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Mucosal Candidiasis Workup

  • Author: Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC); Chief Editor: William D James, MD  more...
 
Updated: Feb 12, 2016
 

Laboratory Studies

Quantitative saliva culture is useful in the diagnosis of oral candidosis. Carriers and patients with oral candidal infection can be distinguished reliably (95% confidence limits) on the basis of quantitative culture, since they harbor more than 400 colony-forming units of candidal organisms per mL of saliva. Ask the patient to rinse his or her mouth for 60 seconds with 10 mL of sterile phosphate-buffered saline (PBS; pH 7.2) or sterile water; then, return the oral rinse to the universal container. If the patient wears a denture, remove it prior to sampling. A rapid commercial system (Microstix-Candida or Oricult-N test) for diagnosing oral candidosis is useful for screening patients in the clinical setting, particularly when microbiology laboratories are not in easy access.

Because Candida species stain poorly by hematoxylin and eosin, staining with periodic acid-Schiff (PAS), Gridley stain, or Gomori methenamine silver (GMS) stain is used. In both Gridley stain and the PAS procedure, fungi appear pinkish red. GMS technique stains yeast cell walls brown-black as a result of deposition of reduced silver. Presence of blastospores and characteristic pseudohyphae or hyphae in the superficial epithelial tissues identifies the fungus as a species of Candida. GMS staining alone cannot perform the speciation of the organism; therefore, cultural or nucleic acid studies also should be used. Polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) are available.[17]

Blastospores similar to those in Candida species may be seen in histoplasmosis or cryptococcosis, both of which are increasingly prevalent and may manifest orally with increasing frequency in the AIDS epidemic. If only blastospores of candidal organisms are seen in tissue sections of patients in whom infection is suspected, serial sections should be searched carefully for pseudohyphae or hyphae.

As tests of humoral immunity, the candida agglutinin test, candida complement-fixation test, candida precipitin test, immunofluorescence, and enzyme-linked immunoassay (ELISA) have been used. Immunity in superficial candidosis and in oral candidosis is predominantly cell mediated. Cell-mediated immunity to C albicans antigens can be demonstrated in most human subjects both by the appearance of delayed skin hypersensitivity to antigens and by in vitro tests of cellular immunity, such as inhibition of leukocyte migration or stimulation of lymphocyte transformation to candidal antigens.

In the serologic tests, four principal types of Candida antigens have been used, including (1) whole nonviable yeast cells, (2) candidal culture filtrates, (3) cell wall polysaccharides or glycoproteins, and (4) cytoplasmic antigens from mechanically disrupted yeast cells. Serologic tests for candidal organisms are not diagnostic tools, since the diagnosis can be achieved more readily by clinical evaluation and by smear or culture.

With regard to hematologic testing, because oral candidosis frequently is associated with HIV disease, nutritional deficiencies, diabetes, or blood dyscrasias, estimates of corrected whole blood folate, vitamin B-12, serum ferritin, glucose, hemoglobin, lymphocyte, and WBC counts can be important. Tests, such as lymphocyte function, serum immunoglobulins, calcium status, or parathyroid hormone levels, are unnecessary except in chronic mucocutaneous candidosis (CMC). Tests of thyroid or adrenocortical function are warranted in selected individuals, since endocrine disorders may be associated with oral candidosis. HIV testing may be indicated.

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Procedures

Although swabs and smears are essential for a microbiological diagnosis of a number of types of oral candidosis, when candidal leukoplakia (chronic hyperplastic candidosis) is suspected, a biopsy specimen should be taken.

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Contributor Information and Disclosures
Author

Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC) Emeritus Professor, University College London; Visiting Professor, Universities of Athens, BPP, Edinburgh, Granada, Helsinki and Plymouth

Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC) is a member of the following medical societies: Academy of Medical Sciences, British Society for Oral Medicine, European Association for Oral Medicine, International Academy of Oral Oncology, International Association for Dental Research, International Association for Oral and Maxillofacial Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Franklin Flowers, MD Department of Dermatology, Professor Emeritus Affiliate Associate Professor of Pathology, University of Florida College of Medicine

Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Surgery

Disclosure: Nothing to disclose.

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Pseudomembranous candidosis.
Erythematous candidosis in HIV/AIDS.
Denture-related stomatitis; a common form of oral candidiasis. From Scully C, Flint SF, Bagan JV, Porter SR, Moos K. Atlas of Oral and Maxillofacial Diseases. 2010. Informa, London.
Angular stomatitis; a common form of oral candidiasis, typically seen in patients with denture-related stomatitis, especially those in whom the denture needs adjustment. In others, it may be a sign of diabetes, nutritional deficiency, or immune defect.
Multifocal candidosis; lingual lesions.
Chronic hyperplastic candidosis; typically affects the tongue dorsum or the commissures of the lips; potentially malignant.
 
 
 
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