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Prevalence and epidemiological characteristics of vaginal candidiasis in the UAE
Abstract
Vaginal candidiasis (VC) continues to be a health problem to women worldwide. Although the majority of VC cases are caused by Candida albicans (C. albicans), non-albicans Candida spp. like C. glabrata and C. tropicalis are emerging as important and potentially resistant opportunistic agents of VC. The objective of this study was to evaluate the prevalence and epidemiology of VC in the UAE through retrospective analysis of pertinent data compiled by the microbiology and infection control unit at Latifa Hospital, Dubai between 2005 and 2011. The incidence of VC significantly increased from 10.76% in 2005 to 17.61% in 2011; average prevalence was 13.88%. C. albicans occurred at a frequency of 83.02%, C. glabrata at 16.5% and C. tropicalis at 1.2%. A single C. dubliniensis isolate was identified in the sample population. The percentage of C. albicans significantly decreased from 83.02% in the sample population as a whole to 60.8% in subjects over 45 years of age (P < 0.01) and that of C. glabrata, C. tropicalis and C. krusei significantly increased from 13.88%, 0.9% and 0.03% to 29.7%, 6.7% and 1.4% (P < 0.05) respectively. The incidence of VC in the UAE is on the rise and the frequency of non-albicans Candida spp. is noticeably increasing especially in postmenopausal women.
... While Candida albicans has long been implicated in the occurrence of vaginal candidiasis, in recent years we have seen an emergence of Candida non albicans in women of childbearing age [4,8,9]. Among these species, Candida glabrata was the most frequent [2,10,11]. Candida glabrata is part of our natural microflora and can be present in the digestive tract, mouth and genital area. Usually well controlled, or harmless, yeast can become pathological in people with weakened immune systems. ...
... The prevalence of vaginal candidiasis due to Candida non albicans is high in our series as reported in the literature. Indeed, alongside Candida albicans, several studies have already reported the possible emergence of non-albicans candida in the pathogenesis of vaginal candidiasis in women of childbearing age [10,[13][14][15][16]. These data corroborate those obtained in the sub-region and elsewhere [17][18][19][20]. ...
... Regarding the age of the patients, the majority of the patients were between [18-40 years old]. This is similar to the results of several studies carried out on vaginal candidiasis where the age group most affected by vaginal candidiasis was that of women in the period of genital activity [7][8][9][10][11][12]14,16,17,26]. However, the majority of these studies did not specifically focus on Candida non albicans candidiasis. ...
Introduction: Vaginal candidiasis is a mycosis caused by a yeast of the genus Candida. Candida albicans was for a long time the first etiology of these mycoses. However, in recent years, an increasing involvement of non-albicans Candida species has been observed. Objective: To describe the epidemiological and mycological aspects of vaginal candidiasis due to Candida non albicans in women who have performed an analysis of the vaginal sample in the Parasitology Mycology laboratory of the University Hospital Center of Brazzaville. Patients, Materials And Method: This was a descriptive and analytical cross-sectional study from July to October 2019 (i.e. 3 months). It concerned all the patients received at the Parasitology-mycology and parasitic immunology laboratory of the CHUB for an analysis of the vaginal sample. The diagnosis was made after direct examination and culture of samples on Sabouraud Chloramphenicol medium with and without Actidione*. The filamentation test on calf serum and the study of the biochemical characteristics of the yeast colonies using the API candida strips from Biomérieux were carried out for each positive culture. Statistical analysis was performed using Epi-info 7.2.2.6 softwares. Results: The frequency of Candida non albicans yeast infection was 64.7%. The median age of patients with Candida non albicans vaginal candidiasis was 35.5 years (25.0 years - 47.0 years) with extremes of 18 and 59 years old. The age group between 18 and 40 was the most represented (68.2%). These were women with secondary education (n=12 ; 54.5%), with a notion of a single sexual partner (n=17 ; 77.3%), pregnant (n=6 ; 27, 3%). In 22.7% there was poor faecal hygiene. The main reasons for taking the samples were… and the non-albicans Candida species were represented by Candida glabrata (36.4%), Candida tropicalis (18.2%), Candida krusei (13.6%), Candida famata (13.6%), Candida parapsilosis (9.1%) and Candida spp (4.6%). Analytical Study Conclusion: Candida non albicansremains the common fungus in our context with a predominance of Candida glabrata. Age, poor faecal hygiene could have a link with the occurrence of these fungal infections, hence the importance of good awareness and systematic research in young women.
