Positive Yeast Culture Research Articles

Antifungal prophylaxis in critically ill patients

We congratulate van Till and colleagues on their review showing that selective decontamination of the digestive tract (SDD) is more effective than single-drug prophylaxis (SAP) in reducing yeast colonisation, infection and mortality [1]. The authors claimed that their review differs from our earlier review, which included paediatric or liver transplant patients. In our review a subgroup analysis was performed in both selected and unselected populations, and demonstrated a significant reduction in yeast carriage and infection in unselected critically ill patients [2]. van Till and colleagues assessed yeast colonisation, lumping together 'positive yeast cultures obtained from sputum, stool, urine and/or wound' [1]. The majority of SDD trials reported positive yeast cultures obtained from surveillance cultures of throat and rectal swabs, whilst the SAP studies mainly assessed positive yeast cultures obtained from diagnostic samples including lower airway secretions, urine and wound fluid. Grouping together surveillance and diagnostic cultures may be misleading in interpreting the efficacy of antifungal interventions. van Till and colleagues' review demonstrated a nonsignificant 41% reduction in candidemia by SDD and a 68% significant reduction by SAP [1]. The authors concluded that SAP prevents candidemia, whilst SDD does not. We believe that van Till and colleagues evaluated two different populations, as the candidemia rates in the control individuals were 3.79% and 1.69% for SAP and SDD, respectively. A larger sample size is almost certainly needed for SDD to demonstrate a significant reduction in candidemia [3].

Mannose-binding lectin deficiency facilitates abdominal Candida infections in patients with secondary peritonitis.

Mannose-binding lectin (MBL) deficiency due to variations in the MBL gene is associated with increased susceptibility to infections. In this study, the association between MBL deficiency and the occurrence of abdominal yeast infection (AYI) in peritonitis patients was examined. Eighty-eight patients with secondary peritonitis requiring emergency laparotomy were included. MBL genotype (wild type [WT] versus patients with variant genotypes), MBL plasma concentrations, and Candida risk factors were examined in patients with and those without AYI (positive abdominal yeast cultures during [re]laparotomy). A variant MBL genotype was found in 53% of patients with AYI and 38% of those without AYI (P = 0.18). A significantly higher proportion of variant patients had an AYI during early peritonitis (during first laparotomy) than WT patients (39% versus 16%, respectively; P = 0.012). Patients with AYI had lower MBL levels than did patients without AYI (0.16 microg/ml [0.0 to 0.65 microg/ml] versus 0.65 microg/ml (0.19 to 1.95 microg/ml); P = 0.007). Intensity of colonization (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0 to 1.1), MBL plasma concentrations of <0.5 microg/ml (OR, 4.5; 95% CI, 1.2 to 16.3), and numbers of relaparotomies (OR, 1.7; 95% CI, 1.0 to 2.8) were independently associated with AYI. In summary, deficient MBL plasma levels were independently associated with the development of AYI in patients with secondary peritonitis and seemed to facilitate early infection.

Rapid testing for vaginal yeast detection: a prospective study

The purpose of this study was to determine the accuracy of rapid vaginal yeast detection assay compared with yeast cultures for the diagnosis of vulvovaginal candidiasis. This was a prospective study that involved 104 subjects, 34 asymptomatic women and 70 symptomatic women with vaginitis. Vaginal swabs were obtained from all subjects for wet mount, yeast culture, and the rapid yeast detection test. Overall, the prevalence rate was 39.4%, based on positive yeast cultures. The rapid yeast test performed by the physician was positive in 30 of 41 subjects with positive cultures and 13 of 63 subjects with negative cultures. The rapid yeast test had 73.1% sensitivity and 82.0% negative predictive value compared with the wet mount, which had 43.9% sensitivity and 70.9% negative predictive value. In symptomatic patients, the test had 77.4% sensitivity and 81% negative predictive value compared with wet mount, which had 51.6% sensitivity. Patient-performed test results were identical to the tests that were performed by the physicians. The cost of the rapid yeast test kit is estimated to be <$10, compared with a mean of $65 for the yeast culture. Rapid yeast detection assay is accurate and affordable compared with the gold standard yeast culture in the diagnosis of vulvovaginal candidiasis. Relative to the wet mount, it is more sensitive, cheaper, and accurate for the rapid diagnosis of vaginal yeast infection.

