fluticasone and Candidiasis

Candidiasis is a rare entity reported as an isolated and primary laryngeal disease. In this condition, inhaled steroids were the single most common predisposing factor. Also mycotic infections of larynx are frequently seen in patients with immune insufficiency, although they have also been reported in individual with normal immune status. We report a case of isolated laryngeal Candidiasis in an immunocompetent individual, with an unusual presentation with exophytic lesion, edema, ulceration, white plaque, and pseudomembranous formation mimicking supraglottic carcinoma, to highlight the clinical of this condition and provide a review of the literature.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Aged; Anti-Asthmatic Agents; Antifungal Agents; Asthma; Candidiasis; Diagnosis, Differential; Fluticasone; Humans; Laryngeal Diseases; Laryngeal Neoplasms; Laryngoscopy; Male; Pulmonary Disease, Chronic Obstructive; Risk Factors; Salmeterol Xinafoate

To review recently published studies presenting novel and relevant information on some esophageal infectious, inflammatory and injurious diseases.. In the treatment of Candida esophagitis, fluconazole remains the treatment of choice, but clinical failures indicate new therapeutic opportunities, like two new echinocandins, micafungin and anidulafungin. Eosinophilic esophagitis is an increasingly recognized entity. New therapeutic insights come from a six-food elimination diet in children and from fluticasone propionate in adults; humanized monoclonal IgG antibody anti-interlukin-5, mepolizumab, has been shown to decrease eosinophilia and ameliorate symptoms. There has been some advance in microscopic characterization of lymphocytic esophagitis. Esophagitis is found to be present in 67% of patients with pemphigo vulgaris, in 32.3% of patients with systemic sclerosis and to be associated with thoracic neoplasias. In the case of caustic ingestion, endoscopic ultrasound with miniprobes has proven not to be better than videoendoscopy. Recent evidence shows that systemic steroids might even be harmful. Mitomycin C applied on fresh wounds is currently being evaluated. Stenting of the stricture has been proposed for contrasting esophageal remodeling.. These recent findings, together with a better understanding of diseases such as eosinophilic or lymphocytic esophagitis, allow new diagnostic and therapeutic approaches.

Topics: Androstadienes; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antifungal Agents; Antineoplastic Agents; Biomarkers; Candidiasis; Caustics; Diet; Eosinophilia; Esophagitis; Esophagus; Fluticasone; Humans; Radiotherapy

Esophageal candidiasis is one of the local side effects of inhaled corticosteroid treatment, and it is difficult to prevent this condition. Our previous report indicated that the prevalence of esophageal candidiasis among patients treated with inhaled fluticasone propionate dry powder (FP-dp) reached up to 37% in Japanese patients. Although a reduction in the daily dose of inhaled FP-dp can eliminate this infection, it may lead to asthma not being well-controlled in these patients.. The aim of this study was to estimate whether switching to an equal daily dose of inhaled hydrofluoroalkane-134a beclomethasone dipropionate (HFA-BDP), the oropharyngeal deposition of which is very low, can eliminate the infection without deterioration of asthma.. A total of 10 stable asthmatic patients with esophageal candidiasis, induced by inhaled FP-dp treatment (400 or 800 microg/ day), were enrolled in this study. A second upper GI endoscopy was performed, more than 1 month but less than 3 months after switching to an equal dose of inhaled HFA-BDP with a tube spacer device, Duopacer. The patients' medications were not changed during the study.. Esophageal candidiasis was eliminated in 9 of the 10 patients. The degree of candidiasis reduced in another patient. The forced expiratory volume in 1 sec (FEV1.0) did not worsen during the study.. Switching from FP-dp to HFA-BDP with Duopacer is useful in preventing esophageal candidiasis.

Topics: Administration, Inhalation; Aged; Aged, 80 and over; Androstadienes; Anti-Asthmatic Agents; Beclomethasone; Candidiasis; Esophageal Diseases; Esophagoscopy; Female; Fluticasone; Humans; Male; Metered Dose Inhalers; Middle Aged; Powders

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Antifungal Agents; Bronchodilator Agents; Bronchopneumonia; Candidiasis; Diagnosis, Differential; Disease Progression; Drug Therapy, Combination; Fluticasone; Humans; Itraconazole; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Salmeterol Xinafoate; Tiotropium Bromide

Although oropharyngeal candidiasis is associated with inhaled corticosteroid (ICS) usage, there is sparse data on the prevalence of posterior pharyngeal candidiasis in those without any detectable oral candidiasis on clinical examination. We systematically investigated the relationship between oral candidiasis on clinical examination and the presence of posterior pharyngeal candidiasis at bronchoscopy.. We conducted a cross-sectional study on a convenience sample of 100 patients undergoing bronchoscopy at our institution. Patients were assessed for symptoms of and risk factors for candida infection and had an examination of their oropharynx for evidence of candidiasis before bronchoscopy. They subsequently had a detailed assessment for posterior candidiasis at bronchoscopy. We performed a posteriori subgroup analysis, which focused solely on those patients on ICS maintenance therapy.. Median age was 54.7 (27-84) years, and 55 patients were male; 47 % of patients were on ICS, and 20 % of this cohort received recent oral corticosteroids. Twenty-eight percent of this convenience sample had posterior pharyngeal candidiasis; however, only 10.7 % (3/28) of these patients had clinically detectable oral candidiasis on clinical examination before bronchoscopy. Factors that were independently associated with the presence of pharyngeal candidiasis at bronchoscopy were OR (95 % CI) ICS usage 6.9 (2.5-19.2), particularly fluticasone usage 6.8 (2.62-17.9) and the presence of dysphonia 3.2 (1.3-8.0). In the subgroup analysis of ICS usage, posterior pharyngeal candidiasis was correlated with the presence of dysphonia but was not independently associated with fluticasone or budesonide dosage.. This study demonstrates that posterior pharyngeal candidiasis in the absence of clinically overt oral candidiasis is frequent amongst ICS users. A history of ICS use, particularly fluticasone usage, as well as the presence of dysphonia are associated with posterior pharyngeal candidiasis at bronchoscopy, even in the absence of clinically overt oral involvement.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Androstadienes; Bronchoscopy; Candidiasis; Candidiasis, Oral; Chi-Square Distribution; Cross-Sectional Studies; Dysphonia; Female; Fluticasone; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Pharyngeal Diseases; Pharynx; Predictive Value of Tests; Risk Factors

