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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Esophageal conditions due to fungal, ulcerative, and neoplastic causes often signal the onset of symptomatic HIV infection. Most cases are fungal and due to Candida albicans, which is characterized by esophageal inflammation causing pain on swallowing (dysphagia and odynophagia). Ulcerative esophageal disease is commonly associated with cytomegalovirus (CMV), idiopathic causes, and herpes simplex virus (HSV). CMV, characterized by odynophagia resulting from ulcerations in the distal third of the esophagus, is clinically indistinguishable from idiopathic ulceration. HSV is more widespread and abrupt than other ulcerative processes, and its erosive injury can cause painful swallowing, ulceration and oral cavity lesions. Patients with esophageal distress, low CD4 counts, and little possibility of other GI conditions most likely suffer from Candida infection and should immediately begin an empiric trial of antifungal therapy. If an individual's first bout of odynophagia does not respond to empiric oral azole therapy, the diagnosis of fungal esophagitis is probably incorrect and an upper endoscopic evaluation should be performed. Patients generally respond quickly and completely to treatment of a first episode of fungal esophagitis; therefore, neither primary prophylaxis nor long-term suppressive therapy are recommended due to the risk of infection with a resistant strain. Failure of patients on suppressive therapy to respond to antifungal medication usually indicates resistant fungal infection that may require treatment with intravenous amphotericin. If CMV-isolated esophagitis is diagnosed, the patient should begin intravenous ganciclovir, followed by IV foscarnet if the healing after three weeks is minimal.
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PMID:Management of HIV-associated esophageal disease. 1136 91

Since seven years, the 23-year-old woman suffered from severe dysphagia and cutaneous Candida-granulomas on the right side of the head, the nose and both hands. The therapy with different oral antimycotics was ineffective. Intravenously and orally administered high-dose fluconazole has induced healing of the mucocutaneous lesions. The esophageal stenosis, most likely caused by esophageal candidosis, was found as the origin of dysphagia. It was successfully treated by fluconazole and endoscopic dilatations.
Mycoses 2003
PMID:[Chronic mucocutaneous candidosis with severe esophageal stricture]. 1295 47

Diabetes mellitus is the most common endocrinologic disease all over the world. 150 million people suffer from this disease, in Poland about 2 million. The disease on the basis of the onset and pathophysiology may be divided into type I and type II. Pathophysiologic changes include diabetic microangiopathy, macroangiopathy and neuropathy. The most common presentations in head and neck are otitis externa, hypoacusis, vertigo, disequilibrium, xerostomia, dysphagia, fungal and recurrent infections. The changes in nasal mucosa are not very well known. Only few papers concerned the problem. The main complaints of patients regarding the nose are xeromycteria, hyposmia and various degree of decreased patency of the nose. Chronic atrophic rhinitis, septal perforation, ulceration of nasal mucosa, alar necrosis, symptoms of staphylococcal or fungal infection can be found during otolaryngologic examination. The treatment in this group of patients should consist of systemic therapy of diabetes mellitus and on the other hand focal therapy with the use of a solution to moisten the nasal mucosa.
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PMID:[Nasal mucosa in patients with diabetes mellitus]. 1452 78

Superficial fungal infection of the mucous membranes (thrush) isolated to the larynx is neither widely reported nor well recognized clinically. Therefore, it is often associated with ineffective treatment and delay in diagnosis, and sometimes associated with unneeded surgical intervention. Eight cases of thrush isolated to the larynx, with no oral or oropharyngeal manifestations, are presented. Four of these were isolated to the vocal folds alone. All patients were adults, and 4 were smokers. Hoarseness was always present. Pain was present inconsistently, and there was no dysphagia or odynophagia, in contrast to other forms of upper aerodigestive tract candidiasis. On average, diagnosis was not made until 6 months after the onset of symptoms. Possible causative factors included use of systemic steroids (3 cases), broad-spectrum antibiotics (1 case), or inhaled steroids (5 cases); diabetes (2 cases); and neutropenia (1 case). In 3 cases, all with thrush isolated to the vocal folds, inhaled steroids were the only causative factor identifiable--a feature reported only twice previously. Three patients underwent surgical procedures that might have been avoided had an accurate diagnosis been made. All patients responded readily to oral fluconazole and removal of predisposing factors where possible. The signs, symptoms, predisposing factors, and treatment are compared to those of 14 cases reported in the literature over 35 years.
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PMID:Laryngeal thrush. 1596 23

In recent years, mycoses have emerged as important infections in clinical practice. This phenomenon is explained by the ever growing number of immunocompromised patients and the increasing number of people travelling in areas where fungal diseases are endemic. Head and neck infections are common in disseminated mycoses and may simulate carcinoma or cause upper airway obstruction. The most frequent causative yeasts or yeast-like organisms include Candida albicans, Cryptococcus neoformans, Histoplasma capsulatum var capsulatum, Blastomyces dermatitidis, Paracoccidioides brasiliensis and Coccidioides immitis. Other causative fungal pathogens include Aspergillus fumigatus and less frequently, Rhizopus oryzae and Rhinosporidium seeberi. Since in most cases their pathophysiology is similar, those microorganisms share a common clinical pathological presentation. Symptoms such as dysphonia or dysphagia associated with hyperplastic and ulcerative lesions on endoscopic examination should prompt biopsies. A purulent or granulomatous inflammatory tissue reaction with pseudoepitheliomatous hyperplasia warrants caution since it may lead to a mistaken diagnosis of carcinoma. The pathologist must look carefully for microorganisms with Grocott and PAS stains. The causative agent can be identified if the pathologist is aware of the risk. Positive culture is needed to institute adequate treatment.
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PMID:[Mycoses of the head and neck]. 1614 62