Prevalence of Vulvovaginal Candidiasis and Susceptibility to Fluconazole in Women

In this study a new method of membrane filtration using a panel of florigenic enzyme substrates to identify and differentiate four major Candida species within 9 to 12 hours was tested for its ability to diagnose vulvovaginal candidiasis. The study subjects were 612 women who were recruited from consecutive patients who attended a gynecological clinic at Ghent University Hospital during a 14-week period. Some subjects had symptoms of vaginitis, but others did not. Each subject underwent a clinical examination including a wet vaginal smear and a vaginal swab, which was placed in transport gel for delivery to the laboratory. The florigenic process involves the formation of a microcolony on a membrane filter over a 9- to 11-hour incubation period. The membrane is cut into five segments, which are impregnated with a buffered solution of a florigenic 4-methylumbilliferyl substrate. After a further incubation period of 30 minutes, during which cleavage of enzyme substrates takes place, the microcolonies are examined under long-wavelength ultraviolet light resulting in blue or orange fluorescence. A positive yeast culture was obtained from the vaginal swabs of 123 of the 612 women (20.1%). Sixty-five of the patients had symptoms of vaginitis (vulvar pruritus and vaginal discharge), and 547 were asymptomatic. Of the 65 symptomatic women, 60% (39 of 65) had a positive KOH wet smear, and 40% (26/65) had a negative KOH result. More than two thirds of the isolated species were C. albicans (68.3%); C. glabrata was found in 16.3%, C. parapsilosis was isolated in 8.9%, and C. humicola, C. krusei, and C. lusitaniae were found in 1.6%, 0.8%, and 0.8%, respectively. The florigenic technique agreed 100% of the time with chromogenic analysis performed as a comparative standard. The highest number of isolated yeasts was found in women with clinical symptoms of candidiasis and a positive KOH test (29 of 35 >1000 CFU/ml). Conversely, women with clinical symptoms and negative KOH test had low numbers of isolated yeasts. When the subjects were divided into subgroups, pregnant women were the most likely, and postmenopausal women with no hormonal replacement therapy were the least likely, to have a positive yeast culture (33 of 103, 32%, P =.045; 15 of 119, 12.6%, P =.003, respectively). Yeast was found in 26.9% of postmenopausal women not taking oral contraceptives (22 of 114), and 14.4% and 14.0% of premenopausal women taking oral contraceptives (16 of 111) or with an intrauterine device (8 of 57), respectively. The rate of yeast colonization was significantly related to the amount of estrogen in oral contraceptives, with the higher concentrations more likely to have positive yeast growth (P =.05). Similarly, yeast colonization in pregnant women grew significantly as pregnancy progressed (P =.05). Twenty-six of the 123 yeast isolates were resistant to fluconazole when subjected to in vitro sensitivity testing.

Characterization of women with a history of recurrent vulvovaginal candidosis

To characterize history, signs, and symptoms in women with a history of recurrent vulvovaginal candidosis (RVVC) and who had consulted with symptoms generally associated with the condition. Eighty-three women with a history consistent with RVVC were interviewed regarding 32 parameters and 10 signs found at the clinical examination were noted. Candida cultures were made from the introitus and the posterior vaginal fornix. Only in a few of the 43 women with and the 40 without a positive yeast culture could any of the many etiological factors that have been associated with RVVC be traced. Only two factors differed between the groups, namely yogurt intake, which was reported by 28 (68%) and 38 (95%) women in these groups, respectively. Vaginal douching was performed by 10 (23%) women in the Candida-positive group and by 17 (42%) women in the Candida-negative group. Pruritus and burning occurred in 31 (72%) and 22 (51%) of culture-positive patients, which was less frequent than in the culture-negative group, i.e. reported by 19 (47%) and 9 (22%) patients, respectively (p = 0.022 and p = 0.007). Edema (p = 0.026) of the vulva as well as erythema (p = 0.019) and edema (p = 0.008) of the vaginal mucosa, caseous discharge (p = 0.016), were found more often in the Candida culture-positive cases. History and results of clinical examination of patients with RVVC are not enough to distinguish those who are culture-positive from those who are culture-negative for Candida from the genital tract.

Is Candida septicemia in premature infants a nosocomial infection?

