Mucosal Candidiasis Workup

Updated: Mar 27, 2020
  • Author: Surbhi Gupta; Chief Editor: William D James, MD  more...
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Approach Considerations

Diagnosis begins with a thorough history and physical examination.

Patients should be asked about immunosuppressive agents (local and systemic), antibiotics, other opportunistic infections, risky sexual contact, and dental procedures. Patients should be asked about difficulty or pain with swallowing, which can be an indication of esophageal spread. During the physical examination, directly visualize the lesions by examining all areas of the mouth or genitals.

Depending on the severity of the infection, potassium hydroxide (KOH) preparation, culture, and antimicrobial sensitivities should be done to confirm the diagnosis.


Laboratory Studies

The initial test for Candida infection is usually cytologic examination by scraping a lesion and placing the sample on a slide. Application of 10% KOH and applying gentle heat lyses host cells and allows for visualization of the organism. Candida presents with pseudohyphae and budding yeasts. In patients with chronic or recalcitrant disease, culture may be performed to confirm the diagnosis and identify resistant organisms. Susceptibility to antifungals can also be obtained and may be useful in the cases of treatment-resistant, recurrent, or immunosuppressed-associated infections. [13]

As tests of humoral immunity, the Candida agglutinin test, Candida complement-fixation test, Candida precipitin test, immunofluorescence, and enzyme-linked immunoassay (ELISA) are available options. Immunity in superficial candidiasis and in oral candidiasis is predominantly cell mediated. Delayed skin hypersensitivity to antigens and in vitro tests of cellular immunity can demonstrate cell-mediated immunity to candidal antigens.

In suspected cases of chronic mucocutaneous candidiasis (CMC), testing for HIV disease, diabetes, folate, vitamin B-12, ferritin, hemoglobin, and blood cell counts should be performed. Tests of thyroid or adrenocortical function are warranted in selected individuals, since endocrine disorders can be associated with oral candidiasis or CMC.