... Some studies have indicated BV to be most prevalent infection, while in some other studies VVC was found to have the highest frequency (Kamara et al., 2000;Gibney et al., 2001;Garcia et al., 2007;Gupta et al., 2009;Shrestha et al., 2011;Chaudhary et al., 2012;Lennox et al., 2013;Sivaranjini et al., 2013;Mobashaeri et al., 2014). C. albicans has been documented to be the major cause of VVC, but the proportion of non-albicans Candida (NAC) species appears to be increasing in last few decades (Stelzner, 1990;Spinillo et al., 1997;Grigoriou et al., 2006;Sobel, 2007;Guzel et al., 2011;Doddaiah et al., 2014;Hamad et al., 2014;Hedayati et al., 2015). This can be attributed to variety of interventions including single dose treatment, low-dosage azole maintenance regimens and the use of over the counter antimycotics. ...
... C. albicans was found to be the single most prevalent species in VVC. This finding of the present study was similar to the studies conducted in Nigeria, USA, Kenya, India, UAE, Iran (Alli et al., 2011;Mintz and Martens, 2013;Nelson et al., 2013;Doddaiah et al., 2014;Hamad et al., 2014;Hedayati et al., 2015). However, this is in contrast to a single study reported in India where C. tropicalis was found to be more prevalent than C. albicans (Sharma and Solanki, 2014). ...
... However present as well as earlier studies have reported very low prevalence of C. krusei (Leon et al., 2002;Nelson et al., 2013). During the last few years the reports regarding the increased frequency of NAC species in VVC have emerged (Spinillo et al., 1997;Grigoriou et al., 2006;Sobel, 2007;Guzel et al., 2011;Vijaya et al., 2014;Hamad et al., 2014;Hedayati et al., 2015). This may be due to the reason that most of the researchers have not preceded the Candida species differentiation. ...
Abnormal vaginal discharge is a frequent complaint of women of child bearing age
seeking gynaecological care. The frequency of different types of vulvovaginal
infections (VVI) showed regional variations. Objectives of the present study were
to determine the prevalence of different types of VVI and species specific
distribution of vulvovaginal candidiasis (VVC) in North India. A total of 200
married women diagnosed by a gynaecologist for VVI were recruited for the
present study. Vaginal swabs from these participants were processed for detection
of bacterial vaginosis (BV), VVC and trichomoniasis based on European
(IUSTI/WHO) guidelines on the management of vaginal discharge (2011). Species
specific distribution of VVC was assessed by HiChrome Candida differential agar,
Germ tube test as well as Scanning electron microscopy. The findings of the
present study indicate that BV was the most prevalent infection (48.5%) followed
by VVC (31%) and mixed infections (20.5%). However, no case of trichomoniasis
was detected. Candida albicans was found to be the most prevalent species. Out of
non-albicans Candida (NAC) species, C. tropicalis was found to be the most
prevalent species. Overall distribution of C. albicans and NAC species indicated
marginally high prevalence of NAC species (53%) than C. albicans (47%). When
VVI were compared between pregnant and non-pregnant subjects, VVC was more
prevalent in pregnant females while BV and mixed infections (MI) were more
prevalent in non-pregnant females. Furthermore, in pregnant women C. tropicalis
(42.8%) was the most prevalent species while in non-pregnant females C. albicans
(43.9%) was the most prevalent species. In conclusion, BV was the most prevalent
VVI in North India. C. albicans was the single most prevalent species in VVC
while among NAC species, C. tropicalis was found to occur at highest frequency.
... VVC continues to represent a very common problem for women and may affect their physical and mental health as well as relationships with their partners [11,12]. Epidemiological trends suggest that more than two thirds of women will experience at least one episode of VVC during their lifetime [12,13]; however, this number may be inaccurate because many studies are based on patient self-reporting without microbiological confirmation [12]. ...
... The concept of antibacterial drugs eliciting VVC is commonly reported in textbooks and ingrained in the thinking of physicians who may vividly recall patients who received an antibiotic prior to developing vaginal symptoms [15,24]. Additionally, scientific reports cite the use of antibiotics as a risk factor for VVC development [11,13,27]. However, studies supporting this hypothesis have been limited by, for example, a lack of mycology cultures [10,14,16,17] or control groups [6,10,16]. ...
... Given that we did not detect any symptomatic VVC, a positive Candida culture represented vaginal colonization; statistical analysis showed no risk for either group. These results are consistent with other epidemiological studies on this subject [11,13,22,25]. Typically, a wide variation in vaginal colonization by Candida spp. ...
