Culture, Candida Screen
ID: LAB241
Last Review: 09/19/2025
Components
Culture Candida Screen
KOH Preparation
 
Specimen Sources
Cervix
Esophageal Brush
Genital
Mouth
Oral Mucosa/Gingiva
Other
Pharyngeal
Stool
Throat
Tongue
Urethra
Urine
Vaginal
Vulva
Collection Requirements
ACCEPTABLE SPECIMENS: throat, mouth, esophageal brush, urine, vaginal secretions

Causes for Rejection:
1. Specimen not labeled with patient's name, MRN, date and time of collection, and collector's initials.
2. Fecal specimen.

Collect specimens as follows:
ORAL:
1. Remove oral secretion or debris from surface of lesion with swab and discard.
2. Using a second swab, vigorously sample lesion, avoiding any areas of normal tissue.
3. Replace swab in the CultureSwab Transport Device.

URINE:
1. Wash hands throughly.
2. To clear urethra of contaminants, clean genital area with antiseptic wipes.
3. Females are to clean from front to back; males are to retract foreskin and cleanse head of penis.
4. While keeping foreskin retracted for males and labia separated for females, urinate 20-25mL directly into the toilet or bedpan. STOP.
5. Position container and begin to void.
6. Fill the container about two-thirds full.
7. Screw cap securely on sterile container without touching the inside rim.
8. Refrigerate specimen after collection if transport will be delayed.
Note: Collect 10 mL of urine from a first morning specimen.

VAGINAL:
1. Use speculum without lubricant.
2. Collect secretions from vaginal vault using a CultureSwab Transport Device. Avoid swabbing the external vaginal orifice.
3. Return swab to the CultureSwab Transport Device.

NOTES:
1. Culture of feces is not recommended. Endoscopy or biopsy best accomplishes diagnosis of invasive gastrointestinal mycosis. The role of yeast in nosocomial diarrhea is controversial. Saprophytic yeast and molds are frequently present as commensal gastrointestinal flora.
2. Gram stain of secretions is a quicker and more cost effective tool for diagnosing fungal vaginitis and oral Candidiasis.
Shipping And Handling
DELIVER IMMEDIATELY TO MICROBIOLOGY IN A TIGHTLY SEALED CONTAINER WITH NO EXTERNAL SPILLAGE.

Causes for Rejection:
1. Specimen container leaking.
Turn Around Time (TATs for Specific Labs Below May Differ)
Turn Around Time:
  • ASAP: 10 Day(s)
  • STAT: 10 Day(s)
  • ROUTINE: 10 Day(s)
Performing Labs, Collection Containers and TATs
▷  Duke Microbiology Laboratory
Clinical Indications
Used to aid in the diagnosis of oral, vaginal, and urinary tract infections due to yeast.
Clinical Significance
The incidence of serious candidiasis has risen sharply and often follows use of broad-spectrum antibiotics, corticosteroids, and other immunosuppressive drugs. As a group, Candida spp. is one of the most frequent opportunistic pathogens in patients with Acquired Immunodeficiency Syndrome (AIDS) and in patients with immune defects.
Interpretation
1. In patients with advanced HIV infection, the appearance of oropharyngeal candidiasis is often a predictor of clinical progression to AIDS. Nearly all AIDS patients have oral candidiasis at some time.
2. Infants may acquire Candida spp. orally during passage through the birth canal, during nursing, or from contaminated bottles. Other factors such as wearing dentures, diabetes and high sugar diets may increase the rate of oral carriage of Candida species.
3. Urine specimens are submitted to detect yeast infections of the kidney.  
4. Most studies show that the vaginal yeast carriage rate in normal females is less than 30%. As with oral yeast carriage rates, patients who are receiving medical attention for various reasons have higher yeast carriage than in the normal population, even though the patients have no clinical evidence of vaginitis. The highest rate of vaginal yeast carriage is found among patients with vaginitis.
5. Vaginal candidiasis occurs most commonly in post-pubertal women who are sexually active or have been taking systemic antibacterial agents or have diabetes mellitus or are in the third trimester of pregnancy. Although the evidence is contradictory, estrogen contraceptive therapy probably predisposes women to infection.
6. Among vaginal candida cultures, C. albicans is the most frequently reported species from unselected groups of women, as well as from patients with vaginitis.  Other Candida species such as C. glabrata, C. tropicalis, C krusei, C. guilliermondii, and C. kefyr have been reported more infrequently.
7. Diagnosis of invasive fungal infections of the gastrointestinal tract is established by biopsy of tissue, not by culturing feces. By themselves positive cultures may be misleading because up to 40% of healthy individuals and up to 75% of compromised patients are colonized with yeast. Candida overgrowth appears to follow antibiotic therapy. The role of yeast in nosocomial diarrhea is controversial. Saprophytic yeast and molds are frequently present as commensal gastrointestinal flora.
8. Gram stain of secretions is a quicker and more cost effective tool for diagnosing fungal vaginitis and oral Candidiasis. In symptomatic women, laboratory diagnosis of vaginal candidiasis based on visualization of yeast on gram stain (sensitivity 65%, specificity 100%) has equal or superior performance characteristics compared with yeast seen on KOH preps (sensitivity 61%, specificity 77%). Presence of yeast is noted on the Gram stain report for vaginal specimen.
Methodology
Culture with identification of yeast present.
Additional Information
1. KOH-Calcofluor White Preparation is not routinely performed with this culture. This test must be requested separately at additional charge, see "KOH preparation, other source" test. 
2. For vaginal specimens, a Gram stain or Wet Prep is performed in lieu of KOH-Calcofluor-White Prep if one is ordered.
Critical Values
No Critical Values