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

Mohammed Bani Hani, Abdel Rahman Al Manasra, Shadi Hamouri, Mohammad Alqudah


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
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.


Esophageal candidiasis, Esophagoscopy, HIV.

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