Candidiasis Diagnosis
Diagnosis
- Laboratory exams are used to help identify the different Candida species and susceptibility to antifungals
Laboratory Tests
Cutaneous Candidiasis
Skin
Oropharyngeal
Candidemia
Skin
- Gram stain or potassium hydroxide (KOH) mount showing predominantly Candida sp
- Gram stain or KOH mount showing predominantly Candida sp
Oropharyngeal
- 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
Candidemia
- 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
Imaging
Chronic Disseminated (Hepatosplenic)
- 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