eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Candidiasis: Differential Diagnoses & Workup

Author: Sabah Kalyoussef, DO, Fellow in Pediatric Infectious Diseases, Children's Hospital at Montefiore
Coauthor(s): Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine; Michael E Greenberg, MD, MPH, Clinical Instructor, Department of Pediatrics, University of California at San Francisco
Contributor Information and Disclosures

Updated: Nov 20, 2008

Differential Diagnoses

Diaper Dermatitis
Endocarditis, Fungal
Fungal Infections in Preterm Infants

Other Problems to Be Considered

Langerhans cell histiocytosis
Paronychia
Seborrheic dermatitis

Workup

Laboratory Studies

The following studies are indicated in candidiasis:

  • Potassium hydroxide (KOH) slide preparation: Scrapings of oral or cutaneous lesions may demonstrate budding yeasts with pseudohyphae.
  • Cultures
    • Blood culture is highly insensitive; fewer than 15% of patients with disseminated disease have positive blood cultures.
    • Urine culture is often positive in individuals who are immunocompromised and have renal or bladder disease.
    • Culture intravascular devices, especially indwelling catheters and especially in neonates suspected of having sepsis.
  • Alpha-glucan assay - Component of fungal cell wall
  • D-arabinatol assay - Measures fungal metabolite

Imaging Studies

  • Ultrasonography and CT scanning may be helpful in making the diagnosis of disseminated candidal infection in the individual who is immunocompromised, especially for renal, bladder, hepatic, and splenic lesions.
  • Endoscopy may be indicated for diagnosis of candidal esophagitis, especially when empiric treatment has failed.

Procedures

  • Lumbar puncture is indicated for patients suspected of having candidal meningitis. Findings may include the following:
    • Elevated opening pressure
    • Increased WBC count, often with predominance of lymphocytes
    • Hyphae, which may be observed on Gram stain

More on Candidiasis

Overview: Candidiasis
Differential Diagnoses & Workup: Candidiasis
Treatment & Medication: Candidiasis
Follow-up: Candidiasis
Multimedia: Candidiasis
References
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References

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Further Reading

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Keywords

candidiasis, candidosis, monilia, thrush, Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, Candida krusei, Candida lusitaniae, Candida stellatoidea, candidal infections, diaper dermatitis, intertrigo, diabetes mellitus, obesity, hyperhidrosis, total nail dystrophy, esophagitis, vaginal yeast infection, balanitis, balanoposthitis, acquired immunodeficiency syndrome, AIDS, very low birth weight premature infants, fungemia, endophthalmitis, meningitis, renal bezoars, arthritis, chronic mucocutaneous candidiasis, CMCC, necrotizing enterocolitis, vaginal candidosis, vulvovaginitis, cutaneous candidiasis, paronychia, onychomycosis, otitis externa, glossitis, hepatic candidiasis, liver abscesses, endocarditis

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Contributor Information and Disclosures

Author

Sabah Kalyoussef, DO, Fellow in Pediatric Infectious Diseases, Children's Hospital at Montefiore
Sabah Kalyoussef, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Osteopathic Association, and Medical Society of New Jersey
Disclosure: Nothing to disclose.

Coauthor(s)

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching

Michael E Greenberg, MD, MPH, Clinical Instructor, Department of Pediatrics, University of California at San Francisco
Michael E Greenberg, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, and American Public Health Association
Disclosure: Nothing to disclose.

Medical Editor

Itzhak Brook, MD, MSc, Professor, Department of Pediatrics, Georgetown University School of Medicine
Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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