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PubMed2001

A comparison of methods for yeast identification including CHROMagar Candida, Vitek system YBC and a traditional biochemical method.

BACKGROUND: CHROMagar Candida (CAC) is a new chromogenic medium for the presumptive identification of clinically-important yeast isolates. A yeast biochemical card (YBC), a part of the Vitek system is an automatic method for the identification of clinically-important yeast isolates. We conducted a comparison of these two methods with a traditional biochemical method in order to choose a rapid and accurate technique for yeast identification. METHODS: All yeast isolates were inoculated onto Sabourand dextrose agar (SDA) and CAC, and incubated at 30 degrees C for 48 hours. All isolates were simultaneously tested using traditional biochemical methods and the yeast biochemical card from the Vitek system. RESULTS: We evaluated 235 yeast isolates from clinical specimens, including 89 Candida albicans, 47 Candida tropicalis, 43 Candida glabrata, six Trichosporon beigelii, and five Candida krusei in addition to 45 isolates of other yeast species. Isolates were presumptively identified on the basis of colony color and appearance on CAC medium. These observations were compared with a traditional biochemical yeast-identification method and also with YBC from the Vitek system. For five commonly-isolated species (Candida albicans, Candida tropicalis, Candida glabrata, Candida krusei and Trichosporon beigelii), agreement among the CAC medium, YBC method and traditional biochemical method were 98.9% (187/189), 96.3% (182/189), 100% (189/189), respectively. CONCLUSIONS: From our comparison, the CAC medium is a convenient and economic method to identify five commonly-noted yeast species, and the YBC method warrants a greater cost and requires a longer period of time to obtain reliable results.

Candida↗
PubMed2003

[Evaluation of Candida species' susceptibility to fluconazole with the disk diffusion method].

Infections caused by yeasts belonging to the genus Candida have increased dramatically in the last decades, especially in hospital settings. Concomittantly, antimycotic resistance has emerged, as well as the appearance of non-Candida albicans isolates. To standardize in vitro antifungal susceptibility tests, the agar diffusion test was developed using disks impregnated with the antimycotic compound. Electronic recording of the inhibition zone (BIOMIC), furnishes objective values for the minimal inhibitory concentration (MIC). The fluconazole susceptibility patterns were determined for Candida species isolated from 2.139 patients seen in outpatient clinics or in health-care centers in Colombia, Ecuador and Venezuela. Candida albicans was the species most frequently isolated (62%), followed at a distance by Candida parapsilosis (11%), Candida tropicalis (8.5%), Candida glabata (3.5%) and Candida krusei (2.2%). MIC determinations showed that 88.1% of these isolates were susceptible to fluconazole, 5.1% were susceptible-dose-dependant and 6.8% resistant. An important proportion (92.1%) of the C. albicans isolates proved susceptible while resistance predominated in the remaining species. These results indicate that the BIOMIC method is rapid and simple, constituting a suitable tool for the epidemiologic surveillance of resistance in Candida species.

Antifungal Agents↗
PubMed2004

In-vitro activity of 5-fluorocytosine against 1,021 Spanish clinical isolates of Candida and other medically important yeasts.

The aim of this study was to determine the prevalence of primary resistance to 5-fluorocytosine (5FC) among clinical isolates of yeasts in Spain where this drug is not currently available for therapy. We have tested the in vitro activity of 5FC against 1,021 recent yeast clinical isolates, including 522 Candida albicans, 140 Candida parapsilosis, 68 Candida glabrata, 41 Candida dubliniensis, 50 Candida guilliermondii, 34 Candida tropicalis, 28 Candida krusei, 20 Candida famata, 11 Cryptococcus neoformans, 5 Cryptococcus albidus, 43 Rhodotorula spp., 24 Trichosporon spp., 5 Saccharomyces cerevisiae, 9 Pichia spp., and 21 isolates from other 11 yeast species. The MICs were determined by the ATB Fungus agar microdilution test (bioMerieux, France) and the following interpretive breakpoints were used: susceptible, > 4 microg/ml; intermediate, 8 to 16 microg/ml; resistant, > 32 microg/ml. 5FC was very active against Candida spp. and other medically important yeasts as 852 (83.4%) of the studied isolates were susceptible (MIC < 4 microg/ml). The species most susceptible to 5FC were C. dubliniensis (100%of isolates; MIC90, 0.25 microg/ml), C. famata (100% of isolates; MIC90, 0.25 microg/ml), C. guilliermondii (98%of isolates; MIC90, 0.25 microg/ml), C. glabrata (95.5% of isolates; MIC90, 0.25 microg/ml), and C. neoformans (90.9% of isolates; MIC90, 2 microg/ml). Primary resistance to 5FC was very uncommon, and a MIC > 32 microg/ml, indicator of in vitro resistance, was observed in 106 isolates (10.4%): 77 C. albicans (16.5% of isolates; MIC90, > 128 microg/ml), 9 C. parapsilosis (6.4% of isolates; MIC90, 8 microg/ml), 4 C. albidus (80% of isolates, MIC50, > 128 microg/ml), 3 C. glabrata (4.4% of isolates; MIC90, 0.25 microg/ml), 3 C. tropicalis (8.8% of isolates; MIC90, 4 microg/ml), 2 C. krusei (7.1% of isolates; MIC90, 8 microg/ml), 2 Rhodotorula spp. (4.6% of isolates, MIC90, 1 microg/ml), 8 Trichosporon spp. (33.3% of isolates; MIC90, 64 microg/ml), and 1 C. lipolytica (50% of isolates). Interestingly, most C. albicans (67 out of 77 isolates) resistant to 5FC were serotype B isolates.

