Presumptive clinical criteria versus endoscopy in the diagnosis of Candida esophagitis at various HIV-1 disease stages

A. Antinori, A. Antinori, A. Ammassari, R. Masetti, A. De Luca, R. Murri, E. Tamburrini, P. Magistrelli

Research output: Contribution to journalArticle

Abstract

Background and Study Aims: The presumptive diagnosis of Candida esophagitis has been included in the Centers for Disease Control (CDC) case definition for full-blown AIDS since 1987. Endoscopic examination should be reserved for patients showing symptoms despite treatment. The purpose of this study was to assess the degree of diagnostic accuracy of the CDC presumptive clinical criteria and to determine the usefulness of upper digestive endoscopy in the diagnosis of Candida esophagitis in patients infected with HIV-1, with and without a previous AIDS-defining event. Patients and Methods: A total of 144 HIV-1 infected patients who had undergone an upper digestive endoscopy were studied retrospectively. To determine the risk and the predictive value of the clinical markers, only the 84 patients without prior antimycotic therapy were included. Results: Of the 84 patients without previous treatment, 34 (41%) had a history of an AIDS-defining illness. Candida esophagitis was found on endoscopy in 11 of the AIDS and 28 of the non-AIDS cases, Oral thrush, either alone (relative risk [R.R.] 9.4; 95% C.I. 2.4-36.4; p <0.01; positive predictive value [PPV] 82%) or in combination with esophageal symptoms (R.R. 7.4; 95% C.I. 2.5-21.9; p <0.01; PPV 89%), was a reliable marker of Candida esophagitis only in patients with a previous AIDS-defining event. The diagnostic value of the CDC presumptive pattern was confirmed by a multivariate analysis after controlling for the CD4 cell count (R.R. 9.3; 95% C.I. 2.3-25.3; p <0.01). On the other hand, in HIV-1 positive patients without a previous AIDS-defining event, the diagnostic accuracy of oral candidiasis, either alone (R.R. 1.4; 95% C.I. 0.8-2.4; p n.s.; PPV 64%) or in combination with esophageal symptoms (R.R. 1.1; 95% C.I. 0.7-1.8; p n.s.; PPV 60%), was too low to allow a reliable diagnosis of Candida esophagitis. Conclusions: A presumptive diagnosis of Candida esophagitis on the basis of the CDC clinical criteria is a valid diagnostic method only in HIV-1 infected patients with a previous diagnosis of full-blown AIDS. Upper digestive endoscopy should be performed in symptomatic patients with no history of an AIDS-defining illness, especially if the diagnosis of esophageal candidiasis is important for surveillance purposes.

Original languageEnglish
Pages (from-to)371-376
Number of pages6
JournalEndoscopy
Volume27
Issue number5
Publication statusPublished - 1995

Fingerprint

Esophagitis
Candida
Endoscopy
HIV-1
Acquired Immunodeficiency Syndrome
Centers for Disease Control and Prevention (U.S.)
Oral Candidiasis
Candidiasis
CD4 Lymphocyte Count
Therapeutics
Multivariate Analysis
Biomarkers

ASJC Scopus subject areas

  • Medicine (miscellaneous)

Cite this

Presumptive clinical criteria versus endoscopy in the diagnosis of Candida esophagitis at various HIV-1 disease stages. / Antinori, A.; Antinori, A.; Ammassari, A.; Masetti, R.; De Luca, A.; Murri, R.; Tamburrini, E.; Magistrelli, P.

In: Endoscopy, Vol. 27, No. 5, 1995, p. 371-376.

