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Bacterial esophagitis in immunocompromised patients.

T J Walsh, N J Belitsos, S R Hamilton

Archives of Internal Medicine

|July 1, 1986

Summary

Bacterial esophagitis is more common in immunocompromised patients than previously thought. Prompt diagnosis is crucial as it can be a significant source of bacteremia, particularly in neutropenic individuals.

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Area of Science:

Gastroenterology
Infectious Diseases
Pathology

Background:

Bacterial esophagitis is an uncommon esophageal infection.
Its clinical and pathological features are not well-characterized, especially in immunocompromised populations.

Observation:

This study analyzed 23 cases of bacterial esophagitis (3 endoscopic biopsies, 20 autopsies).
A significant proportion of patients (14/23) had hematologic malignancies, aplastic anemia, or solid tumors.
Ten patients were profoundly neutropenic (WBC < 100/mm³).

Findings:

Gram-positive cocci were the most frequent organisms (14 cases), followed by mixed gram-negative bacilli and gram-positive cocci (5 cases).
Four patients developed bacteremic bacterial esophagitis, all of whom were immunocompromised (3 profoundly neutropenic, 1 with gestational prematurity).
The bacteria causing bacteremia were all gram-positive: viridans-group streptococci, Staphylococcus aureus, Staphylococcus epidermidis, and Bacillus species.

Implications:

Bacterial esophagitis may be underdiagnosed and should be considered in immunocompromised patients presenting with esophageal symptoms.
It represents a potential source of gram-positive bacteremia in severely immunocompromised individuals, particularly those with profound neutropenia.
Further research is warranted to elucidate the pathogenesis and optimal management strategies for bacterial esophagitis in at-risk populations.

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