Antifungal Agents↗
PubMed2006

Survey of amphotericin B susceptibility of Candida clinical isolates determined by Etest.

BACKGROUND AND PURPOSE: The minimal inhibitory concentrations (MICs) of amphotericin B (AmB) determined by the National Committee for Clinical Laboratory Standards (NCCLS; NCCLS document M27-A) broth dilution method are in a relatively narrow ranges and this may lead to underestimation of the AmB-resistant rate in clinical isolates. We evaluated in vitro susceptibility of clinical isolates of Candida spp. to AmB using Etest and determined the distribution of AmB MICs in different species. METHODS: We used the Etest (AB Biodisk, Solna, Sweden) to evaluate the MICs of Candida isolates randomly collected during 2001-2003 in a teaching hospital. RESULTS: Of the 572 isolates evaluated, Candida albicans (50.7%) was the most common species, followed by Candida tropicalis (23.9%), Candida parapsilosis (13.1%), Candida glabrata (9.4%), Candida krusei (1.9%), and Candida guilliermondii (0.9%). The majority of isolates were from blood (85%). The minimal concentrations of AmB required to inhibit 50%/90% of the isolates (MIC(50)/MIC(90)) were 0.19/0.38 microg/mL for C. krusei, 0.125/0.38 microg/mL for C. glabrata, 0.094/0.25 microg/mL for C. tropicalis, 0.032/0.19 microg/mL for C. albicans, 0.016/0.125 microg/mL for C. parapsilosis, and 0.023/0.032 microg/mL for C. guilliermondii. Only 1 blood isolate of C. glabrata was resistant to AmB (MIC > or =1 microg/mL) [0.17%]. 18.2% of isolates were less susceptible to AmB (MIC > or =0.19 microg/mL) with the highest rates for C. krusei (63.6%), followed by C. glabrata (37.0%), C. tropicalis (29.9%), C. albicans (11.0%), C. parapsilosis (5.3%), and C. guilliermondii (0%). More isolates collected from patients with hematologic malignancy were less susceptible to AmB than those collected from those with other diseases (30.5% vs 15.4%, p<0.05). CONCLUSION: This study demonstrated that AmB resistance remains rare at this hospital in Candida clinical isolates despite increasing use of this agent during the past 4 decades.

Amphotericin B↗
PubMedDate not supplied

[In vitro investigations of Candida strains for itraconazole].

Results of studies in vitro of the susceptibility of 102 strains of Candida type (88--Candida albicans, 7--Candida intermedia, 3--Candida parapsilosis, 1--Candida stellatoidea, 3--Torulopsis candida), to itraconazole have been reported. The strains were isolated from lesions of the skin and mucous membranes. The strains tested showed no resistance to this drug. Itraconazole concentrations inhibiting completely the growth of the yeast-like fungi ranged from 0.02 to 35.0 micrograms/ml of a culture medium. Strains of Candida albicans have shown the least susceptibility, most Candida intermedia. Changes in sensitivity (MIC) of some strains of Candida type for itraconazole after 48 and 72-hrs periods of incubation were very little.

Antifungal Agents↗
PubMedDate not supplied

Candida immunity in patients undergoing surgical treatment for heart valve disease.

