Anatomic Pathology: Infectious Disease Pathology

1070) A 30-year-old, HIV-positive intravenous drug user complained of difficulty swallowing. On endoscopy, the esophagus showed white plaques. A biopsy specimen was obtained. Which of the following statements BEST describes the histologic findings?

• Greater than 90% of patients with AIDS develop oropharyngeal candidiasis. Esophageal candidiasis develops in more than 10% and is the most common infection in HIV-infected patients.

• Antifungal therapy is usually instituted in any HIV-positive patient with esophageal symptoms, and biopsy is recommended only if treatment fails.

• More than one pathogen may be present in the same biopsy specimen, and Candida may coexist with herpes simplex virus (HSV) and cytomegalovirus (CMV).

• Cultures of the biopsied tissue for fungi and viruses are less specific than histology because a positive culture may indicate only colonization.

• Inhaled corticosteroid use has been described in cases of esophageal candidiasis in HIV-seronegative patients.

Kanda N, Yasuba H, Takahashi T, et al: Prevalence of esophageal candidiasis among patients treated with inhaled fluticasone propionate. Am J Gastroenterol 2003;98(10):2146-2148.

Sutton FM, Graham DY, Goodgame RW: Infectious esophagitis. Gastrointest Endosc Clin N Am 1994;4(4):713-729.

Vazquez JA: Optimal management of oropharyngeal and esophageal candidiasis in patients living with HIV infection. HIV AIDS (Auckl) 2010;2:89-101.

 
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