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    03Sep2018

    Letter to the editor 2: Predictors of oesophageal candidiasis in persons with or without HIV infection

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    Martha F Mushi1, Nathaniel Ngeta2, Mariam M Mirambo1, Stephen E. Mshana1

    1. Microbiology and Immunology Department; Weill Bugando School of Medicine, P.O. Box 1464, Mwanza,
    2. Department of Internal Medicine Weill Bugando School of Medicine, P.O. Box 1464 Mwanza, Tanzania.

    DOI: https://dx.doi.org/10.4314/ahs.v18i2.33

    Cite as: Mushi MF, Ngeta N, Mirambo MM, Mshana SE. Letter to the editor 2: Predictors of oesophageal candidiasis in persons with or without

    HIV infection. Afri Health Sci. 2018;18(2): 470-471. https://dx.doi.org/10.4314/ahs.v18i2.33

    In reply,

    With great curiosity we have read the letter to editor by Bongomin F. and colleagues1 written as a comment to our recent published article in African Health Sciences2, we appreciate their interest to our article and inputs. The interest of the study was to investigate the risk factors for esophageal candidiasis (EC). The risk factors are clearly indicated in the original manuscript regardless of HIV status1. In addition, HIV was also analysed as one of the risk factor as previously reported elsewhere 3,4. The increase in age was found to protect the patients from developing EC as previous published5. In order not to confuse the reader, the odd ratio and 95%confidence interval for age variable in table 2 in the original article1 was reversed to

    		 show the decrease in age as the risk of ECand presented in the abstract and content of the original manuscript1. In addition, in this letter to editor we have included results regarding factors associated with EC in HIV negative individuals. Of 554 HIV negative patients, 20(3.6%) had EC. On multivariate logistic regression analysis, increase in age independently protected HIV negative population from getting EC (OR 0.95, 95%CI; 0.92-0.99; p=0.0035), whilebeing female (OR 11.74, 95%CI; 1.55-

    88.82; p=0.017), alcohol use(OR 20.45, 95%CI; 4.8986.56; <=0.001), smoking(OR 5.44, 95%CI; 1.18-25.12; p=0.03), antibiotic use(OR 5.2, 95%CI; 1.67-16.21; p<0.005), and having peptic ulcer diseases  (OR 8.24, 95%CI; 2.21-30.72; p<0.002) independently predicted EC among HIV negative patients (table 4).

    Table 4: Risk factors associated with esophageal candidiasis among HIV negative

    patients attending endoscopy unit (n=554)

    Variable  Univariate  Multivariate
         
      EC    n

    (%)

    		 OR(95%CI) P value OR(95%CI) P
    Age* 3931-50 0.99(0.96-1.02) 0.365 0.95(0.92-0.99) 0.035
    Sex           
    Male (307) 11(3.6) 1      
    Female (247) 9(3.6) 1.02(0.414-2.496) 0.97 11.74(1.55-88.82) 0.017
    Alcohol           
    No (475) 6(1.3) 1      
    Yes (79) 14(17.7) 16.8(6.25-45.35) <0.001 20.45(4.89-86.56) <0.001
    Smoking          
    No (515) 13(2.5) 1      
    Yes (39) 7(18) 8.45(3.15-22.64) <0.001 5.44(1.18-25.12) 0.03
    Corticosteroid use          
    No (551) 18(3.3) 1      
    Yes (3) 2(66.7) 59.2(5.13-683.5) 0.001 – –
    Clinical presentation          
    No (241) 3(1.2) 1      
    Yes (313) 17(5.43) 4.56(1.32-15.73) 0.016 3.90(0.90-16.85) 0.068
    Antibiotics use           
    No (448) 9(2.01) 1      
    Yes (106) 11(10.38) 5.64(2.27-14.01) <0.001 5.2(1.67-16.21) 0.005
    Diabetic           
    Negative (542) 14(2.6) 1      
    Positive (12) 6(50.0) 37.7(10.81-

    131.62)

    		 <0.001 – –
    PUD          
    No (473) 13(2.8) 1      
    Yes (81) 7(8.6) 3.35(1.29-8.66) 0.013 8.24(2.21-30.72) 0.002
    Asthma           
    No (550) 18(3.27) 1      
    Yes (4) 2(50.0) 29.56(3.94-

    221.79)

    		 0.001 – –

    PUD is the peptic ulcer diseases; some known variable like use of corticosteroid, having diabetic and asthma were not include in multivariate analysis because the patients with EC were very few which could lead to a very wide confidence interval.

