Editing Candidiasis (section)

== Diagnosis ==
[[File:Vaginal swab wet mount of candida.jpg|thumb|Vaginal swab wet mount of candida (phase contrast) showing the pseudohyphae]]
[[File:Candida albicans PHIL 3192 lores.jpg|thumb|[[Agar plate]] culture of ''C. albicans'']]
[[File:Vaginal wet mount of candidal vulvovaginitis.jpg|thumb|[[KOH test]] on a [[vaginal wet mount]], showing slings of pseudohyphae of ''[[Candida albicans]]'' surrounded by round vaginal epithelial cells, conferring a diagnosis of [[candidal vulvovaginitis]] ]]
[[Image:Esophageal candidiasis (2) PAS stain.jpg|thumb|Micrograph of esophageal candidiasis showing hyphae, [[biopsy]] specimen, [[PAS stain]]]]
[[File:Candida Gram stain.jpg|thumb|right|[[Gram stain]] of ''Candida albicans'' from a vaginal swab; the small oval [[chlamydospore]]s are 2–4&nbsp;[[micrometre|μm]] in diameter ]]
[[File:CHROMAgar with N glabratus, P kudriavzevii, Candida albicans and Candida tropicalis, annotated.jpg|thumb|Chromogenic agar can help in indicating the involved species of ''Candida'' versus similar fungi. (CHROMAgar shown)]]
[[File:Mycology algorithm.png|thumb|Algorithm for the diagnosis of ''Candida'' versus differential diagnoses.]]
In oral candidiasis, simply inspecting the person's mouth for white patches and irritation may make the diagnosis. A sample of the infected area may also be taken to determine what organism is causing the infection.<ref name="mayoclinic.org">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/oral-thrush/diagnosis-treatment/drc-20353539|title=Oral thrush - Diagnosis and treatment - Mayo Clinic|website=www.mayoclinic.org|access-date=2019-08-06|archive-date=2019-08-06|archive-url=https://web.archive.org/web/20190806172949/https://www.mayoclinic.org/diseases-conditions/oral-thrush/diagnosis-treatment/drc-20353539|url-status=live}}</ref>

Symptoms of vaginal candidiasis are also present in the more common [[bacterial vaginosis]];<ref>{{cite web |url=http://women.webmd.com/features/is-it-yeast-infection | first = Terri | last = Warren |title=Is It a Yeast Infection? |year=2010 |access-date=2011-02-23 |url-status=live |archive-url=https://web.archive.org/web/20110225041728/http://women.webmd.com/features/is-it-yeast-infection |archive-date=2011-02-25 }}</ref> aerobic vaginitis is distinct and should be excluded in the differential diagnosis.<ref>{{cite journal | vauthors = Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B | title = Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis | journal = BJOG | volume = 109 | issue = 1 | pages = 34–43 | date = January 2002 | pmid = 11845812 | doi = 10.1111/j.1471-0528.2002.00432.x | hdl = 10067/1033820151162165141 | s2cid = 8304009 | url = https://repository.uantwerpen.be/docman/irua/30bd6b/6019.pdf | hdl-access = free }}</ref> In a 2002 study, only 33% of women who were self-treating for a yeast infection were found to have such an infection, while most had either bacterial vaginosis or a mixed-type infection.<ref>{{cite journal | vauthors = Ferris DG, Nyirjesy P, Sobel JD, Soper D, Pavletic A, Litaker MS | title = Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis | journal = Obstetrics and Gynecology | volume = 99 | issue = 3 | pages = 419–25 | date = March 2002 | pmid = 11864668 | doi = 10.1016/S0029-7844(01)01759-8 | s2cid = 25895596 }}</ref>

Diagnosis of a yeast infection is confirmed either via microscopic examination or culturing.  For identification by light microscopy, a scraping or swab of the affected area is placed on a [[microscope slide]]. A single drop of 10% [[potassium hydroxide]] (KOH) solution is then added to the specimen. The KOH dissolves the skin cells, but leaves the ''Candida'' cells intact, permitting visualization of [[hyphae|pseudohyphae]] and budding [[yeast cell]]s typical of many ''Candida'' species.<ref>{{cite journal | title = Fluorescence staining vs. routine KOH smear for rapid diagnosis of oral candidiasis-A diagnostic test | vauthors = Lu H, Zhou P, Zhao W, Hua H, Yan Z | journal = Oral Diseases | volume = 26 | issue = 5 | pages = 941–47 | date=July 2020 | pmid = 32011074 | doi = 10.1111/odi.13293 }}</ref>

