Oesophageal candidiasis in COVID-19 рatients

The purpose is to examine the incidence and clinical characteristics of сandidiasis esophagitis in COVID-19 patients. Material and methods. We conducted a retrospective observational study by analyzing the medical records of 68 patients with COVID-19 and esophageal candidiasis. All of the patients received in-patient treatment at the Republic Clinical Infectious Diseases Hospital in Kazan from 2020 to 2022. Results. From 2020 to 2022, 1177 fibrogastroduodenoscopies (FGDS) were performed on patients with COVID-19 at the Republic Clinical Infectious Diseases Hospital in Kazan. Esophageal candidiasis was diagnosed in 68 (5.8%) of the examined patients, Mostly often, elderly patients with chronic pathology of the gastrointestinal tract (65%) and diabetes mellitus (29%). Esophageal candidiasis developed in patients with different severity of COVID-19, including mild forms of infection. According to the Kodsi scale, grade I of esophageal damage was diagnosed in 63.3%, grade II in 27.9%, grade III in 4.4%, grade IV in 4.4% of patients. Patients complained of epigastric pain (34.6%), chest pain (7.7%), dysphagia (7.7%), nausea and vomiting (13.4%), heartburn (1.9%), hiccups (1.9%). 41.5% of patients had no “esophageal” complaints. Antimycotic therapy for candidal esophagitis was carried out with fluconazole at a daily dose of 400 mg, then 200 mg for 14 days. 92.5% of patients were discharged with improvement or clinical recovery. Death occurred in 5 (7.5%) patients. The cause of death was COVID-19 complications (ARDS, PE, multiple organ failure syndrome, acute kidney failure, etc.). Conclusion. The development of esophageal candidiasis is possible in patients with any severity of COVID-19. Esophageal candidiasis can be asymptomatic. The severity of fungal infection of the esophagus correlates with the severity of coronavirus infection. Patients with severe forms of COVID-19 may develop grades III and IV of esophageal damage. If esophageal candidiasis is detected in a patient with COVID-19, a mycological test of blood, urine and bronchoalveolar lavage should be performed to identify other localizations of invasive candidiasis.