Candidiasis Diagnosis

• Laboratory exams are used to help identify the different Candida species and susceptibility to antifungals

• Gram stain or potassium hydroxide (KOH) mount showing predominantly Candida sp

• Gram stain or KOH mount showing predominantly Candida sp

• Gram stain or KOH preparation showing masses of hyphae, pseudohyphae and yeast forms
• Culture is not specific because Candida grows easily from normal mouths
• Irregular esophageal mucosa on radiologic studies

• Definitive: Biopsy during endoscopy or by brushing
• In appropriate clinical settings, endoscopic appearance of white patches that show masses of hyphae and pseudohyphae on scraping is enough evidence to initiate therapy
• To avoid invasive procedures, empiric antifungal therapy may be given to an at-risk patient who presents with typical symptoms along with oral thrush

Intra-abdominal

• Single or multiple ulcerations containing Candida deep in ulcer beds on endoscopy; white plaques and thickening of mucosal folds in the duodenum and jejunum may also be seen
  

• Confirmed by presence of yeast or hyphae and a normal pH (4-4.5) in a wet-mount preparation with the use of saline and 10% potassium hydroxide
• Please see Vaginitis: Trichomoniasis, Candidiasis, Bacterial Vaginosis disease management chart for further information

• Culture and biopsy of involved areas/organs

• Definitive diagnosis can be made only by histopathologic demonstration of the organism invading tissue or by the isolation of Candida sp from normally sterile body sites eg blood
• However, blood cultures are negative in many patients with disseminated infection
• A presumptive clinical diagnosis based on the presence of typical signs and symptoms in a high-risk patient is often the basis for initiating antifungal therapy

• Definitive: Biopsy with culture and histopathologic exam or aspiration of  ≥1 abscesses in an attempt to identify the infecting organism

• Blood cultures may be negative in mamy patients
• The presence of endophthalmitis and major embolic episodes should raise suspicion of candidal endocarditis

• Dilated retinal examination
• Fundoscopy shows large and off-white cotton ball-like lesions with indistinct borders; cellular aggregates can be seen in vitreous; hemorrhages, Roth Spots, hypopyon, anterior chamber inflammation, iritis
• Vitrectomy is helpful diagnostically and therapeutically

• Renal involvement is indicated by granular casts with hyphal elements on urinalysis
• Urine fungal culture
• Cystoscopic visualization with biopsy either biopsy-proven fungus ball or tissue invasion is necessary to determine presence of disease invasion

• Cerebrospinal fluid (CSF) findings: Pleocytosis, hypoglycorrhachia and elevated protein levels, wet mount Gram stain positive for Candida sp

• Definitive diagnosis: Biopsy with demonstration of tissue invasion
• Positive sputum cultures usually represent colonization rather than active infection and therefore should not prompt treatment

• Culture of peritoneal fluid

• Blood cultures are usually negative
• Osteomyelitis may be diagnosed by percutaneous needle aspiration of the involved area

• Cultures of blood and involved veins

• Computed tomography (CT) scan/magnetic resonance imaging (MRI) scan/ultrasonography reveal multiple hepatosplenic filling defects and/or abscesses
• CT scan is the most specific diagnostic tool
  • The lesions are hypodense and many times have ring enhancement

• Echocardiography is used to detect vegetations

• CT scan may show abscesses

• X-ray and CT scan are nonspecific

• X-ray: Nonspecific