The authors review the epidemiology, clinical manifestations, diagnosis, and treatment of fungal thyroiditis cases previously reported in the medical literature. Aspergillus was by far the most common cause of fungal thyroiditis. Immunocompromised patients, such as those with leukemia, lymphoma, autoimmune diseases, and organ-transplant patients on pharmacological immunosuppression were particularly at risk. Fungal thyroiditis was diagnosed at autopsy as part of disseminated infection in a substantial number of patients without clinical manifestations and laboratory evidence of thyroid dysfunction. Local signs and symptoms of infection were indistinguishable from other infectious thyroiditis and included fever, anterior cervical pain, thyroid enlargement sometimes associated with dysphagia and dysphonia, and clinical and laboratory features of transient hyperthyroidism due to the release of thyroid hormone from follicular cell damage, followed by residual hypothyroidism. Antemortem diagnosis of fungal thyroiditis was made by direct microscopy and culture of a fine-needle aspirate, or/and biopsy in most cases. Since most patients with fungal thyroiditis had disseminated fungal infection with delay in diagnosis and treatment, the overall mortality was high.
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PMID:Fungal thyroiditis: an overview. 1648 84

Eosinophilic esophagitis (EE) is a rarely diagnosed condition involving eosinophilic infiltration of the esophageal mucosa. Here we present a case of EE in a 69-year-old Japanese man, who presented with abdominal pain, appetite loss, and a history of bronchial asthma. Laboratory findings included peripheral eosinophilia and an increased serum immunoglobulin E level. Computed tomography showed diffuse severe thickening of the esophageal wall, and a barium esophagogram revealed a small caliber of the middle and lower portion of the esophagus, without normal peristaltic contractions. Endoscopy of the esophagus showed a pale mucosa, with adherent whitish exudates resembling fungal infection, and prominent ring-like contractions. Histologic examination of a biopsy specimen revealed marked eosinophil infiltration into the esophageal mucosa. Endoscopic ultrasonography (EUS) demonstrated marked circumferential thickening of the esophageal submucosal layer, and an esophageal manometry study showed a high percentage of ineffective esophageal peristalsis and high-amplitude esophageal body contractions. EUS findings showed no change even after oral corticosteroid therapy, although the histological findings were improved. This is thought to be the first documented Japanese case of EE. EE should be considered in the differential diagnosis in cases of esophageal motility disturbance, even if the patients do not complain of dysphagia.
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PMID:A Japanese case of eosinophilic esophagitis. 1693 10

The authors review the epidemiology, clinical manifestations, diagnosis and treatment of Pneumocystis jiroveci thyroiditis of 15 cases reported in the medical literature. Patients with acquired immunodeficiency disease syndrome were particularly at risk. P. jiroveci thyroiditis was diagnosed at autopsy as a part of disseminated infection in a substantial number of patients without clinical manifestations and laboratory evidence of thyroid dysfunction. Local signs and symptoms of infection were indistinguishable from other infectious thyroiditis and included neck enlargement with or without cervical pain, sometimes associated with dysphagia and dysphonia, and clinical and laboratory features of hypothyroidism. Antemortem diagnosis of fungal thyroiditis was made by direct microscopy and culture of a fine-needle aspirate in most cases. As most patients with P. jiroveci thyroiditis had disseminated Pneumocystis infection with a delay in diagnosis and treatment, the overall mortality was high. Pneumocystis jiroveci thyroiditis is rare but should be suspected in HIV-infected patients with CD4 count lower than 200 cells micro(-1) on prophylatic inhalatory pentamidine who present with neck enlargement with or without pain, and clinical and laboratory evidence of hypothyroidism.
Mycoses 2007 Nov
PMID:Pneumocystis jiroveci thyroiditis: report of 15 cases in the literature. 1794 3

The close relationship between guttural pouches, cranial nerves, and sympathetic structures make neurologic abnormalities due to diseases of the guttural pouches (especially mycosis) possible. Recognition of epistaxis or mucopurulent nasal discharge, together with signs of dysfunction of the cranial nerves in contact with the guttural pouches, are important key points in order to consider a comprehensive evaluation of these structures and further definitive diagnosis. Diseases of the guttural pouches can also cause signs such as dysphagia, abnormal soft palate positioning, laryngeal paralysis, and Horner syndrome due to lesions in one or more of the cranial nerves or sympathetic structures involved with these functions. Therefore, an accurate diagnosis is essential for treatment.
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PMID:Guttural pouch diseases causing neurologic dysfunction in the horse. 2210 44

The medical records of 28 horses with guttural pouch mycosis were reviewed. The most commonly observed clinical signs were nasal discharge, epistaxis, dysphagia and/or cough. All 28 horses had the disease unilaterally, however, in five of them, it had spread into the contralateral pouch via the mesial septum. Three horses were treated medically, 11 horses underwent surgery and seven horses were treated both medically and surgically. Fifty percent of horses (14/28) were euthanased or died, fifty percent of horses (14/28) survived. There was no significant correlation between treatment method (medical, surgical, combination) and survival rate. The most common reason for euthanasia was dysphagia due to pharyngeal dysfunction. There was a highly significant correlation between the presence of dysphagia and non-survival (p=0.008).
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PMID:Guttural pouch mycosis in horses: a retrospective study of 28 cases. 2311 43


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