with esophageal candidiasis. All patients were adults, with an age range of 20-70 years. Three patients were females (19%). In all patients, Candida albicans was the causative organism. Six (38%) of the patients were considered immunocompetent. Conclusion: The prevalence of esophageal candidiasis in the studied population was markedly lower than in other countries. Future studies to elucidate mechanisms of esophageal candidiasis in healthy individuals and to investigate protective factors in low prevalence populations are needed.