Yeast colonization of the vagina is found in about 30% of all pregnant women. Premature infants are severely endangered by generalized fungal infections due to their immature immune system. The objective of this study was to elucidate the relationship between vaginal yeast colonization of the mothers and Candida septicemia in their premature babies. In a prospective study, running from 12/1994 to 8/1996, 176 mothers, facing probable premature birth, were investigated, when hospitalized, for vaginal yeast colonization. 150 premature infants (birth weights ranging from 550 to 2390 g) of these mothers were culturally examined for yeasts in specimens from the mouth, ear, stool and urine immediately after birth as well as once weekly in the following weeks. The patients were divided into two groups. In group A, oral prophylaxis with nystatin was practiced only in infants with at least one positive yeast culture. In group B, all patients received nystatin prophylaxis. Candida septicemia developed one or two weeks after birth mainly in infants with birth weights below 1000 g. Primary oral prophylaxis with nystatin lowers considerably the risk of developing Candida infection.

Chronic vulvovaginal candidiasis: characteristics of women with Candida albicans, C glabrata and no candida.

Although as many as 5% of all women complain of chronic vulvovaginitis, little is known about these women. They may often be misdiagnosed and the role of vaginal yeast culture in diagnosing vulvovaginal candidiasis (VVC) among them has not been clearly defined. To address these deficiencies, we tabulated initial diagnoses among new patients and conducted a medical record-based, unmatched case-control study among women reporting a history of chronic vulvovaginitis (four or more episodes in the past year) at a vulvovaginitis specialty clinic. Clinical presentation and medical history were compared for women who had a positive vaginal yeast culture for either Candida albicans or C glabrata, or who had a negative culture. One-third of the women had no apparent vulvovaginal disease at their initial visit. All women reported similar symptoms, except for an increased prevalence of painful sexual intercourse in women with C albicans (chi 2 p = 0.014 versus women with C glabrata and p < 0.001 versus women with no candida). Women with C glabrata were more likely to be non-white (chi 2 p = 0.071 compared with women with C albicans) and to report an underlying medical condition (chi 2 p < or = 0.001 versus both women with C albicans and women with no candida). Physical examination was normal only in women with no candida. C albicans cases were more likely to have positive potassium hydroxide microscopy (chi 2 p = 0.016) and a pH < or = 4.5 (chi 2 p = 0.011) than were C glabrata cases. These results suggest that reliance on symptoms and signs alone will result in significant misdiagnosis of chronic vulvovaginitis. Among women with VVC, subtle differences in clinical presentation do not reliably distinguish women with C albicans from those with C glabrata. Our study also indicates that vaginal yeast cultures, while not necessary for every patient, are valuable in confirming negative diagnoses, detecting microscopy false-negatives, and identifying non-C albicans isolates.

Clinical and Microscopic Diagnosis of Vaginal Yeast Infection: A Prospective Analysis

Study objectives: To evaluate the accuracy of clinical findings and direct microscopy in the diagnosis of yeast vaginitis. Design: Prospective. Setting: Urban teaching hospital emergency department and walk-in clinic. Participants: Seventy-one consecutive nonmenstruating women with a presenting complaint of vaginal discharge, itching, or pain. Interventions: Trained emergency physicians and nurse practitioners, blinded to culture results, collected clinical information, examined vaginal secretions, and obtained yeast cultures. Treatment was based on clinical impression and not altered by the study. Associations between clinical and laboratory parameters and yeast culture results were evaluated. Results: Twenty-three patients (32.4%) had positive yeast cultures. Accepted risk factors were seen in patients with and without culture-positive yeast vaginitis. Clinical criteria for yeast vaginitis—including pruritus, caseous discharge, perineal edema or erythema, and patient self-diagnosis—were more common in women with yeast vaginitis but were seen with other causes of vaginitis. Watery discharge and amine odor (negative "whiff" test) were good predictors of an alternative diagnosis, but, again, accuracy was poor. Gram stain showing yeast was the most accurate laboratory method of diagnosis. Saline microscopy, potassium hydroxide, and methylene blue were all equal and only moderately accurate, with a significant proportion of false-negative and false-positive results. Conclusion: Standard criteria for diagnosis of monilial vaginitis are relatively unreliable. Gram stain, absence of watery discharge, and patient self-diagnosis of "another yeast infection" are the best independent predictors of a positive culture. [Abbott J: Clinical and microscopic diagnosis of vaginal yeast infection: A prospective analysis. Ann Emerg Med May 1995;25:587-591.]