For the culturing method, a sterile swab is rubbed on the infected skin surface. The swab is then streaked on a culture medium. The culture is incubated at 37&nbsp;°C (98.6&nbsp;°F) for several days, to allow development of yeast or bacterial colonies. The characteristics (such as morphology and colour) of the colonies may allow initial diagnosis of the organism causing disease symptoms.<ref name="Guarner Brandt 2011 pp. 247–280">{{cite journal | last1=Guarner | first1=J. | last2=Brandt | first2=M. E. | title=Histopathologic Diagnosis of Fungal Infections in the 21st Century | journal=Clinical Microbiology Reviews | publisher=American Society for Microbiology | volume=24 | issue=2 | date=2011-04-01 | issn=0893-8512 | pmid=21482725 | pmc=3122495 | doi=10.1128/cmr.00053-10 | pages=247–280}}</ref>
Respiratory, gastrointestinal, and esophageal candidiasis require an [[endoscopy]] to diagnose.<ref name="SIFO" /><ref name="Medscape workup">{{cite web|vauthors=Hidalgo JA, Vazquez JA|title=Candidiasis: Workup|url=http://emedicine.medscape.com/article/213853-workup#showall|website=Medscape|publisher=WebMD|access-date=22 June 2016|date=18 August 2015|url-status=live|archive-url=https://web.archive.org/web/20160611062234/http://emedicine.medscape.com/article/213853-workup#showall|archive-date=11 June 2016}}</ref> For gastrointestinal candidiasis, it is necessary to obtain a 3–5&nbsp;milliliter sample of fluid from the [[duodenum]] for [[microbiological culture|fungal culture]].<ref name="SIFO" /> The diagnosis of gastrointestinal candidiasis is based upon the culture containing in excess of 1,000 [[colony-forming units]] per milliliter.<ref name="SIFO" />