Introduction and hypothesis:
Acute uncomplicated lower urinary tract infections (UTI) and vulvovaginal candidiasis (VVC) both occur frequently in women. Although VVC is believed to commonly occur after antibiotic therapy, few studies have demonstrated this association. Thus, the aim of the study was to estimate the prevalence of colonization by Candida spp. and VVC after norfloxacin (NOR) use for UTI and the effects on the vaginal microbiota and inflammatory process.
Methods:
This was a prospective cohort study of women with culture-proven UTI who were treated with NOR (antibiotic group). The control group consisted of women with noninfectious diseases or in preventive care. Candida vaginal infections were monitored both clinically and mycologically at baseline and at the follow-up evaluation.
Results:
All women showed UTI remission after NOR treatment, and no woman in either group, antibiotic and control, showed symptoms of VVC. Both groups showed similar ratios of a positive Candida culture at baseline (6.7 % and 12.8 %, respectively) and at follow-up (3.3 % and 8.5 %, respectively) (p = 0.2768 and p = 0.5035, respectively). The antibiotic group showed no increased risk of Candida colonization or VVC after NOR treatment compared with the control group [odds ratio (OR) 0.556, 95 % confidence interval (CI) 0.2407-10.05].
Conclusions:
NOR was effective for UTI treatment, did not increase the risk of vaginal colonization by Candida or VVC, and did not lead to major disturbances of the vaginal microbiota.
... There is only one single-center retrospective study on VVC in the UAE demonstrating an incidence of VVC significantly increasing from 10.8% in 2005 to 17.6% in 2011 with an average prevalence of 13.9% [72]. We have conservatively assumed that 6% of the 4 million adult women (aged 15-50) have recurrent VVC, a total of 190,330 (Table 3). ...
... We have conservatively assumed that 6% of the 4 million adult women (aged 15-50) have recurrent VVC, a total of 190,330 (Table 3). Hamad et al. found the percentages of species implicated to be C. albicans was 83%, C. glabrata was 16.5% and C. tropicalis was 1.2% [72]. ...
The United Arab Emirates has very little data on the incidence or prevalence of fungal diseases. Using total and underlying disease risk populations and likely affected proportions, we have modelled the burden of fungal disease for the first time. The most prevalent serious fungal conditions are recurrent vulvovaginitis (~190,000 affected) and fungal asthma (~34,000 affected). Given the UAE’s low prevalence of HIV, we estimate an at-risk population of 204 with respect to serious fungal infections with cryptococcal meningitis estimated at 2 cases annually, 15 cases of Pneumocystis pneumonia (PCP) annually, and 20 cases of esophageal candidiasis in the HIV population. PCP incidence in non-HIV patients is estimated at 150 cases annually. Likewise, with the same low prevalence of tuberculosis in the country, we estimate a total chronic pulmonary aspergillosis prevalence of 1002 cases. The estimated annual incidence of invasive aspergillosis is 505 patients, based on local data on rates of malignancy, solid organ transplantation, and chronic obstructive pulmonary disease (5.9 per 100,000). Based on the 2022 annual report of the UAE’s national surveillance database, candidaemia annual incidence is 1090 (11.8/100,000), of which 49.2% occurs in intensive care. Fungal diseases affect ~228,695 (2.46%) of the population in the UAE.
... The results of our study were similar to that of previous researches in Turkey (49.2%) [38], Egypt (50.4%) [21], Iran (50.5 and 51.6%) [39,40]. Lower yeast prevalence was reported from Greece (12,1%) [41], UAE (13.88%) [42], India (20.0%) [43], Gabon (28.52%) [44], Ghana (36.5%) [45], Lebanon (39.0 and 44.8%) [1,33], and Tanzania (45.7%) [46]. Studies from Yemen, Ethiopia reported also a lower prevalence of VVC among nonpregnant reproductive-aged women than the current study [20,47]. ...
... Many previous studies have reported findings that agree with our results, including Guzel [20]. The data in different parts of the world have recorded higher rates of C. albicans in VVC (75- [7,39,42,44,50], while lower rates of 25.9, 41.7 and 44.21% were reported from Ghana [51], Pakistan [52] and Iran [17], respectively. According to previous reports, C. albicans was responsible for 85-95% of VVC patients; however, most studies, published during the last years, reported incidence of C. albicans below 85% and in some regions even below 50% [5]. ...
