MERKMALE DER CANDIDA-OSOPHAGITIS BEI TUMOR- UND AIDS-PATIENTEN: HISTOPATHOLOGISCHE STUDIE AN 23 PATIENTEN

Candida oesophagitis is a common concomitant disease in neutropenic cancer patients after chemotherapy as well as in HIV-patients. In order to characterize the features of oesophagitis in each population, we reviewed the medical history and pathology records of 23 patients (18 cancer-patients, 5 HIV-patients) with culture and autopsy-proven Candida oesophagitis. Histopathological patterns of morphology, invasion, angioinvasion and inflammation were evaluated. Virtually all patients, 17/18 cancer- and 5/5 HIV-patients, had a history of previous mucosal candidosis or candidemia. There was a significant difference histopathologically in depth of invasion of the Candida-organisms between cancer and HIV-patients. Only in HIV-patients organisms were observed within the muscularis propria and the adventitia (2/5 vs 0/18; p = 0,04). The frequency of angioinvasion (12/18 vs 3/5) was similar in both groups. Neutropenia (<500/μl) was present in 12 (68%) of 18 cancer patients vs 0/5 HIV-patients (p = 0,01). Correspondingly there was a significant higher PMN/MN ratio in the oesophageal inflammatory infiltrate in HIV-patients, reflecting chemotherapy-induced neutropenia in cancer patients (p = 0,02). Oesophageal candidosis in HIV-patients may be highly invasive despite the presence of neutrophils. These findings suggest an impaired inflammatory response of HIV-patients to invasive candidosis, leading to impaired mucosal host defence.