*5.2.4 Diagnostic factors for HIV esophagitis*

It is important to rule out CMV esophagitis by performing endoscopy before confirming the HIV esophagitis diagnosis because most HIV ulcers are not distinguishable from CMV ulcers on the basis of just the clinical and radiological criteria alone. In addition, specimens from biopsy, brushings and viral cultures from the esophagus may be needed in order to be certain about the diagnosis and offer the patient the correct treatment.

During the period of transient chills, fever, malaise and rash of early infection with HIV, multiple, small, aphthoid lesions are observed on patients. In addition, giant deep ulcers measuring several centimeters can be seen later. Large ulcers may be complicated by fistula formation, perforation, hemorrhage, or superinfection in patients.

As most cases of HIV esophagitis responds well to oral steroids treatments, but CMV esophagitis is treated with toxic antiviral agents like ganciclovir, it is essential to differentiate between these infections. Hence endoscopic investigation should be undertaken before treating the patients.

#### *5.2.5 Diagnostic factors for varicella-zoster virus (VZV) esophagitis*

Severe esophagitis can be caused by Varicella-zoster virus (VZV), and finding its concurrent demographic lesions is extremely important to its diagnosis and also development of effective treatment plan for the patients.

On esophagogastroduodenoscopy (EGD), VZV has different features, which can range from infrequent vesicles of ulcerative lesions to a confluence of ulceration with necrosis. Epithelial cells with VZV display ballooning degeneration, edema and multinucleated giant cells with eosinophilic inclusion bodies on histologic investigation. In differentiating VZV from HSV, immunohistochemical staining utilizing monoclonal antibodies is usually helpful in the process.

#### *5.2.6 Diagnostic factors for Epstein-Barr virus (EBV) esophagitis*

Epstein–Barr virus (EBV) causes different syndromes in people. Crohn's disease and ulcerative colitis are common diseases that can be manifested by EBV, but the incidence and prevalence of EBV are still not well stated in both immunocompetent and immunodeficient people, hence, it should be seriously considered in any person presenting with symptoms of the esophagus. EBV esophagitis in an immuunocompetent individual is a rare occurrence, and thus represents either a primary infection, reactivation/reoccurrence, which si usually is characterized acute onset of symptoms and extensive ulcerative involvement of the upper/mid third of the esophagus. Oral hairy leukoplakia has similar histologic features of esophageal lesions linked to the EBV.

#### *5.2.7 Diagnostic factors for human papillomavirus (HPV) esophagitis*

Multiple epithelial lesions and cancers that are predominantly found on cutaneous mucosal surfaces are caused by the human papillomavirus (ahpv), which is a non-enveloped, double stranded, circular DNA virus. The virus has over 100 subtypes, and people with persistent HPV infection, especially those with many sexual partners are at very high risk for contracting more subtypes of HPV. At present, the HPV infection can be classified as non-genital/cutaneous; mucosal or anogenital and epidermodysplasia verruciformis (EV).

In some cases, the clinical lesions of HPV can be visibly identifiable, but in other cases, latent lesions of HPV may require testing for viral deoxyribonucleic acid (DNA) before confirming the diagnosis. In majority of the cases, HPV infections are latent and most lesions manifest as warts rather than malignancy in clinic.

Nowadays, the HPV has been identifies as the etiological agent for laryngeal, oral, lung and anogenital cancer. HPV subtypes six and 11 are low risk and usually manifest with the formation of condylomata and low grade precancerous lesions. However, HPV 16 and 18 are high risks that are responsible for high grade intraepithelial lesions, which progress to malignancies.

It is also crucial to note that HPV alone does not cause cancer, but it requires triggers such as folate deficiency, smoking, immunosuppression, and pregnancy and ultraviolet (UV) light exposure.

Esophagitis caused by HPV is an asymptomatic illness. Lesions of the disease are usually found in the middle to distal esophagus in patients and they may

#### *Infectious Esophagitis DOI: http://dx.doi.org/10.5772/intechopen.99917*

look like erythematous macules, white plaques, nodules, or exuberant frondlike lesions. The diagnosis of HPV esophagitis is made based on histology, and koilocytosis, giant cells, and cytologic atypia are visible on immunohistochemical stains.