Background: Vaginal candidiasis is frequent in women of reproductive age. Accurate identification Candida
provides helpful information for successful therapy and epidemiology study; however, there are very limited data
from the Vietnam have been reported. This study was performed to determine the prevalence, species distribution
of yeast causing vaginal discharge and antifungal susceptibility patterns of Candida albicans among symptomatic
non-pregnant women of reproductive age.
Methods: Vaginal discharge samples were collected from 462 women of reproductive age in Hanoi, Vietnam
between Sep 2019 and Oct 2020. Vaginal swabs from these patients were examined by direct microscopic
examination (10% KOH). CHROMagar™ Candida medium and Sabouraud dextrose agar supplemented with
chloramphenicol (0.5 g/l) were used to isolate yeast, and species identification was performed using morphological
tests and molecular tools (PCR and sequencing). Antifungal susceptibility testing was determined according to the
Clinical and Laboratory Standards Institute guidelines (M27-A3 and M27-S4).
Results: The prevalence of vaginal yeast colonization in non-pregnant women was 51.3% of 462 participants. Nine
different yeast species were identified. Among these isolates, C. albicans (51.37%) was the most frequent, followed
by C. parapsilosis (25.88%), C. glabrata (11.37%), C. tropicalis (4.31%), C. krusei (3.92%), C. africana (1.57%),
Saccharomyces cerevisiae (0.78%), C. nivariensis (1 isolates, 0.39%), and C. lusitaniae (1 isolates, 0.39%), respectively.
Among C. albicans, all 46 isolates were 100% susceptible to micafungin, caspofungin, and miconazole. The susceptibility rates to amphotericine B, 5-flucytosine, fluconazole, itraconazole and voriconazole were 95.65, 91.30,
91.30, 82.61 and 86.95%, respectively.
Conclusions: The prevalence of VVC among symptomatic non-pregnant women of reproductive age in Vietnam
was higher than many parts of the world. The high frequency of non-albicans Candida species, which were often
more resistant to antifungal agents, was a notable feature. Resistance rates of vaginal C. albicans isolates to
antifungal agents was low. Our findings suggest that continued surveillance of changes in species distribution and
susceptibility to antifungals should be routinely screened and treated.
... The results of our study were similar to that of previous researches in Turkey (49.2%) [38], Egypt (50.4%) [21], Iran (50.5 and 51.6%) [39,40]. Lower yeast prevalence was reported from Greece (12,1%) [41], UAE (13.88%) [42], India (20.0%) [43], Gabon (28.52%) [44], Ghana (36.5%) [45], Lebanon (39.0 and 44.8%) [1,33], and Tanzania (45.7%) [46]. Studies from Yemen, Ethiopia reported also a lower prevalence of VVC among nonpregnant reproductive-aged women than the current study [20,47]. ...
... Many previous studies have reported findings that agree with our results, including Guzel [20]. The data in different parts of the world have recorded higher rates of C. albicans in VVC (75- [7,39,42,44,50], while lower rates of 25.9, 41.7 and 44.21% were reported from Ghana [51], Pakistan [52] and Iran [17], respectively. According to previous reports, C. albicans was responsible for 85-95% of VVC patients; however, most studies, published during the last years, reported incidence of C. albicans below 85% and in some regions even below 50% [5]. ...
Background
Vaginal candidiasis is frequent in women of reproductive age. Accurate identification Candida provides helpful information for successful therapy and epidemiology study; however, there are very limited data from the Vietnam have been reported. This study was performed to determine the prevalence, species distribution of yeast causing vaginal discharge and antifungal susceptibility patterns of Candida albicans among symptomatic non-pregnant women of reproductive age.
Methods
Vaginal discharge samples were collected from 462 women of reproductive age in Hanoi, Vietnam between Sep 2019 and Oct 2020. Vaginal swabs from these patients were examined by direct microscopic examination (10% KOH). CHROMagar™ Candida medium and Sabouraud dextrose agar supplemented with chloramphenicol (0.5 g/l) were used to isolate yeast, and species identification was performed using morphological tests and molecular tools (PCR and sequencing). Antifungal susceptibility testing was determined according to the Clinical and Laboratory Standards Institute guidelines (M27-A3 and M27-S4).
Results
The prevalence of vaginal yeast colonization in non-pregnant women was 51.3% of 462 participants. Nine different yeast species were identified. Among these isolates, C. albicans (51.37%) was the most frequent, followed by C. parapsilosis (25.88%), C. glabrata (11.37%), C. tropicalis (4.31%), C. krusei (3.92%), C. africana (1.57%), Saccharomyces cerevisiae (0.78%), C. nivariensis (1 isolates, 0.39%), and C. lusitaniae (1 isolates, 0.39%), respectively. Among C. albicans, all 46 isolates were 100% susceptible to micafungin, caspofungin, and miconazole. The susceptibility rates to amphotericine B, 5-flucytosine, fluconazole, itraconazole and voriconazole were 95.65, 91.30, 91.30, 82.61 and 86.95%, respectively.
