{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T11:43:40Z","timestamp":1777635820309,"version":"3.51.4"},"reference-count":20,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2025,1,3]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Candida<\/jats:italic>\n                      esophagitis is usually readily identified on routine H&amp;E-stained sections as the infection typically presents with prominent acute inflammation as a clue to search for organisms. However, in some cases, inflammation is absent, and detection of organisms relies on the observation of zones exhibiting parakeratosis with a delicate \u2018flaky\u2019 appearance. Our study aimed to establish a correlation between the histomorphology of oesophageal candidiasis and an associated clinical profile.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We reviewed 53 sequential biopsy specimens from patients with\n                      <jats:italic>Candida<\/jats:italic>\n                      esophagitis collected over 1 year. Biopsies were assessed for acute inflammation, intraepithelial lymphocytosis and lymphoid aggregates. Patients\u2019 medical records were reviewed for data on age, gender, race, immune status, smoking, corticosteroid use, HIV status and organ transplantation history. Correlations between these factors and histomorphological patterns were assessed using test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 53 biopsies, 20 lacked acute inflammation and 33 had it. 15 biopsies showed both acute and lymphoid inflammation and 5 showed lymphocytosis only. Among 16 smokers, 6 (37%) had acute inflammation and 10 (63%) had parakeratosis. In non-smokers, 24 (71%) had acute inflammation and 10 (29%) had parakeratosis. A significant correlation was found between smoking and absence of acute neutrophilic infiltration (p=0.025), but no other clinical factor was associated with inflammatory patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Candida<\/jats:italic>\n                      esophagitis can be uninflamed with \u2018flaky\u2019 parakeratosis or associated with acute inflammation or lymphocytosis with or without neutrophilic infiltration. Inflammation was often absent in smokers, suggesting synergistic local immunosuppressive effect is this overall immunosuppressed population.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jcp-2024-209908","type":"journal-article","created":{"date-parts":[[2025,1,11]],"date-time":"2025-01-11T13:20:30Z","timestamp":1736601630000},"page":"535-539","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["\u2018Sneaky\u2019 uninflamed oesophageal candidiasis: morphological clues and comparison with candidiasis associated with inflammation"],"prefix":"10.1136","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6842-2336","authenticated-orcid":false,"given":"Yasamin","family":"Mirzabeigi","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2707-7629","authenticated-orcid":false,"given":"Turky","family":"Alkhatery","sequence":"additional","affiliation":[{"name":"Department of Basic Sciences, Majmaah University, Al Majma'ah, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1822-5109","authenticated-orcid":false,"given":"Amr","family":"Abulaban","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4845-7016","authenticated-orcid":false,"given":"Felipe","family":"Ruiz Casas","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9788-8218","authenticated-orcid":false,"given":"Elizabeth Anne","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,11]]},"reference":[{"key":"2025112108451768000_78.8.535.1","unstructured":"Robertson KD , Nagra N , Mehta D . Esophageal candidiasis. In: StatPearls. Treasure Island (FL), 2024."},{"key":"2025112108451768000_78.8.535.2","first-page":"333","article-title":"Etiology, diagnosis and treatment of infectious esophagitis","volume":"8","author":"Roso\u0142owski","year":"2013","journal-title":"Prz Gastroenterol"},{"key":"2025112108451768000_78.8.535.3","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.1933-18"},{"key":"2025112108451768000_78.8.535.4","doi-asserted-by":"publisher","DOI":"10.1007\/BF01324956"},{"key":"2025112108451768000_78.8.535.5","doi-asserted-by":"publisher","DOI":"10.1038\/s41379-018-0060-4"},{"key":"2025112108451768000_78.8.535.6","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqw210"},{"key":"2025112108451768000_78.8.535.7","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro2636"},{"key":"2025112108451768000_78.8.535.8","first-page":"307","article-title":"Candida esophagitis","volume":"36","author":"Haulk","year":"1991","journal-title":"Adv Intern Med"},{"key":"2025112108451768000_78.8.535.9","doi-asserted-by":"publisher","DOI":"10.1046\/j.1442-2050.2003.00305.x"},{"key":"2025112108451768000_78.8.535.10","doi-asserted-by":"publisher","DOI":"10.14740\/gr1019w"},{"key":"2025112108451768000_78.8.535.11","first-page":"161","article-title":"Is endoscopic diagnosis of Candida albicans esophagitis reliable? Correlations with pathology and mycology","volume":"25","author":"Redah","year":"2001","journal-title":"Gastroenterol Clin Biol"},{"key":"2025112108451768000_78.8.535.12","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2014-0132-RA"},{"key":"2025112108451768000_78.8.535.13","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000001394"},{"key":"2025112108451768000_78.8.535.14","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e31829dff19"},{"key":"2025112108451768000_78.8.535.15","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0133589","article-title":"Long-Term Trends in Esophageal Candidiasis Prevalence and Associated Risk Factors with or without HIV Infection: Lessons from an Endoscopic Study of 80,219 Patients","volume":"10","author":"Takahashi","year":"2015","journal-title":"PLoS One"},{"key":"2025112108451768000_78.8.535.16","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0000000000000199"},{"key":"2025112108451768000_78.8.535.17","doi-asserted-by":"publisher","DOI":"10.1177\/0022034511421200"},{"key":"2025112108451768000_78.8.535.18","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.175.4.2684"},{"key":"2025112108451768000_78.8.535.19","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2013.54.1.160"},{"key":"2025112108451768000_78.8.535.20","first-page":"162","article-title":"An epidemiologic analysis of co-occurring alcohol and tobacco use and disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions","volume":"29","author":"Falk","year":"2006","journal-title":"Alcohol Res Health"}],"container-title":["Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jcp-2024-209908","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T16:45:26Z","timestamp":1763743526000},"score":1,"resource":{"primary":{"URL":"https:\/\/jcp.bmj.com\/lookup\/doi\/10.1136\/jcp-2024-209908"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,11]]},"references-count":20,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,7,18]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/jcp-2024-209908"],"URL":"https:\/\/doi.org\/10.1136\/jcp-2024-209908","relation":{},"ISSN":["0021-9746","1472-4146"],"issn-type":[{"value":"0021-9746","type":"print"},{"value":"1472-4146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,11]]}}}