Invasive oesophageal candidiasis: current and developing treatment options.

Area of Science:

• Medical Mycology
• Infectious Diseases
• Immunology

Background:

• Oesophageal candidiasis is a significant opportunistic infection, often indicating underlying immunodeficiency, including HIV/AIDS.
• It affects approximately 10% of immunocompromised individuals and has a high relapse rate (60% within 6 months) if the cause is unaddressed.
• Systemic azoles are standard treatment, but antifungal-refractory cases pose a clinical challenge.

Purpose of the Study:

• To review the challenges and therapeutic options for oesophageal candidiasis, particularly in the context of antifungal resistance.
• To highlight the emergence of refractory cases and their clinical implications.
• To discuss the role of newer antifungal agents in managing difficult-to-treat mucosal candidiasis.

Main Methods:

• Literature review of oesophageal candidiasis, HIV infection, immunodeficiency, and antifungal treatments.
• Analysis of current treatment guidelines and emerging therapeutic strategies.
• Evaluation of the in vitro and clinical data for newer antifungals against Candida species.

Main Results:

• Oesophageal candidiasis is a key indicator of HIV progression and immunodeficiency.
• Antifungal resistance is a growing concern, leading to malnutrition and increased mortality.
• Newer agents like voriconazole and caspofungin demonstrate potent activity against resistant Candida strains.

Conclusions:

• Oesophageal candidiasis management requires addressing underlying immunodeficiency.
• Antifungal resistance necessitates exploring alternative and novel therapeutic agents.
• Voriconazole and caspofungin represent valuable additions to treat refractory oesophageal candidiasis.