What causes infectious esophagitis?

Updated: May 02, 2019
  • Author: Deepika Devuni, MBBS; Chief Editor: BS Anand, MD  more...
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Answer

Infectious agents known to cause esophagitis include the following:

  • Candida species: Candida albicans is the most common offending pathogen, [7] but other Candida species, such as C tropicalis, C glabrata, and C parapsilosis, have also been implicated as rare causes of esophagitis
  • Noncandidal fungi (eg, Aspergillus, Histoplasma, Cryptococcus, Blastomyces)
  • In hosts infected with human immunodeficiency virus (HIV), CMV, HSV, Mycobacterium avium-intracellulare, idiopathic
  • Bacterial species (eg, normal flora, Mycobacterium tuberculosis, M avium-intracellulare, Staphylococcus, Streptococcus, Lactobacillus, Nocardia)
  • Parasitic infections (eg, Chagas disease, Trypanosoma cruzi, Cryptosporidium, Pneumocystis, Leishmania donovani)

Major predisposing factors for Candida esophagitis include antibiotic use, radiation therapy or chemotherapy, hematologic malignancies, and acquired immunodeficiency syndrome (AIDS). Other conditions associated with an increased incidence of Candida esophagitis include esophageal stasis, alcoholism, malnutrition, and advanced age. Occasionally, Candida esophagitis can occur in otherwise healthy individuals with no underlying esophageal or systemic disease. [18, 19, 20, 21, 22, 23, 24]

Other infections of the esophagus are rare and most often develop in patients with neutropenia, AIDS, burns, trauma, or generalized sepsis. Actinomycosis may produce severe esophagitis with deep ulcers and fistulous tracts to the mediastinum, pleural space, tracheobronchial tree, and skin. The diagnosis can be confirmed by the presence of characteristic sulfur granules on endoscopic biopsy specimens.

In persons with HIV, the most significant risk factor for infectious esophagitis is a persistently low CD4 count, but reports exist of individuals who develop fungal esophagitis during the seroconversion phase.


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