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. 2020 Mar 30;9(4):939.
doi: 10.3390/jcm9040939.

Infectious Esophagitis in Romanian Children: From Etiology and Risk Factors to Clinical Characteristics and Endoscopic Features

Mădălina Adriana Bordea  1   2 , Alexandru Pîrvan  2 , Dan Gheban  3 , Ciprian Silaghi  4 , Iulia Lupan  5 , Gabriel Samașca  6 , Lia Pepelea  1 , Lia Monica Junie  1 , Carmen Costache  1
Affiliations

Infectious Esophagitis in Romanian Children: From Etiology and Risk Factors to Clinical Characteristics and Endoscopic Features

Mădălina Adriana Bordea et al. J Clin Med. .

Abstract

Objectives: The aim of this study is to provide information about prevalence, etiology, risk factors, clinical characteristics and endoscopic features of various types of infectious esophagitis in children.

Methods: We performed a total of 520 upper gastrointestinal tract endoscopies in Pediatric Clinic II, Emergency Hospital for Children, Cluj-Napoca. Indications for endoscopy in our cohort were gastrointestinal tract symptoms such as dysphagia, heartburn, or appetite loss.

Results: The prevalence of infectious esophagitis in the study population was 2.11% (11 patients). Candida albicans (C. albicans) was the most frequent cause. Our data illustrates that herpes simplex virus (HSV)-induced esophagitis is common in immunocompromised patients and should be systematically suspected in cases of severe dysphagia, heartburn, or hematemesis. In the present study, all cytomegalovirus (CMV) esophagitis patients were immunocompromised. Immunodeficiency (81.8%) and prolonged antibiotic therapy with broad-spectrum antibiotics were by far the most important risk factors involved in the pathogenicity of the disease. Dysphagia, appetite loss, heartburn, epigastralgia, and hematemesis were the main clinical manifestations. Infectious esophagitis was associated with significant mortality. In four patients, endoscopy during life showed signs of infectious esophagitis; however, the precise etiology was only established post-mortem, in the pathological anatomy laboratory department. A risk factor involved in pathogenesis of post-mortem diagnosed infectious esophagitis is the DiGeorge syndrome for CMV and HSV patients.

Conclusions: The study illustrates that infectious esophagitis should be considered in immunocompromised infants with prolonged antibiotic therapy with broad-spectrum antibiotics.

Keywords: clinical characteristics; endoscopic assessment; esophagitis; etiology; prevalence; risk factors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Herpes simplex virus (HSV)-inducedesophagitis (microscopy-HE, 400×) with serous vesicle formation.
Figure 2
Figure 2
Cytomegalovirus (CMV)-induced esophagitis (microscopy-HE, 1000×):intracytoplasmic and intranuclear large, basophilic inclusion bodies surrounded by a clear halo (Cowdry type B).
See this image and copyright information in PMC

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