Conclusions
The prevalence of VVC among symptomatic non-pregnant women of reproductive age in Vietnam was higher than many parts of the world. The high frequency of non- albicans Candida species, which were often more resistant to antifungal agents, was a notable feature. Resistance rates of vaginal C. albicans isolates to antifungal agents was low. Our findings suggest that continued surveillance of changes in species distribution and susceptibility to antifungals should be routinely screened and treated.
... However, antifungal resistance and recurrence rates are typically higher with the NAC species, necessitating prolonged and/or alternative treatment options (23,27). Even more troubling are several reports indicating that NAC species are being increasingly identified as causative agents of VVC (28,29). Moreover, while the virulence mechanisms driving C. albicans immunopathogenesis at the murine vaginal mucosa are well described (e.g., hypha formation, candidalysin expression, and inflammasome activation), those responsible for immunopathology caused by NAC species remain poorly defined. ...
... In support of this, a clinical study by Dennerstein et al. demonstrated that of 44 women presenting with vaginitis-like symptoms and harboring a NAC yeast, 86% reported spontaneous improvement without requiring antifungal intervention (30). On the other hand, the relatively large number (ϳ5% to 10%) of VVC cases universally caused by C. glabrata cannot be denied, suggesting that NAC species do actively contribute to symptomatic VVC (20,23,24,28). C. glabrata remains a formidable clinical challenge, as these infections are largely unresponsive to standard fluconazole therapy, given the intrinsic resistance of C. glabrata to the azole class (54). Often, prolonged treatment regimens (weeks to months) with alternative topical azole (e.g., miconazole and terconazole) or antifungal (e.g., flucytosine and amphotericin B) drugs are required, in conjunction with boric acid vaginal suppositories (55,56). ...
The human fungal pathogen Candida albicans is the major etiological agent of vulvovaginal candidiasis (VVC). Despite this fact, other non- albicans Candida (NAC) species have frequently been reported as well. Despite their presence in the vaginal environment, little is known about their capacity to elicit immune responses classically associated with C. albicans -mediated immunopathology, including neutrophil recruitment and pro-inflammatory cytokine signaling. Therefore, using a combination of in vitro and in vivo approaches, we undertook a comparative analysis to determine whether a representative panel of NAC species could colonize, induce immunopathological markers, or cause damage at the vaginal mucosa. Using a murine model of VVC, C. albicans was found to induce robust immunopathology (neutrophils, IL-1β) and elicit mucosal damage. However, all NAC species tested (including C. dubliniensis , C. tropicalis , C. parapsilosis , C. krusei , C. glabrata , andC. auris ) induced significantly less damage and neutrophil recruitment, despite achieving similar early colonization levels as C. albicans . These results largely correlated with notable lack of the NAC species ( C. dubliniensis and C. tropicalis included) to form hyphae both in vitro and in vivo. Furthermore, both C. dubliniensis and C. tropicalis induced significantly less expression of the ECE1 gene encoding for Candidalysin, a key fungal virulence determinant driving VVC immunopathology. In order to determine the relative capacity of these species to elicit inflammasome-dependent IL-1β release, both WT and NLRP3-/- THP-1 cells were challenged in vitro. While most species tested elicited only modest amounts of IL-1β, challenge with C. albicans led to significantly elevated levels that were largely NLRP3-dependent. Collectively, our findings demonstrate that although NAC species are increasingly reported as causative agents of VVC, C. albicans appears to be exceedingly vaginopathogenic, exhibiting robust immunopathology, hypha formation and Candidalysin expression. Thus, this study provides mechanistic insight as to why C. albicans is overwhelmingly the major pathogen reported during VVC.
... Other authors have reported an increase in VVC occurrence during the last decades. For example, in Dubai, VVC incidence rates increased significantly from 10.76% in 2005 to 17.61 in 2011 [7]. ...
... Candida glabrata may be underscored among emergent species. Besides being the most frequent NCAC, and its occurrence has been on the increase [1,2,7,[9][10][11][12][13][14][15]. ...
