Candida vulvovaginitis laboratory findings: Difference between revisions

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{{Candidiasis}}
{{Candida vulvovaginitis}}
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==Overview==
The diagnosis of [[Candida]] [[vulvovaginitis]] is based on the clinical findings, supported by laboratory findings. Laboratory studies done for diagnosis include measurement of the vaginal pH, visualization of hyphae on wet mount/ microscopy, as well as culture.
 
==Laboratory Findings==
The laboratory findings consistent with the diagnosis of [[Candida]] [[vulvovaginitis]] include:<ref name="pmid16990387">{{cite journal |vauthors=Eckert LO |title=Clinical practice. Acute vulvovaginitis |journal=N. Engl. J. Med. |volume=355 |issue=12 |pages=1244–52 |year=2006 |pmid=16990387 |doi=10.1056/NEJMcp053720 |url=}}</ref><ref name="pmid22519657">{{cite journal |vauthors=Mendling W, Brasch J |title=Guideline vulvovaginal candidosis (2010) of the German Society for Gynecology and Obstetrics, the Working Group for Infections and Infectimmunology in Gynecology and Obstetrics, the German Society of Dermatology, the Board of German Dermatologists and the German Speaking Mycological Society |journal=Mycoses |volume=55 Suppl 3 |issue= |pages=1–13 |year=2012 |pmid=22519657 |doi=10.1111/j.1439-0507.2012.02185.x |url=}}</ref><ref name="pmid17560449">{{cite journal |vauthors=Sobel JD |title=Vulvovaginal candidosis |journal=Lancet |volume=369 |issue=9577 |pages=1961–71 |year=2007 |pmid=17560449 |doi=10.1016/S0140-6736(07)60917-9 |url=}}</ref>
*[[Vaginal]] pH: [[vaginal]] pH is normal (ranges from 4.0-4.5)
*[[Wet mount]] or Saline preparation: It will help in detection of [[hyphae]], [[clue cells]] and motile [[trichomonas]] differentiating different causes of [[vaginitis]].
*[[10% Potassium hydroxide preparation]]: It is more sensitive than [[wet mount]] to demonstrate budding [[blastospores]] or [[pseudohyphae]].
*Culture: [[Culture]] for diagnosing [[candida]] [[vulvovaginitis]] not recommended in patients with positive microscopy. However, it should be done in a symptomatic woman with a negative microscopy and a normal vaginal [[pH]]Culture using [[Sabouraud agar]], [[Nickerson’s medium]], or Microstix-Candida medium identify [[candida]] [[species]] with equal sensitivity.
 
===Approach to patient with Candida Vulvovaginitis===
The following is a algorithm for diagnosis and treatment of vulvovaginal candidiasis :
{{Family tree/start}}
{{Family tree | | | | | | A01 | | | |A01= Symptomatic [[Vaginitis]]}}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | C01 | | | |C01= Whitish discharge adherent to the vaginal walls, excoriations and fissures in the genital area}}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | | | | | E01 | | | |E01= Perform direct microscopy of the vaginal discharge with saline or 10% KOH<br> Estimate pH of vaginal discharge}}
{{Family tree | | | | | | |!| | | | | }}
{{Family tree | | |,|-|-|-|^|-|-|.|}}
{{Family tree | |F01| | | | |F02| |F01=Negative direct microscopy<br> pH < 4.5| F02= Positive direct microscopy}}
{{Family tree | | |!| | | | | | |!| | | | | | }}
{{Family tree | |G01| | | | |G02| | | |G01= Send for [[culture]]<br>Consider azole therapy|G02= No culture necessary }}
{{Family tree | | | | | | | | | |!| | | | }}
{{Family tree | | | | | | | |,|-|^|-|-|.| }}
{{Family tree | | | | | | | H01| | |H02|H01=[[pH]] < 4.5<br>No excess WBC's|H02= [[pH]] > 4.5<br>Excess WBC's}}
{{Family tree | | | | | | | |!| | | | |!| }}
{{Family tree | | | | | | |I01| | |I02|I01=Start [[azole]] therapy|I02=Consider mixed infection}}
{{Family tree/end}}
<small>Algorithm adopted from Vulvovaginal candidiasis Lancet 2007; 369: 1961–71<ref name="pmid17560449">{{cite journal| author=Sobel JD| title=Vulvovaginal candidosis. | journal=Lancet | year= 2007 | volume= 369 | issue= 9577 | pages= 1961-71 | pmid=17560449 | doi=10.1016/S0140-6736(07)60917-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17560449 }} </ref></small>


==Overview==
==Gallery==
A small amount of the vaginal discharge is examined using a microscope (called a wet mount and KOH test). Sometimes, a culture is taken when the infection does not improve with treatment or recurs many times.
<gallery>
Image: Moniliasis01.jpeg| Wet mounted vaginal smear specimen, revealed the presence of Candida albicans, which had been extracted from a patient with vaginal candidiasis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
</gallery>


==References==
==References==
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Latest revision as of 20:47, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Overview

The diagnosis of Candida vulvovaginitis is based on the clinical findings, supported by laboratory findings. Laboratory studies done for diagnosis include measurement of the vaginal pH, visualization of hyphae on wet mount/ microscopy, as well as culture.

Laboratory Findings

The laboratory findings consistent with the diagnosis of Candida vulvovaginitis include:[1][2][3]

Approach to patient with Candida Vulvovaginitis

The following is a algorithm for diagnosis and treatment of vulvovaginal candidiasis :

 
 
 
 
 
Symptomatic Vaginitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Whitish discharge adherent to the vaginal walls, excoriations and fissures in the genital area
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform direct microscopy of the vaginal discharge with saline or 10% KOH
Estimate pH of vaginal discharge
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Negative direct microscopy
pH < 4.5
 
 
 
 
Positive direct microscopy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Send for culture
Consider azole therapy
 
 
 
 
No culture necessary
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
pH < 4.5
No excess WBC's
 
 
pH > 4.5
Excess WBC's
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Start azole therapy
 
 
Consider mixed infection

Algorithm adopted from Vulvovaginal candidiasis Lancet 2007; 369: 1961–71[3]

Gallery

References

  1. Eckert LO (2006). "Clinical practice. Acute vulvovaginitis". N. Engl. J. Med. 355 (12): 1244–52. doi:10.1056/NEJMcp053720. PMID 16990387.
  2. Mendling W, Brasch J (2012). "Guideline vulvovaginal candidosis (2010) of the German Society for Gynecology and Obstetrics, the Working Group for Infections and Infectimmunology in Gynecology and Obstetrics, the German Society of Dermatology, the Board of German Dermatologists and the German Speaking Mycological Society". Mycoses. 55 Suppl 3: 1–13. doi:10.1111/j.1439-0507.2012.02185.x. PMID 22519657.
  3. 3.0 3.1 Sobel JD (2007). "Vulvovaginal candidosis". Lancet. 369 (9577): 1961–71. doi:10.1016/S0140-6736(07)60917-9. PMID 17560449.
  4. "Public Health Image Library (PHIL)".

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