The appearance of Candida antigen (Latex agglutination method), Candida antibodies (indirect immunofluorescence) and positive fungal cultures as well as the lymphocyte transformation response to Candida antigen "in vitro" was studied in a series of 37 successive patients before and after heart valve replacement. The Candida antigen test was positive preoperatively in 11/36 (31%) and postoperatively in 14/36 (39%) of the patients and in 2/200 (1%) of the controls (blood donors). The differences in the frequencies of positive tests between the patient group and the control group are significant (p less than 0.001). The lymphocyte response to Oidiomycin (Candida albicans) preoperatively was greater than the mean control value in 6/11 (54.5%) of the patients showing a positive Candida antigen test, but only in 4/25 (16.0%) of the patients who were Candida antigen negative. The total number of lymphocytes and the number of ANAE positive (T) cells as well as the lymphocyte response to Oidiomycin (OID), tuberculoprotein (PPD) and phytohaemagglutinin (PHA) decreased markedly postoperatively. Candida antibody titres were positive (greater than or equal to 1:128) in 3/37 (8%) of the postoperative patients and in 2/84 (2.4%) of the controls. This difference is not significant. Positive Candida antibody titres were found postoperatively in 15/37 (41%) of the patients, which is a significantly higher frequency than that seen preoperatively (p less than 0.005). More positive fungal cultures from throat specimens (p less than 0.005) were found in the patient group before surgery than in the control group (hospital personnel). After surgery the number of positive fungal cultures in these cases decreased (p less than 0.001) due to the use of oral antifungal prophylaxis with nystatin tablets.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Impaired systemic immunity and frequent infection in patients with Candida antigen after hepatectomy.

BACKGROUND/AIMS: Infection after hepatic resection constitutes a major cause of morbidity and mortality. We examined the role of Candida antigen in systemic immunity and the infectious complications after hepatectomy. MATERIAL AND METHODS: In 25 hepatectomized patients, the Candida antigen titers were measured by a latex agglutination test (CAND-TEC). In the patients with Candida antigen (n = 10; 40%) and those without (n = 15; 60%), multiple immunological parameters, including the total lymphocyte count, lymphocyte subpopulations, phytohemagglutinin (PHA) response, and natural killer (NK) activity, and the incidence of infectious complications were compared. RESULTS: In the preoperative and operative parameters, there were no significant differences between the two groups. In the postoperative immune parameters, a significant attenuation in the total lymphocyte number (p < 0.01) and NK activity (p < 0.01) was observed in the patients with Candida antigen, compared with the findings in patients without Candida antigen. A bacterial infection was identified in 5 of 10 patients (50.0%) with Candida antigen, and in 1 of 15 patients (6.7%) without Candida antigen (p < 0.05). In contrast, the Candida culture was negative for all patients. CONCLUSIONS: Both a profound attenuation of systemic immunity and frequent bacterial infections were observed in the hepatectomized patients with Candida antigen.

Adult↗
PubMed1990

[The suppressive effect of intravenous fluconazole against endogenous candida endophthalmitis in rabbits].

The therapeutic effect of intravenous fluconazole against endogenous candida endophthalmitis was investigated in rabbits. Twelve albino rabbits and a candida strain isolated from the human vitreous were used. Endogenous candida endophthalmitis was made by intravenous inoculation of 8 x 10(5) candida albicans spores in rabbits. In the first of two series of experiments, three rabbits out of six were injected intravenously with 5 mg/kg.b.w. of fluconazole at 30 minutes, 1 day and 2 days after inoculation. Another three control rabbits received no medication. The clinical course of the eyes was observed for a week and the viable cell numbers of candida in the eye were counted at 7 days after inoculation. Three rabbits treated with fluconazole developed no ocular lesions and no candida spores whatsoever were isolated from the eyes. In contrast, three rabbits in the control group developed bilateral chorioretinitis and candida albicans was isolated from each of 6 eyes. In the second series, three out of six rabbits were injected intravenously of the same dose of fluconazole as described above for four days starting at 3 days after inoculation, when chorioretinitis was first observed. No medication was given to another three rabbits as a control. All six rabbits in this series developed chorioretinitis similarly and candida spores were isolated from all eyes at 7 days after inoculation. These results show that intravenous fluconazole is effective in the prevention of the endogenous candida endophthalmitis in rabbits but ineffective for these short term therapeutic applications after onset.

Animals↗
PubMed1997

Prevalence, density, and manifestations of oral Candida albicans in patients with Sjögren's syndrome.