Research output: Contribution to journalArticle

Antinori, A, Antinori, A, Ammassari, A, Masetti, R, De Luca, A, Murri, R, Tamburrini, E & Magistrelli, P 1995, 'Presumptive clinical criteria versus endoscopy in the diagnosis of Candida esophagitis at various HIV-1 disease stages', Endoscopy, vol. 27, no. 5, pp. 371-376.
Antinori, A. ; Antinori, A. ; Ammassari, A. ; Masetti, R. ; De Luca, A. ; Murri, R. ; Tamburrini, E. ; Magistrelli, P. / Presumptive clinical criteria versus endoscopy in the diagnosis of Candida esophagitis at various HIV-1 disease stages. In: Endoscopy. 1995 ; Vol. 27, No. 5. pp. 371-376.
@article{3f468a324a9c4d0a9667801be673ecb2,
title = "Presumptive clinical criteria versus endoscopy in the diagnosis of Candida esophagitis at various HIV-1 disease stages",
abstract = "Background and Study Aims: The presumptive diagnosis of Candida esophagitis has been included in the Centers for Disease Control (CDC) case definition for full-blown AIDS since 1987. Endoscopic examination should be reserved for patients showing symptoms despite treatment. The purpose of this study was to assess the degree of diagnostic accuracy of the CDC presumptive clinical criteria and to determine the usefulness of upper digestive endoscopy in the diagnosis of Candida esophagitis in patients infected with HIV-1, with and without a previous AIDS-defining event. Patients and Methods: A total of 144 HIV-1 infected patients who had undergone an upper digestive endoscopy were studied retrospectively. To determine the risk and the predictive value of the clinical markers, only the 84 patients without prior antimycotic therapy were included. Results: Of the 84 patients without previous treatment, 34 (41{\%}) had a history of an AIDS-defining illness. Candida esophagitis was found on endoscopy in 11 of the AIDS and 28 of the non-AIDS cases, Oral thrush, either alone (relative risk [R.R.] 9.4; 95{\%} C.I. 2.4-36.4; p <0.01; positive predictive value [PPV] 82{\%}) or in combination with esophageal symptoms (R.R. 7.4; 95{\%} C.I. 2.5-21.9; p <0.01; PPV 89{\%}), was a reliable marker of Candida esophagitis only in patients with a previous AIDS-defining event. The diagnostic value of the CDC presumptive pattern was confirmed by a multivariate analysis after controlling for the CD4 cell count (R.R. 9.3; 95{\%} C.I. 2.3-25.3; p <0.01). On the other hand, in HIV-1 positive patients without a previous AIDS-defining event, the diagnostic accuracy of oral candidiasis, either alone (R.R. 1.4; 95{\%} C.I. 0.8-2.4; p n.s.; PPV 64{\%}) or in combination with esophageal symptoms (R.R. 1.1; 95{\%} C.I. 0.7-1.8; p n.s.; PPV 60{\%}), was too low to allow a reliable diagnosis of Candida esophagitis. Conclusions: A presumptive diagnosis of Candida esophagitis on the basis of the CDC clinical criteria is a valid diagnostic method only in HIV-1 infected patients with a previous diagnosis of full-blown AIDS. Upper digestive endoscopy should be performed in symptomatic patients with no history of an AIDS-defining illness, especially if the diagnosis of esophageal candidiasis is important for surveillance purposes.",
author = "A. Antinori and A. Antinori and A. Ammassari and R. Masetti and {De Luca}, A. and R. Murri and E. Tamburrini and P. Magistrelli",
year = "1995",
language = "English",
volume = "27",
pages = "371--376",
journal = "Endoscopy",
issn = "0013-726X",
publisher = "Georg Thieme Verlag",
number = "5",

}

TY - JOUR

T1 - Presumptive clinical criteria versus endoscopy in the diagnosis of Candida esophagitis at various HIV-1 disease stages

AU - Antinori, A.

AU - Antinori, A.

AU - Ammassari, A.

AU - Masetti, R.

AU - De Luca, A.

AU - Murri, R.

AU - Tamburrini, E.

AU - Magistrelli, P.

