Candida vulvovaginitis laboratory findings: Difference between revisions
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{{ | {{Candida vulvovaginitis}} | ||
{{CMG}} | {{CMG}}; {{AE}}{{DN}} | ||
==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> | |||
== | ==Gallery== | ||
<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== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category: | [[Category:Disease]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
[[Category:Gynecology]] | [[Category:Gynecology]] | ||
[[Category: | [[Category:Obstetrics]] | ||
Latest revision as of 20:47, 29 July 2020
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Candida vulvovaginitis Microchapters |
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Candida vulvovaginitis laboratory findings On the Web |
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Risk calculators and risk factors for Candida vulvovaginitis laboratory findings |
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]
- 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 :
| 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
-
![Wet mounted vaginal smear specimen, revealed the presence of Candida albicans, which had been extracted from a patient with vaginal candidiasis. From Public Health Image Library (PHIL). [4]](/images/b/bf/Moniliasis01.jpeg)
Wet mounted vaginal smear specimen, revealed the presence of Candida albicans, which had been extracted from a patient with vaginal candidiasis. From Public Health Image Library (PHIL). [4]
![Wet mounted vaginal smear specimen, revealed the presence of Candida albicans, which had been extracted from a patient with vaginal candidiasis. From Public Health Image Library (PHIL). [4]](/index.php/File:Moniliasis01.jpeg)
References
- ↑ Eckert LO (2006). "Clinical practice. Acute vulvovaginitis". N. Engl. J. Med. 355 (12): 1244–52. doi:10.1056/NEJMcp053720. PMID 16990387.
- ↑ 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.
- ↑ 3.0 3.1 Sobel JD (2007). "Vulvovaginal candidosis". Lancet. 369 (9577): 1961–71. doi:10.1016/S0140-6736(07)60917-9. PMID 17560449.
- ↑ "Public Health Image Library (PHIL)".