OBJECTIVE: Various investigators have reported a high prevalence of oral Candida species in patients with salivary gland dysfunction (SGD). The purpose of this study was to assess the prevalence of oral Candida albicans, its oral manifestations, and to compare the number of colony-forming units of Candida albicans in patients with primary Sjögren's syndrome and secondary Sjögren's syndrome with the whole unstimulated salivary flow rate in each group. METHOD: An age-sex-matched group of control subjects was selected for comparison. Oropharyngeal collection of samples and culturing was performed on each subject. Quantitative cultures specific for Candida albicans were performed. RESULTS: The frequency distribution indicated that > 80% of all SS subjects were positive for Candida albicans vs. none of the controls. The most common lesion was angular cheilitis followed by chronic atrophic candidiasis. The subjects with Sjögren's syndrome also demonstrated significantly high numbers of Candida albicans colony-forming units. CONCLUSIONS: This study indicates significantly higher Candida albicans colonization in patients with primary or secondary Sjögren's syndrome as compared to a control population. Candida albicans colonization was higher in patients with secondary Sjögren's syndrome than in patients with primary Sjögren's syndrome; however, the amount of Candida albicans was not universally relative to salivary flow.

Adult↗
PubMed2006

Comparative study of disc diffusion and microdilution methods in susceptibility testing of micafungin against Candida species.

OBJECTIVES: To compare the Clinical Laboratory Standards Institute CLSI M44-A disc diffusion (DD) and M27-A2 broth microdilution (MD) methods for determining the susceptibility of Candida spp. to micafungin (FK463). PATIENTS AND METHODS: A total of 355 clinical yeast isolates including 270 Candida albicans, 45 Candida glabrata, 24 Candida krusei, 11 Candida tropicalis and 5 Candida parapsilosis were studied. The MIC of micafungin was determined by following the CLSI M27-A2 guidelines (MD). Endpoints were defined as the lowest concentration of micafungin resulting in partial inhibition (IC(50)) of visual growth after 24/48 h of incubation at 35 degrees C. Final concentrations were 0.008-4 mg/L of micafungin. DD testing was performed using a CLSI M44-A document with 2.5 mug micafungin discs. Zone diameter endpoints were read after 24/48 h of incubation at 35 degrees C. Arbitrary breakpoints were 4 mg/L for MD and 15 mm for DD. RESULTS: The best correlation was observed when we read MD 48 h/DD 24 and 48 h (97%). When the reading was MD 24 h/DD 24 and 48 h the percentage of correlation was 95.2%. CONCLUSIONS: The DD method performs well for testing the susceptibility of Candida spp. to micafungin. More studies involving more Candida strains with elevated MIC values are needed.

AIDS-Related Opportunistic Infections↗
PubMed2002

Colonization of voice prostheses by albicans and non-albicans Candida species.

OBJECTIVES: The purposes of the study were to assess the colonization of tracheoesophageal voice prostheses by albicans and non-albicans Candida species and to determine their susceptibility for three antimycotics that are frequently used for prophylaxis or treatment of oral candidiasis (i.e., miconazole, fluconazole, and nystatin). STUDY DESIGN: In total, 101 patients, corresponding to 170 voice prostheses, were monitored over a period of 28 months. METHODS: An enzymatic two-step method was used for differentiation and presumptive identification of Candida species colonizing the voice prostheses. The identity of the isolates was confirmed by the germ-tube test, morphological appearance on cornmeal agar with 0.5% Tween 80, sugar assimilation tests, and appearance on CHROMagar Candida (CHROMagar Co., Paris), Albicans ID (BioMérieux Vitek, Hazelwood, MO), and Fluoroplate Candida (Merck, Darmstadt, Germany). Susceptibility testing for miconazole, fluconazole, and nystatin was performed according to the microdilution method of the National Committee for Clinical Laboratory Standards. RESULTS: The predominant species isolated were Candida albicans (41.4%), Candida glabrata (33.1%), Candida krusei (15.9%), and Candida tropicalis (5.3%). A broad range of minimal inhibitory concentrations of the isolates was observed for miconazole and fluconazole. In contrast, minimal inhibitory concentration values for nystatin were narrowly distributed around 4 microg/mL for all isolates, suggesting uniform sensitivity. CONCLUSION: Our data on the prevalence and susceptibility of yeast isolates will contribute to a rational choice of an antimycotic for prophylaxis of the early deterioration and leakage of tracheoesophageal voice prostheses.

