Candida Colonization and Esophagitis in HIV-Negative Patients: An Endoscopic, Histopathological, and Molecular Study

Candida esophagitis (CE) is a recognized opportunistic infection in immunocompromised individuals, but data from HIV-negative patients remain limited. This study aimed to determine the prevalence, clinical manifestations, risk factors, and molecular characteristics of CE in HIV-negative adults undergoing upper gastrointestinal endoscopy.

In this cross-sectional study, 455 HIV-negative adults with upper gastrointestinal symptoms who underwent esophagogastroduodenoscopy were evaluated. An esophageal mucosal sample for fungal culture was collected from all patients, while biopsy for histopathology was performed only when endoscopic findings suggested Candida infection. Active CE was defined by compatible endoscopic lesions, histopathological evidence of tissue invasion, and a positive fungal culture. Candida species were identified using PCR-RFLP.

Candida was detected in 84 patients (18.5%), and histopathologically confirmed that CE was identified in 16 patients (3.5%). The most common symptoms among CE patients were epigastric pain (68.8%) and acid reflux (56.3%). Diabetes mellitus (OR = 6.19, p = 0.001), denture use (OR = 3.72, p = 0.020), corticosteroid use (OR = 4.54, p = 0.025), and antibiotic use (OR = 5.08, p = 0.018) were significantly associated with CE. Among patients with CE (n = 16), molecular analysis showed Candida albicans as the predominant species (81.3%), followed by C. glabrata (12.5%) and C. tropicalis (6.2%).

CE is an uncommon yet clinically relevant condition in HIV-negative patients. Metabolic factors, medication exposure, and denture use significantly increase the risk of CE. Early identification of high-risk individuals and accurate species detection may support timely diagnosis and appropriate management.