Bongomin, Felix

Fayemiwo, Samuel A

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Letter to the editor 1: Predictors of  oesophageal candidiasis in persons with or without HIV infectionFelix Bongomin1,2, Samuel A Fayemiwo1,31. Division of  Infection, Immunity and Respiratory Medicine, The University of  Manchester, Manchester, M13 9PL, UK.2. Department of  Medical Microbiology and Immunology, Faculty of  Medicine, Gulu University, P.O. Box 166, Gulu, Uganda.3. University College Hospital, Department of  Medical Microbiology and Parasitology, College of  Medicine, Ibadan, Nigeria.DOI: https://dx.doi.org/10.4314/ahs.v18i2.32cite as: Bongomin F, Fayemiwo SA. Letter to the editor 1: Predictors of  oesophageal candidiasis in persons with or without HIV infection. Afri Health Sci. 2018;18(2): 468-469. https://dx.doi.org/10.4314/ahs.v18i2.32Corresponding author:Felix Bongomin,Department of  Medical Microbiology and Immunology, Faculty of  Medicine, Gulu University, P.O. Box 166, Gulu, Uganda.Tel: +44 7884 440 402, Manchester, UKEmail: felix.bongomin@manchester.ac.ukDear Sir,We read with great interest the article by Mushia nd col-leagues recently published in African Health Sciences1.The authors present data on predictors of  endoscopically diagnosed oesophageal candidiasis (OC). Much as this is an interesting and one of  the largest studies of  its kind in the region, it is confusing in one respect. A major distinc-tion between predictors of  OC in HIV-infected patients and risk factors for development of  OC in HIV-uninfect-ed individuals should have been drawn in the abstract. Additionally, HIV which is a major risk factor for oe-sophageal candidiasis is missing in the conclusions, and its odds ratio is not only inconsistent with that provided in Table 2 of  the results section, but also out of  the 95% confidence interval. OC (or Candida oesophagitis) is the most common in-fectious disease of  the oesophagus; it is an opportunistic infection that complicates disorders associated with gran-ulocyte and/or lymphocyte numbers and dysfunction2,3. OC is an AIDS-defining illness occurring in patients with advanced HIV disease and is estimated to occur in at least 5% of  patients who are on antiretroviral therapy (ART) and in 20% who are ART-naïve4,5. Predictors of  OC in HIV-infected patients include low CD4 counts (typically <50 cells/µL), high HIV RNA viral load , oropharyngeal candidiasis and ART naivety6–8.There is no published data on predictors of  OC in HIV-uninfected patients. However, risk factors for the development of  OC in HIV negative from several pub-lished studies are as summarised in Table 1.Table 1: risk factors for the development of oesophageal candidiasis in HIV-infected and HIV-1 uninfected patients 2 Major risk factors Other risk factors • HIV/AIDS •  • Low CD4 counts • High HIV-RNA viral load • ART naïve patients  • Oropharyngeal candidiasis  • Cancer • Irradiation (radiotherapy) • Chemotherapy  • Diabetes • Hyperglycaemia  • Immunodeficiency • Long-term broad-spectrum oral antibiotic use • Proton pump inhibitors  • Transplant recipients on chemotherapy • Presence of oral candidiasis (in children) • Smoking • Alcoholism  • Reflux esophagitis • Inhaled corticosteroid use • Xerostomia (inadequate saliva) • Chronic diseases (liver cirrhosis, chronic heart failure etc.) • High sugar diet • Increasing age  • Previous gastric surgeries • Oral steroid therapy • Defective neutrophil motility   3 African Health Sciences© 2018 Bongomin et al. Licensee African Health Sciences. This is an Open Access article distributed under the terms of  the Creative commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.   African Health Sciences Vol 18 Issue 2, June, 2018468Despite the retrospective nature of  the study, the au-thors have shown some important association between oesophageal candidiasis and risk factors such as diabetes and antibiotic use, though decreasing age as a risk factor as mentioned by the authors in the abstract contradicts their own data provided in Table 2 and established evi-dence9. Summary Table 2 requires rigorous statistical ad-justments and improvement on data presentation.Hence, we regret that the study does not live up to its title and has failed to inform the readers on the predictors of  OC both in HIV-infected and HIV-uninfected individu-als; it is “a prevalence and factors associated with oesoph-ageal candidiasis” study, as suggested in the aim rather than “predictors of  oesophageal candidiasis” as currently stated in the title. Declaration of  interestNoneReferences1. Mushi MF, Ngeta N, Mirambo MM, Mshana SE. Pre-dictors of  esophageal candidiasis among patients attend-ing endoscopy unit in a tertiary hospital, Tanzania: a ret-rospective cross-sectional study. Afr Health Sci [Internet]. 2018 Apr 4;18(1):66. Available from: https://www.ajol.info/index.php/ahs/article/view/1691342. Grossi L, Ciccaglione AF, Marzio L. Esophagitis and its causes: Who is “guilty” when acid is found “not guilty”? World J Gastroenterol [Internet]. 2017;23(17):3011. Avail-able from: http://www.wjgnet.com/1007-9327/full/v23/i17/3011.htm3. Hassan TIY, Mahony M. Oesophageal candidiasis in an immunocompetent child. Ir Med J [Internet]. 2014 Sep;107(8):243–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/252829664. Buchacz K, Baker RK, Palella FJ, Chmiel JS, Lichten-stein KA, Novak RM, et al. AIDS-defining oppor-tunistic illnesses in US patients, 1994–2007: a co-hort study. AIDS [Internet]. 2010;24(10):1549–59. Available from: http://content.wkhealth.com/linkback/openurl?s id=WKPTLP:landing page&an=00002030-201006190-000175. d’Arminio Monforte A, Vago L, Lazzarin A, Boldorini R, Bini T, Guzzetti S, et al. AIDS-defining diseases in 250 HIV-infected patients; a comparative study of  clinical and autopsy diagnoses. AIDS [Internet]. 1992 Oct;6(10):1159–64. Available from: http://www.ncbi.nlm.nih.gov/pubmed/13346756. Tavitian A, Raufman JP, Rosenthal LE. Oral candidia-sis as a marker for esophageal candidiasis in the acquired immunodeficiency syndrome. Ann Intern Med [Internet]. 1986 Jan;104(1):54–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/39405057. Saeed SA, Boyle JT. Other Diseases of  the Esoph-agus. In: Pediatric Gastrointestinal and Liver Dis-ease [Internet]. Elsevier; 2011. p. 255–260.e1. Available from: http://linkinghub.elsevier.com/retrieve/pii/B97814377077481002478. Takahashi Y, Nagata N, Shimbo T, Nishijima T, Wata-nabe K, Aoki T, et al. Long-Term Trends in Esophageal Candidiasis Prevalence and Associated Risk Factors with or without HIV Infection: Lessons from an Endoscopic Study of  80,219 Patients. Andes DR, editor. PLoS One [Internet]. 2015 Jul 24;10(7):e0133589. Available from: http://dx.plos.org/10.1371/journal.pone.01335899. Weerasuriya N, Snape J. A study of  candida esophagitis in elderly patients attending a district general hospital in the UK. Dis Esophagus [Internet]. 2006 Jun 1;19(3):189–92. Available from: https://academic.oup.com/dote/ar-ticle/2194918/AAfrican Health Sciences Vol 18 Issue 2, June, 2018 469

Letter to the editor 1: Predictors of oesophageal candidiasis in persons with or without HIV infection

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Letter to the editor 1: Predictors of oesophageal candidiasis in persons with or without HIV infection

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