Aged↗
PubMed1994

The in vitro proteolytic and saccharolytic activity of Candida species cultured in human saliva.

The proteolytic and saccharolytic activity of 4 Candida species was investigated in batch cultures of pooled, human mixed saliva supplemented with glucose. All the Candida species investigated (Candida albicans, Candida tropicalis, Candida glabrata and Candida krusei) demonstrated a marked growth in saliva with a concomitant reduction in pH from about 7.5 to 3.3, within 72 h. Isotachophoretic analysis of the culture supernatant revealed the presence of a variety of acid anions of which pyruvate and acetate were the most abundant. Proteolysis of salivary components, evaluated by a biochemical assay and sodium dodecyl sulfate-polyacrylamide gel electrophoresis, was exhibited by all 4 Candida species, although there was inter-species variation. Despite the similarity in growth rates, C. tropicalis and C. krusei demonstrated greater proteolytic activity than C. albicans and C. glabrata. Neither candidal growth nor proteolysis was observed in glucose-free control saliva samples. In contrast, the degree of saccharolytic and proteolytic activity of a single isolate of C. albicans in glucose-supplemented parotid saliva appeared to be relatively weak compared with mixed saliva. As the oral cavity provides ideal low pH niches periodically supplemented with dietary carbohydrates, the acidic proteinases of Candida species may play a role in the pathogenesis of oral candidiasis.

Analysis of Variance↗
PubMed1983

Adherence and penetration of vascular endothelium by Candida yeasts.

Metastatic infection after hematogenous dissemination of Candida species is presumably dependent on the fungus traversing the vascular endothelium. An in vitro model of the earliest events of metastatic Candida infection was developed with whole vascular strips. Freshly obtained porcine blood vessels were secured in a perforated Lucite template that allowed the application of yeasts directly to the endothelial surface. Multiple wells allowed experimental and control observations on the same vascular segments. Adherence to endothelium was greatest with Candida albicans and Candida tropicalis, less with Candida Krusei, and least with Candida parapsilosis, Candida pseudotropicalis, and Torulopsis glabrata. This hierarchy of adherence parallels that in other in vitro systems employing mucosal epithelial cells or fibrin-platelet matrixes and reflects the known virulence of the respective species and their potential for hematogenous dissemination. C. albicans and C. tropicalis yeasts that adhered were capable of directly traversing the endothelial surface before the production of germ tubes. Heat or Formalin-killed yeasts and viridans group streptococci, although adherent, were incapable of vascular penetration, a process presumably attributable to enzymatic digestion of host tissue. Loss of integrity of penetrated endothelial tissue was verified by loss of dye exclusion, lactic dehydrogenase release, and ultramicroscopic changes. These two steps, adherence and penetration, provide direct insight into the earliest events in hematogenous Candida species dissemination and suggest that C. albicans and C. tropicalis yeasts are capable of initiating tissue invasion before germ tubes have had the opportunity to form and participate in the invasive process.

Adhesiveness↗
PubMed2005

In vitro method to study antifungal perfusion in Candida biofilms.

Antimycotic perfusion through Candida biofilms was demonstrated by a modification of a simple in vitro diffusion cell bioassay system. Using this model, the perfusion of three commonly used antifungal agents, amphotericin B, fluconazole, and flucytosine, was investigated in biofilms of three different Candida species (i.e., Candida albicans, Candida parapsilosis, and Candida krusei) that were developed on microporous filters. Scanning electron microscopy revealed that C. albicans formed a contiguous biofilm with tightly packed blastospores and occasional hyphae compared with C. parapsilosis and C. krusei, which developed confluent biofilms displaying structural heterogeneity and a lesser cell density, after 48 h of incubation on nutrient agar. Minor structural changes were also perceptible on the superficial layers of the biofilm after antifungal perfusion. The transport of antifungals to the distal biofilm-substratum interface was most impeded by C. albicans biofilms in comparison to C. parapsilosis and C. krusei. Fluconazole and flucytosine demonstrated similar levels of perfusion, while amphotericin B was the least penetrant through all three biofilms, although the latter appeared to cause the most structural damage to the superficial cells of the biofilm compared with the other antifungals. These results suggest that the antifungal perfusion through biofilm mode of growth in Candida is dependent both on the antimycotic and the Candida species in question, and in clinical terms, these phenomena could contribute to the failure of Candida biofilm-associated infections. Finally, the in vitro model we have described should serve as a useful system to investigate the complex interactions that appear to operate in vivo within the biofilm-antifungal interphase.

