Epidemiology and etiology

® The occurrence of oropharyngeal and esophageal candidiasis is an indicator of immune suppression, often developing in infants, the elderly, and the immunocompromised. One-third to one-half of geriatric inpatients develop OPC. Denture stomatit-

is is present in 24% to 60% of denture wearers, more commonly in women than men. Oral candidiasis is the most commonly reported adverse drug event among patients receiving inhaled corticosteroids.25 The prevalence of esophageal candidiasis is 37% among patients treated with inhaled corticosteroids.26 The incidence is highest among patients receiving high doses of corticosteroids or those with diabetes.

The prevalence of HIV infection plays a significant role in the incidence of OPC and esophageal candidiasis. In the 1980s, the incidence of OPC increased fivefold, in

association with the spread of HIV infections. Although HIV infection remains a risk factor for candidiasis, the introduction of highly active antiretroviral therapy pre-

cipitated a decline in the incidence of both infections by 50% to 60%.

OPC remains the most common opportunistic infection in patients with HIV. Eighty to ninety percent of HIV-positive patients develop OPC.2 For 70% of these patients, it is the first manifestation of HIV infection.30 The incidence of oropharyn-geal infection increases with decreasing CD4 lymphocyte counts, with an incidence of 60% in patients with a CD4 count less than 200 cells/mm .

Although esophageal candidiasis represents the first manifestation of HIV infection in less than 10% of cases, it is the second most common AIDS-defining dis-31

ease. As with OPC, the incidence of esophageal candidiasis increases with decreasing CD4 counts.

C. albicans accounts for 80% of cases of OPC and esophageal candidiasis. Over the last 20 years, an increasing incidence of C. albicans resistance has been accompanied by an increased incidence of nonalbicans species infections, including C. glab-rata, C. tropicalis, C. krusei, and C. parapsi-losis. In patients with cancer, nonalbic-

2q ans Candida species account for almost half of all cases.

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