Occurrence of corrugated white patch lesions on lateral border of tongue in lymphoma patients during cytostatic treatment.

The question of whether or not there was an association between immunosuppression and occurrence of corrugated white patch lesions on the lateral border of the tongue was studied in 79 patients being treated for non-Hodgkin lymphoma or Hodgkin's disease. The mouths of 55 patients (mean age 47.8 years, 34 males, 21 females) were examined during periods of chemotherapy. All patients were HIV-seronegative. White non-removable lesions on the lateral margins of the tongue were noted in 27 patients (42.8%) 74 days after commencement of chemotherapy and 10 days after termination of medication. In 12 cases (44.4%) the lesions were bilateral. Epstein-Barr virus (EBV) DNA was found by gene amplification using polymerase chain reaction (PCR) in one of the two biopsy samples taken. No white lesion on the lateral border of tongue had been seen in any patient before treatment, nor were any evident 1 year after treatment. Leucocyte counts were significantly (P = 0.001) lower when the lesion was present than when it was not detected. Before chemotherapy, 70.4% of patients with lesions and 47.6% of patients without lesions had positive salivary yeast cultures. Yeasts could be cultured from the saliva of 80.5% of patients when the lesions were present. In 2 patients clinical oral candidiasis was diagnosed at the time of the lesion. The study revealed a correlation between the occurrence of corrugated white, non-removable lesions of the lateral borders of the tongue, high salivary yeast counts and leucocytopenia.(ABSTRACT TRUNCATED AT 250 WORDS)

VAGINAL YEASTS IN PARTURIENTS AND INFESTATION OF THE NEWBORNS

Abstract. Vaginal yeasts from 992 full‐term pregnancy parturients in the delivery room were cultured and identified. Yeasts were similarly cultured from the mouth of the newborns seven days after birth to find out whether a viable yeast infection had taken place. Anamnestic data concerning genital infection earlier or during the present pregnancy were collected from the parturients. The yeast findings are compared with results from similar cultures from gynecologic out‐patients. Vaginal yeast infection had been diagnosed before the present pregnancy in 16.5 per cent and in some phase of the present pregnancy before the delivery in 8.5 per cent of the parturients. A positive yeast culture with no clinical symptoms during the pregnancy was found in 9.9 per cent. Clinical symptoms were present in 61 per cent of the yeast culture positive parturients. Altogether 3 155 specimens were studied and 670 yeasts were identified. Positive yeast cultures from parturients were obtained in 23.7 per cent and from gynecologic patients in 30.9 per cent. Candida albicans was the most common yeast. It was followed by Saccharomyces cerevisiae in the parturients and Torulopsis glabrata in the gynecologic patients. Pityrosporum ovale/orbiculare was also common in the latter material. S. cerevisiae as well as Pityrosporum species are usually not identified in the medical yeast laboratories, for methodological reasons. Positive yeast culture from the mouth of the newborns were obtained only in 20 cases. A symptomatic oral candidosis was not present in any of the cases.

Oropharyngeal candidiasis in patients treated with triamcinolone acetonide aerosol

Thirty asthmatic patients participating in a trial of triamcinolone acetonide aerosol were evaluated to determine the relationships among symptoms of sore throat or hoarseness, the appearance of the throat on physical examination, and the presence of yeasts on pharyngeal culture. Observations were recorded prior to aerosol therapy and repeated after 2 wk, 4 wk, 6 wk, 4 mo, and 6 mo of therapy. A total of 15 patients (50%) experienced sore throat or hoarseness, 15 (50%) had yeasts cultured from the pharynx on at least one occasion, and 11 (37%) at some point had an abnormal throat examination; however, there was no predictable relationship between symptoms or abnormal physical examinations and the presence of a positive culture. The frequency of positive cultures did not change significantly during the observation period. Twelve patients had positive yeast cultures on 50% or more of their samples. The incidence of symptoms was not sigficantly increased in these chronically colonized patients. Symptoms were usually transient, and discontinuation of the aerosol or antifungal therapy was unnecessary. Triamcinolone aerosol was not associated with significantly increased pharyngeal colonization with yeasts in this 6-mo study. Existing chronic colonization is not necessarily a contraindication to triamcinolone therapy. Sore throat and hoarseness are usually unrelated to yeast infection in patients using triamcinolone acetonide aerosol.