Amphotericin B↗
PubMed1994

In vitro infection of human fetal membranes with Candida species.

To assess whether Candida species can penetrate intact fetal membranes under in vitro conditions, Candida albicans, Candida tropicalis, Candida guilliermondii, Candida pseudotropicalis and Candida glabrata were inoculated onto the surface of the maternal side of the membranes obtained from 4 pregnant women undergoing repeat cesarean section. After incubation under culture conditions, membranes were evaluated by histological examination. C. albicans inoculated onto the maternal side penetrated and passed to the fetal side and caused some degeneration of the structure of the membrane epithelium. The other four Candida species grew heavily on the maternal surface but did not penetrate and invade the membranes. This effect of C. albicans on fetal membranes may explain the potential mechanism in the development of Candida infections of the amniotic fluid, fetal membranes and possibly the fetus.

Amniotic Fluid↗
PubMed2006

In vitro interactions of anidulafungin with azole antifungals, amphotericin B and 5-fluorocytosine against Candida species.

Anidulafungin, an echinocandin, is in late stage development for the treatment of fungal infections. We investigated the activity of anidulafungin in combination with other antifungal agents (fluconazole, itraconazole, ketoconazole, amphotericin B and 5-fluorocytosine) against four isolates each of Candida albicans, Candida glabrata, Candida parapsilosis and Candida tropicalis, and two isolates of Candida krusei using a macrobroth chequerboard method with interactions evaluated by fractional inhibitory concentration indices (FICIs). Additive activity (FICI > 0.5 to 1) or indifference (FICI > 1 to < 4) was observed in 85 of 90 interactions of anidulafungin with another antifungal agent. Synergy with itraconazole (FICI or=4), a drug rarely used systemically, was noted for four strains of C. tropicalis. The combination of anidulafungin and amphotericin B demonstrated additive activity for each of the 18 isolates of Candida tested. These results suggest additional studies are warranted, for example in animal models, to evaluate further the potential of combination antifungal therapy with anidulafungin for Candida infections.

Amphotericin B↗
PubMed2003

Fluconazole resistance rate of Candida species from different regions and hospital types in Taiwan.

From April 15 to June 15, 1999, 581 clinical Candida isolates from 19 hospitals in Taiwan were collected and susceptibilities to fluconazole of these isolates were determined by a broth microdilution method. A total of 42 (7.2%) isolates were resistant to fluconazole. Isolates from medical centers had a higher resistance rate to fluconazole than those from regional hospitals (10.7% vs 4.9%). Candida species isolated from different regions had different degrees of susceptibility to fluconazole. Approximately 2.5%, 6.5%, and 11.8% of Candida isolates from middle, north, and south regions, respectively, were resistant to fluconazole. The prevalence of the combination of Candida glabrata, Candida krusei, and Candida tropicalis infections were 44.5%, 49.8%, and 62.7% in middle, north, and south regions, respectively. There is an association between the rate of fluconazole resistance and the number of non-albicans Candida species collected from different regions and hospital types.

Academic Medical Centers↗
PubMed1999

Clinical significance of identifying candida on cervicovaginal (Pap) smears.

This study was undertaken to determine the clinical significance of detecting candida on Pap smear. Clinical information was obtained from a questionnaire sent to the health care provider whenever candida was identified during the study period. Candida was identified in 309 (3.0%) of the 10,370 Pap smears examined. Completed questionnaires were returned on 137 (44.3%) patients. All 137 smears were reviewed. Ninety-nine (72%) patients were asymptomatic, 29 (21%) had symptoms typical of candida infection, and nine (7%) had nonspecific symptoms. Forty-four (32%) patients had been treated for candida during the original clinic visit. After the Pap smear reported candida, 19 (20%) of the 93 nontreated patients were contacted and treated, while 10 (11%) were scheduled for further evaluation. No action was taken on the remaining 64 (69%) patients. There was a significant association between having initial symptoms and receiving immediate treatment (P < 0.001) and undergoing subsequent treatment or further evaluation after the Pap smear report (P < 0.001). Marked inflammation was statistically associated with symptoms (P = 0.014), but the form or number of candida organisms was not. In conclusion, the identification of Candida on Pap smear does not necessarily indicate a symptomatic infection, although the Pap smear results had a direct impact on the treatment of 21% of patients in this study and served as a confirmation for clinical treatment in another 32% who had received such treatment at the time of the original visit.

Adolescent↗