Endoscopic findings of an 18-year old man with intermittent dysphagia showed widespread white exudations of the oesophagus. First misinterpreted as oesophageal candidiasis the mucosal biopsies revealed the histological features of a severe eosinophilic oesophagitis. Under treatment with topical steroids the symptoms dissolved. The control endoscopy showed a histological remission with absence of eosinophilic granulocytes, too. The eosinophilic oesophagitis is a rare allergy-like inflammation of the oesophagus especially seen in young men with increasing incidence. Without treatment the long-term risk of eosinophilic oesophagitis is the induction of severe oesophageal strictures.

Topics: Administration, Oral; Adolescent; Androstadienes; Anti-Allergic Agents; Antifungal Agents; Biopsy; Candidiasis; Deglutition Disorders; Diagnosis, Differential; Dose-Response Relationship, Drug; Eosinophilia; Esophagitis; Esophagoscopy; Esophagus; Fluticasone; Humans; Male; Miconazole

Development of oropharyngeal candidiasis is a frequently reported adverse effect of inhaled corticosteroid use, but the prevalence of esophageal candidiasis is unknown. The aim of this study was to estimate the prevalence of esophageal candidiasis among patients treated with an inhaled corticosteroid, fluticasone propionate.. Upper GI endoscopy was performed on 49 patients treated with inhaled fluticasone propionate to examine the prevalence of esophageal candidiasis. Of the patients, 36 had bronchial asthma and 13 had chronic obstructive pulmonary disease. To compare the prevalence with control patients, upper GI endoscopy was performed on 700 consecutive patients without malignancy or immunosuppression.. The prevalence of esophageal candidiasis was 37% among patients treated with inhaled fluticasone propionate, whereas only 0.3% of the control patients had the infection. The prevalence was especially high among patients with diabetes mellitus or those who were treated with a high dose of inhaled fluticasone propionate. Moreover, a reduction in the daily dose of inhaled fluticasone propionate eliminated the infection in four of five patients.. Esophageal candidiasis is a common complication of inhaled corticosteroid use.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adult; Age Distribution; Aged; Androstadienes; Asthma; Candidiasis; Cohort Studies; Dose-Response Relationship, Drug; Esophagoscopy; Esophagus; Female; Fluticasone; Follow-Up Studies; Humans; Male; Middle Aged; Prevalence; Probability; Risk Assessment; Sex Distribution

Gastrointestinal endoscopy was performed in two bronchial asthma patients using inhaled corticosteroid who complained of odynophagia. The endoscopic finding was high grade with white moss (Grade III) in both patients. Esophageal candidiasis is often recognized in bronchial asthmatic patients receiving long-term fluticasone propionate (FP) dry powder (Diskhaler) inhalation. We therefore examined the complicated context of esophageal candidiasis in patients with long-term FP inhalation. Out of 20 bronchial asthmatic patients who had been using FP inhalation long-term, seven showed signs of esophageal candidiasis. Three patients had mild grade (Grade I), one middle grade (Grade II) and three high grade (Grade III) candidiasis, with a frequency of 35%. This rate is higher than the usual spontaneous occurrence rate of esophageal candidiasis, and it is suggested that inhalation of corticosteroid medication can penetrate into the esophagus after deep inhalation. We tested this hypothesis in two studies. 1) To measure the esophageal concentration of FP, four healthy adults inhaled 200 microg FP once. Right after inhalation, FP concentration in the esophageal washing fluid was 3.3 microg. On another day, 30 minutes after the same dose of inhaled FP, one FP concentration in the esophageal washing fluid was 0.67 microg (immediately laydown), and another was 0.11 microg (remained standing). This indicates that even though FP dissipates quickly, it remains in the esophagus 30 minutes after inhalation. 2) We observed the process in one patient with high grade (Grade III) esophageal candidiasis. The time of inhalation was changed from just after getting up and just before going to bed to before breakfast and before dinner. Under this regimen, the signs of esophageal candidiasis improved from high to middle grade.. If asthmatic patients do not go to sleep immediately after FP inhalation, the remaining FP in the esophagus decreases rapidly, thereby decreasing the risk of esophageal candidiasis. In addition, by changing the FP inhalation times to before breakfast and dinner, the remaining FP in the esophagus is washed away and does not remain in the esophagus. Therefore, this study, which avoided inhalation before going to bed, provides useful information for the prevention and improvement of esophageal candidiasis.

Topics: Administration, Inhalation; Adult; Androstadienes; Anti-Allergic Agents; Asthma; Candidiasis; Esophageal Diseases; Female; Fluticasone; Humans; Male; Middle Aged; Powders