PY - 1995

Y1 - 1995

N2 - Background and Study Aims: The presumptive diagnosis of Candida esophagitis has been included in the Centers for Disease Control (CDC) case definition for full-blown AIDS since 1987. Endoscopic examination should be reserved for patients showing symptoms despite treatment. The purpose of this study was to assess the degree of diagnostic accuracy of the CDC presumptive clinical criteria and to determine the usefulness of upper digestive endoscopy in the diagnosis of Candida esophagitis in patients infected with HIV-1, with and without a previous AIDS-defining event. Patients and Methods: A total of 144 HIV-1 infected patients who had undergone an upper digestive endoscopy were studied retrospectively. To determine the risk and the predictive value of the clinical markers, only the 84 patients without prior antimycotic therapy were included. Results: Of the 84 patients without previous treatment, 34 (41%) had a history of an AIDS-defining illness. Candida esophagitis was found on endoscopy in 11 of the AIDS and 28 of the non-AIDS cases, Oral thrush, either alone (relative risk [R.R.] 9.4; 95% C.I. 2.4-36.4; p <0.01; positive predictive value [PPV] 82%) or in combination with esophageal symptoms (R.R. 7.4; 95% C.I. 2.5-21.9; p <0.01; PPV 89%), was a reliable marker of Candida esophagitis only in patients with a previous AIDS-defining event. The diagnostic value of the CDC presumptive pattern was confirmed by a multivariate analysis after controlling for the CD4 cell count (R.R. 9.3; 95% C.I. 2.3-25.3; p <0.01). On the other hand, in HIV-1 positive patients without a previous AIDS-defining event, the diagnostic accuracy of oral candidiasis, either alone (R.R. 1.4; 95% C.I. 0.8-2.4; p n.s.; PPV 64%) or in combination with esophageal symptoms (R.R. 1.1; 95% C.I. 0.7-1.8; p n.s.; PPV 60%), was too low to allow a reliable diagnosis of Candida esophagitis. Conclusions: A presumptive diagnosis of Candida esophagitis on the basis of the CDC clinical criteria is a valid diagnostic method only in HIV-1 infected patients with a previous diagnosis of full-blown AIDS. Upper digestive endoscopy should be performed in symptomatic patients with no history of an AIDS-defining illness, especially if the diagnosis of esophageal candidiasis is important for surveillance purposes.

AB - Background and Study Aims: The presumptive diagnosis of Candida esophagitis has been included in the Centers for Disease Control (CDC) case definition for full-blown AIDS since 1987. Endoscopic examination should be reserved for patients showing symptoms despite treatment. The purpose of this study was to assess the degree of diagnostic accuracy of the CDC presumptive clinical criteria and to determine the usefulness of upper digestive endoscopy in the diagnosis of Candida esophagitis in patients infected with HIV-1, with and without a previous AIDS-defining event. Patients and Methods: A total of 144 HIV-1 infected patients who had undergone an upper digestive endoscopy were studied retrospectively. To determine the risk and the predictive value of the clinical markers, only the 84 patients without prior antimycotic therapy were included. Results: Of the 84 patients without previous treatment, 34 (41%) had a history of an AIDS-defining illness. Candida esophagitis was found on endoscopy in 11 of the AIDS and 28 of the non-AIDS cases, Oral thrush, either alone (relative risk [R.R.] 9.4; 95% C.I. 2.4-36.4; p <0.01; positive predictive value [PPV] 82%) or in combination with esophageal symptoms (R.R. 7.4; 95% C.I. 2.5-21.9; p <0.01; PPV 89%), was a reliable marker of Candida esophagitis only in patients with a previous AIDS-defining event. The diagnostic value of the CDC presumptive pattern was confirmed by a multivariate analysis after controlling for the CD4 cell count (R.R. 9.3; 95% C.I. 2.3-25.3; p <0.01). On the other hand, in HIV-1 positive patients without a previous AIDS-defining event, the diagnostic accuracy of oral candidiasis, either alone (R.R. 1.4; 95% C.I. 0.8-2.4; p n.s.; PPV 64%) or in combination with esophageal symptoms (R.R. 1.1; 95% C.I. 0.7-1.8; p n.s.; PPV 60%), was too low to allow a reliable diagnosis of Candida esophagitis. Conclusions: A presumptive diagnosis of Candida esophagitis on the basis of the CDC clinical criteria is a valid diagnostic method only in HIV-1 infected patients with a previous diagnosis of full-blown AIDS. Upper digestive endoscopy should be performed in symptomatic patients with no history of an AIDS-defining illness, especially if the diagnosis of esophageal candidiasis is important for surveillance purposes.

UR - http://www.scopus.com/inward/record.url?scp=0029149533&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029149533&partnerID=8YFLogxK

M3 - Article

C2 - 7588351

AN - SCOPUS:0029149533

VL - 27

SP - 371

EP - 376

JO - Endoscopy

JF - Endoscopy

SN - 0013-726X

IS - 5

ER -