Laboratory Diagnosis of Candidiasis

Microscopy of native preparations is mostly used in the laboratory diagnosis of candidiasis. Serological tests are conducted in addition. Depending on the character and localization of the process, the skin scales, scrapings from the mucous membranes and nails, pus, mucous clots of sputum are examined with the microscope for Candida fungi.

In examination of native preparations, the pathological material is placed on a glass slide and 10 per cent alkali (KOH or NaOH) solution is poured over it, a cover slide is then put on top and the preparation examined with a microscope first at low and then at high magnification. Fine mycelial threads (particularly abundant in thrush) and yeast cells characteristically in the stage of division (budding) are seen. Several smaller daughter cells are found next to the maternal (large) cell. The budding yeast cells in the preparation may form clusters resembling bunches of grapes. It should be borne in mind that when yeast are present as saprophytes, only occasional yeast cells are found in the preparation, and not always, while in candidiasis yeast cells and mycelium are a constant finding.

The preparations are stained when there is doubt concerning the origin of the occasional yeast cells. A small clump of the material to be examined is placed into a drop of tap water on a glass slide, blended with a loop or small spatula, spread in a thin layer on the glass, and fixed over the flame of a burner. The Gram, Ziehl-Neelsen or Romanovsky-Giemsa stain is used.

The agglutination reaction testifies to the presence of candidiasis only if the result is sharply positive in a dilution of 1: 160 and higher. A lower titre of the reaction may be produced in individuals who do not have candidiasis but are simply carriers of saprophytic yeast.

Treatment of Candidiasis Patients

Some forms of superficial candidiasis (e.g. interdigital yeast erosion of the hands, 'bath' dermatitis, etc.) are cured after the removal of factors which favour their development and the prescription of external agents. The most beneficial among them are 1-2 per cent aqueous or alcohol solutions of aniline dyes: gentian violet (crystal violet), methylene blue. The formula for aniline dyes prepared on alcohol is as follows:

Rp: Gentian violet, seu Methylenum coeruleum 0.4

  Spiritus vini rectif. 40% 20.0

  MDS. For external application

Paints such as a 5-10-20 per cent solution of sodium borate in glycerin, silver nitrate solutions, Castellani's paint are also used. Ointments and creams of pimafucin, micozolon, miconozol, aeconazol, lamisil, etc. are prescribed.

In disseminated and protracted forms of candidiasis of the skin and visible mucous membranes, the identified unfavourable external and internal factors are removed whenever possible or reduced and oral anti-yeast antibiotics are prescribed. These are: ketoconazol (nizoral, oranozol 0.2 g) 1 tablet x 2/day for 5 days; itroconazole (orungal) 200 mg/day for 3 days, fluconazol (diflucan in capsules 0, 05 g; 0, 15 g; 0, 1 g; 0, 2 g and solution for intravenous injections in dose 150 mg single). Nystatin and levorin the daily dose of which (10 000 000 - 12 000 000 and 5 000 000 – 6 000 000 U) is divided into three or four portions. They are given for 14 to 17 days (depending on the character of the process). Treatment with fungicidal agents is combined with the prescription of vitamins of the B complex, ascorbic acid, rutin; children are given a vitamin A concentrate in addition. Good results are given prescriptions of terbinafin (lamisil) 250 mg single a day.

Candidiasis Prevention

The timely detection and treatment of yeast diseases (particularly those of the oral mucosa) in children and the staff of children's establishments prevent mass candidiasis (thrush, perleche, yeast dermatitis of the newborn) in these collectives. The prevention of thrush in the newborn is linked with the application of measures for treating the expectant and nursing mothers, and not allowing individuals with yeast lesions to take care of the infants. Sick children are isolated from healthy ones. Much importance in the prevention of candidiasis among children is attributed to a rational diet, hygienic care, and disinfection of articles used in the care of children, bedclothes and clothes. The exogenic and endogenic factors conducive to the development of candidiasis should be borne in mind and attempts made to remove them. Antibiotics and corticosteroids, for instance, should be prescribed against the background of saturation of the patient's body with vitamins. The patient's mouth should be examined carefully and regularly because the appearance of white films is often the first sign of the development of visceral candidiasis.

Control over production technology is a measure for preventing interdigital erosions on the hands of persons working at canneries and fruit and vegetable processing enterprises, where everything should be done to prevent maceration of the epidermis with water, acids, and fruit syrups. Measures for the control of traumas should be undertaken.

The treatment of diabetes and obesity in patients with metabolic disorders, treatment of gastro-intestinal diseases, vegetoneurosis, general invigorating therapy for weakened patients and persons who had suffered from severe infections, correction of vitamin-balance disorders—all this prevents the development of superficial and systemic forms of candidiasis. Vitamins, especially those of the B complex, are recommended as a preventive measure for these patients, whereas those treated with large doses of antibiotics and corticosteroids are prescribed preventive nystatin therapy (2 000 000 U for 3-4 weeks).

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