    African

    Health Sciences

    © 2018 Mushi et al. Licensee African Health Sciences. This is an Open Access article distributed under the terms of the Creative commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

    470                                                                                                  African Health Sciences Vol 18 Issue 2, June, 2018

    Furthermore, we have noted that, the original published presented during proofreading, for this reason we have article did not incorporate the corrections which were presented the correct table 3 as seen below:

    Table 3: Characteristics of HIV negative patients with EC

    S/number Sex Age Presentation Alcohol Smoking Antibiotic Diabetic Cirrhosis PUD Asthma
    1 Male 20 Hemoptysis Yes Yes No No Yes No No
    2 Female 24 Ep. pain No No Yes No No Yes No
    3 Male 32 Ep. Pain Yes Yes Yes No No No No
    4 Female 30 Ep. Pain Yes No Yes No No No No
    5 Male 47 Dysphagia Yes Yes Yes Yes No No No
    6 Female 17 Dysphagia No No No No No No Yes
    7 Male 40 Ep. pain Yes No Yes No No Yes No
    8 Female 38 Ep. pain Yes No No Yes No No No
    9 Female 47 Ep. pain No No No Yes No No No
    10 Male 77 Ep. pain Yes Yes Yes No No No No
    11 Female 38 Ep. pain No No Yes No No Yes No
    12 Male 34 UGIB Yes Yes No No No Yes No
    13 Female 60 Ep. pain Yes No Yes No No Yes No
    14 Male 28 Ep. pain Yes Yes No No No No No
    15 Male 40 Dysphagia Yes No No Yes No Yes No
    16 Male 36 Ep. pain Yes No Yes Yes No No No
    17 Male 44 UGIB Yes Yes No No Yes No No
    18 Female 62 Ep. pain No No No Yes No No No
    19 Female 33 Ep. pain Yes No Yes No No Yes No
    20 Male 23 Ep. pain No No Yes No No No Yes

    Note; Ep. Pain is epigastric pain and UGIB is upper gastro intestinal bleeding

    References

    1.                  Bongomin F, Fayemiwo S: Predictors of oesophageal candidiasis in persons with or without HIV infection. Afri Health Sci 2018, 18(2).

    2.                  Mushi MF, Ngeta N, Mirambo MM, Mshana SE: Predictors of esophageal candidiasis among patients attending endoscopy unit in a tertiary hospital, Tanzania: a retrospective cross-sectional study. African Health Sciences 2018, 18(1):66-71.

    3.                  Crowe SM, Carlin JB, Stewart KI, Lucas CR, Hoy JF:

    		 Predictive value of CD4 lymphocyte numbers for the development of opportunistic infections and malignancies in HIV-infected persons. Journal of acquired immune deficiency syndromes, 1991, 4(8):770-776.

    4.                  Martinez AC, Tobal FG, Ruiz-Irastorza G, Lopez AG, Navia FA, Sangrador CO, Arribas MM: Risk factors for esophageal candidiasis. European Journal of Clinical Microbiology and Infectious Diseases, 2000, 19(2):96-100.

    5.                  Greenwald DA: Aging, the gastrointestinal tract, and risk of acid-related disease. The American Journal of Medicine Supplements 2004, 117(5):8-13.
    African Health Sciences Vol 18 Issue 2, June, 2018 471

     Letter to the editor 2 Predictors of oesophageal candidiasis in persons  with or without HIV infection.PDF  

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