PEDIATRICS Vol. 30 No. 1 July 1962, pp. 71-85
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ENTERIC CANDIDIASIS

Diagnosis and Clinical Considerations

Philip J. Kozinn M.D.1 and Claire L. Taschdjian B.Sc., M.S.1

1 Department of Pediatrics, Maimonides Hospital, Brooklyn, New York

Direct microscopic examination of fecal smears permits differentiation between the saprophytic and the pathogenic phase of intestinal Candida albicans. The pathogenic phase is characterized by the presence of mycelia (M) in direct smears. When C. albicans is present saprophytically, direct fecal smears are negative or show the yeast form (Y) only. MY-positive fecal smears were found with nine times higher frequency in abnormal than in normal-appearing stools of infants with oral thrush who yielded C. albicans in stool cultures. Candidal enteritis was diagnosed on the basis of MY-positive fecal smears in 27 patients, and was ruled out on the basis of MY-negative fecal smears in six patients who yielded the organism in cultures only. The validity of the a priori diagnosis was tested by the comparative response of the MY-positive and the MY-negative patients to specific anticandidal therapy (nystatin) given by mouth. Of the patients, 88% responded clinically and mycologically as predicted on the basis of direct mycological stool examinations. Of the MY-positive patients, 80% responded to nystatin within an average of 3 days' therapy. All six MY-negative patients failed to respond within an average of 12 days' therapy. The difference in response was found to be statistically significant. Oral and/or cutaneous candidiasis was present in 85% of the MY- positive patients. The presence of oral and/or cutaneous candidiasis in a patient with diarrhea furnishes a clinical clue to probable candidal etiology of the enteritis.




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