Candida Esophagitis in a Male Homosexual = AIDS?

Canadian Journal of Gastroenterology and Hepatology, May 2019

A.B.R. Thomson

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Candida Esophagitis in a Male Homosexual = AIDS?

THE CANADIAN JOURNAL OF GASTROENTEROLOGY /VOL. l NO. l C a n d i d a esophagitis i n a male homosexual == AIDS? A.B.R. THOMSON. 0 0 Oi1?i.1ion oj Gmm,cnrerology. Oe/>mtment of Med1cme. 519 Rohcrr Newton Research B11ildinK. Un11,ersity ofAll1erta. Edmonton , AlhL>rta T6G 2C2 ALMOST OVERNIGHT A NEW IMMUNOLOGICAL DISEASE HAS emerged in epidemic proportions. This devastating modern day plague, rhe acquired immune deficiency syndrome (AIDS), is characterised by a profound defect in immune function . Susccptibi li ty to opporru n istic infections is probably the cause of the alarm ingly high fata lity rate among AIDS sufferers. This suscep tibil ity arises from a severe deficie ncy in cell-med iated imm u ne function owing to the qualitative and quantitative depiction of helper I in ducer T lymphocytes (T4). - The ane rgy, neoplasm a nd increased susceptibili ty to oppor? tunistic and other infections a rc central to the development of immunodeficiency and the clin ical manifestations of AIDS . Currently, most AIDS patients are from recognizable high risk groups; homosexuals, b isexuals. persons having a high number of sexual partners a nd those practising receptive ana l intercourse, intravenous drug users, per~ons receiving whole blood or blood components before routine screening of donors and ch ildren born to HIV positive mothers. Sta ndard precau? tions, sim ilar to those used for preventing hepatitis B virus transmission. should protect health care workers and others in contact with AIDS patients from becoming infected. It must be emphasised that, at presen t, being HIV positive is much more common than clinically detectable disease. AIDS su fferers often presen t with gastrointestinal symp? toms. Initially, the patient may have an acute viral illness last? ing up to two weeks with symptoms including diarrhea, nausea , vom iring and anorexia. Diarrhea is also a late ma n ifesrntion of the disease which is accompan ied by substantial weight loss. While there may be specific infecting agents. not all per? sons arc found to be infected with an opportunistic or non? opportunistic organism such as protozoa (cryprosporidium, Entamoeba hiswlytica, Giardia lamblia, lsospora belli), viruses (cytomegalovirus, Herpes simplex), fungi (Candida alhicans) or bacteria (Mycobacterium avium-incracellulare, Salmonella typhimurium). In th is edition (Page33), Noble and co-workers from the Uni? versity of British Columbia describe candida esophagi ti:. in a male homosexual who did not have an underlyi ng HIV infec? tion . A speci fic but reversi ble impairment in ncurrophil func? tion was p resent which presumably resu lted in defective candidacidal activity. Did this patien t have AIDS? Th e clinical presentation was consistent with recent criteria for definition of the disease but on two occasions. separated by six months, no HIV an tibody was detected e ither by ELISA or Weste rn blot technique. In addition the patient's OKT4:0KT8 lymphocytc ratio was nor? mal. Although there was a selective reduction in serum lgG, no other common stigmata seen in chronic mucocucaneous candidiasis was present. There was no sign of hyperkcratos1s o r onychomycosis, no h istory of ch ildhood recurrent infections or evidence for lymphocyte defect. Two endoscopic studies, two and 12 months following anti? fungal therapy, revealed complete resolution of the candida esophagi tis. This case shows that clinical criteria alone should not be used to establish a diagnosis of AIDS. even in high risk pilticnt populations. Alternative mec hanisms for opportunistic infec? tions in homosexual males shou ld be explored in those pmicnts who arc HIV negative. MEDIATORS INFLAMMATION The Scientiifc World Journal Hindawi Publishing Corporation ht p:/ www.hindawi.com Hindawi Publishing Corporation ht p:/ www.hindawi.com Journal of Diabetes Research Disease Markers Journal of Hindawi Publishing Corporation ht p:/ www.hindawi.com Immunology Research PPAR Research Hindawi Publishing Corporation ht p:/ www.hindawi.com Submit your manuscr ipts http://www.hindawi.com Obesity Journal of Ophthalmology Hindawi Publishing Corporation ht p:/ www.hindawi.com Stem Cells International Hindawi Publishing Corporation ht p:/ www.hindawi.com Evidence-Based Complementary Journal of Oncology Disease nal and Mathematical Methods Hindawi Publishing Corporation ht p:/ www.hindawi.com AIDS and ology


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A.B.R. Thomson. Candida Esophagitis in a Male Homosexual = AIDS?, Canadian Journal of Gastroenterology and Hepatology, DOI: 10.1155/1987/198415