=== Classification ===
Candidiasis may be divided into these types:
* Mucosal candidiasis
** [[Oral candidiasis]] (thrush, oropharyngeal candidiasis)<ref name="Medscape clinical" /><ref name="Thrush - 2015 review" />
*** Pseudomembranous candidiasis<ref name="Thrush - 2015 review" />
*** Erythematous candidiasis<ref name="Medscape clinical" /><ref name="Thrush - 2015 review" />
*** Hyperplastic candidiasis<ref name="Thrush - 2015 review" />
*** [[Denture-related stomatitis]]<ref name="Medscape clinical" /><ref name="Thrush - 2015 review" /> — ''Candida'' organisms are involved in about 90% of cases
*** [[Angular cheilitis]]<ref name="Medscape clinical" /><ref name="Thrush - 2015 review" /> — ''Candida'' species are responsible for about 20% of cases, mixed infection of ''C. albicans'' and ''[[Staphylococcus aureus]]'' for about 60% of cases.
*** [[Median rhomboid glossitis]]<ref name="Thrush - 2015 review" />
** [[Candidal vulvovaginitis]] (vaginal yeast infection)<ref name="Medscape clinical" /><ref name=Mastro2013>{{cite journal | vauthors = Mastromarino P, Vitali B, Mosca L | title = Bacterial vaginosis: a review on clinical trials with probiotics | journal = The New Microbiologica | volume = 36 | issue = 3 | pages = 229–38 | date = July 2013 | pmid = 23912864 | url = http://www.newmicrobiologica.org/PUB/allegati_pdf/2013/3/229.pdf | archive-url = https://web.archive.org/web/20150518165920/http://www.newmicrobiologica.org/PUB/allegati_pdf/2013/3/229.pdf | url-status = live | archive-date = 2015-05-18 }}</ref>
** Candidal [[balanitis]] — infection of the glans penis,<ref name="Medscape clinical" /> almost exclusively occurring in uncircumcised males<ref name="Nyirjesy 2013">{{cite journal | vauthors = Nyirjesy P, Sobel JD | title = Genital mycotic infections in patients with diabetes | journal = Postgraduate Medicine | volume = 125 | issue = 3 | pages = 33–46 | date = May 2013 | pmid = 23748505 | doi = 10.3810/pgm.2013.05.2650 | s2cid = 25586978 }}</ref>
** [[Esophageal candidiasis]] (candidal esophagitis)<ref name="Medscape clinical" /><ref name="Yamada 2009" >{{cite book|vauthors=Yamada T, Alpers DH |title=Textbook of gastroenterology|year=2009|publisher=Blackwell Pub.|location=Chichester, West Sussex|isbn=978-1-4051-6911-0|edition=5th|page=814|display-authors=etal}}</ref>
** Gastrointestinal candidiasis<ref name="pmid24789109" /><ref name="pmid24612332" /><ref name="SIFO" />
** Respiratory candidiasis<ref name="Medscape clinical">{{cite web | vauthors=Hidalgo JA, Vazquez JA | title=Candidiasis: Clinical Presentation | url=http://emedicine.medscape.com/article/213853-clinical#showall | website=Medscape | publisher=WebMD | access-date=22 June 2016 | date=18 August 2015 | url-status=live | archive-url=https://web.archive.org/web/20160601153633/http://emedicine.medscape.com/article/213853-clinical#showall | archive-date=1 June 2016 }}</ref><ref name="pmid24789109" />
* Cutaneous candidiasis
** Candidal [[folliculitis]]<ref name="Medscape clinical" />
** [[Candidal intertrigo]]<ref name="Medscape clinical" />
** [[Candidal paronychia]]<ref name="Medscape clinical" />
** Perianal candidiasis, may present as [[pruritus ani]]<ref name="Andrews">{{cite book | first1 = William D | last1 = James | first2 = Dirk M | last2 = Elston | first3 = Timothy G | last3 = Berger | first4 = George Clinton | last4 = Andrews |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier|pages=308–311|year=2006 |isbn=978-0-7216-2921-6|display-authors=etal}}</ref>{{rp|309}}
** [[Candidid]]
** [[Chronic mucocutaneous candidiasis]]<ref name="Medscape clinical" />
** [[Congenital cutaneous candidiasis]]<ref name="Skoczylas 2014 179–89"/>
** Diaper candidiasis: an infection of a child's [[diaper]] area<ref name="Andrews" />{{rp|309}}
** [[Erosio interdigitalis blastomycetica]]
** Candidal [[onychomycosis]] (nail infection) caused by ''Candida''<ref name="Medscape clinical" /><ref>{{cite journal | vauthors = Nolting S, Brautigam M, Weidinger G | title = Terbinafine in onychomycosis with involvement by non-dermatophytic fungi | journal = The British Journal of Dermatology | volume = 130 | pages = 16–21 | date = April 1994 | issue = Suppl 43 | pmid = 8186136 | doi = 10.1111/j.1365-2133.1994.tb06088.x | s2cid = 37415499 }}</ref>
* [[Systemic candidiasis]]<ref name="Medscape clinical" />
** Candidemia, a form of [[fungemia]] which may lead to [[sepsis]]<ref name="Medscape clinical" />
** [[Invasive candidiasis]] (disseminated candidiasis) — organ infection by ''Candida''<ref name="Medscape clinical" />
** Chronic systemic candidiasis (hepatosplenic candidiasis) — sometimes arises during recovery from [[neutropenia]]<ref name="Medscape clinical" /><ref name="Reiss 2011">{{cite book| first1 = Errol | last1 = Reiss | first2 = H. Jean | last2 = Shadomy | first3 = G. Marshall | last3 = Lyon |title=Fundamental medical mycology|year=2011|publisher=John Wiley & Sons|location=Hoboken, N.J.|isbn=978-1-118-10176-6|chapter-url=https://books.google.com/books?id=eTkxR7lxr4YC&q=candidiasis&pg=PT360|chapter=Chapter 11|url-status=live|archive-url=https://web.archive.org/web/20160430223033/https://books.google.com/books?id=eTkxR7lxr4YC&pg=PT360&dq=candidiasis&hl=en&sa=X&ei=jEgpUv35FIWA0AWe_ICYBg&redir_esc=y#v=onepage&q=candidiasis&f=false|archive-date=2016-04-30}}</ref>
* [[Antibiotic candidiasis]] (iatrogenic candidiasis)