Purpose:
Vulvovaginal candidiasis (VVC) is one of the most frequent female genital disorders and Candida glabrata is the second most common agent. Current study was aimed to study the susceptibility to antifungal agents of C. glabrata isolated from vaginal samples and some virulence attributes in order to better understand why this species is emerging as the main VVC agents.
Methods:
A total of 60 C. glabrata vaginal isolates were included in this study. Firstly they were screened by susceptibility tests to antifungal agents. The isolates that showed sensitivity or resistance to fluconazole were evaluated for their virulence potential, including ability to adhere to polystyrene and vaginal ring, cell surface hydrophobicity (CSH) and capacity to form biofilm.
Results:
Candida glabrata isolates varied significantly in adherence capacity, biofilm formation and CSH. However, it was possible to observe that isolates resistant to fluconazole adhered more efficiently to the vaginal ring and were statistically more able to form biofilm.
Conclusion:
These results allow hypothesizing that C. glabrata is an emergent agent in VVC probably because the treatment with fluconazole selects this species. But once adhered, yeasts remain on biotic or abiotic surfaces causing colonization or VVC symptomatology.
... Vulvovaginal candidiasis (VVC) is classified as primary or non-complicated when manifested by sporadic or infrequent episodes with mild or moderate symptoms in healthy and non-pregnant woman, while complicated episodic and recurrent cases of Candida vulvovaginitis have more severe symptoms and signs with high frequency of resistant yeast species [1] [2]. Changes of pH, vaginal microbiota, and the endogenous host factors may trigger the disease [1]- [4]. ...
... In this group, two samples (12.5%) were resistant to antifungal, one C. albicans isolate (6.25%) and one C. glabrata isolate (6.25%). The isolates obtained from the other 14 patients, C. albicans (12) and C. tropicalis (2) were susceptibility to fluconazole. ...
... Similarly, Onderdonk et al. reported that using povidone-iodine resulted in a notable reduction in the normal flora, specifically Lactobacilli, thereby increasing the likelihood of vaginal infections [109]. Douching gives temporary relief but is known to be associated with numerous side effects, including cervical cancer, pelvic inflammatory disease, low birth weight, preterm birth, bacterial vaginosis, HIV transmission, sexually transmitted diseases, ectopic pregnancy, recurrent vulvovaginal candidiasis, and infertility [4,19,[27][28][29]. According to Yildırım et al. study, there is an increased susceptibility to vaginal infections among women who engage in vaginal douching (VD) [107]. ...
In the era of globalization, the concept of world health needs to be practiced where a significant consideration should be given to women health. Of many issues, the most common and under-rated is vulvovaginal candidiasis (VVC); a superficial to invasive mucosal infection of lower reproductive tract in women, primarily caused by commensal yeast Candida. The inability of conventional drugs in triumphing the VVC has made researchers to review the potential of traditional medicines. The present review aimed to highlight the problem and concerns of women related to VVC, covering all aspects of disease development, host response, conventional drug failure, and possibilities of formulating phytomolecule based VVC therapy. The health and disease issues in women are considerably severe, especially for those living in impoverished conditions. Any dysbiosis in vaginal microbiome disturbs the harmony between residing microbes and leads to commencement of VVC. Lactobacillus is key care-taker microbe that keeps check on over growth of Candida by various means. However, Candida have evolved numerous virulence traits to overcome the governance of Lactobacillus as well as host immune system. The present review comprehensively outlined the virulence, and pathogenicity of Candida along with its interaction with host immune system. The review has also highlighted the current conventional drugs and their drawbacks, along with potential of ethnopharmacological phytoactive molecules as future therapies for defining the therapeutic management of the disease.
Graphical Abstract
... Additionally, Candida Research Article mSystems was enriched in the VVC_BV and VVC groups, contributing to VVC infection (29). The high relative abundance of C. albicans in the VVC group was consistent with previous findings (30)(31)(32). However, Candida content was still lower in the VVC_BV group than in the VVC group. ...
Although vaginitis is closely related to vaginal microecology in females, the precise composition and functional potential of different types of vaginitis remain unclear. Here, metagenomic sequencing was applied to analyze the vaginal flora in patients with various forms of vaginitis, including cases with a clue cell proportion ranging from 1% to 20% (Clue1_20), bacterial vaginitis (BV), vulvovaginal candidiasis (VVC), and BV combined with VVC (VVC_BV). Our results identified Prevotella as an important biomarker between BV and Clue1_20. Moreover, a gradual decrease was observed in the relative abundance of shikimic acid metabolism associated with bacteria producing indole as well as a decline in the abundance of Gardnerella vaginalis in patients with BV, Clue1_20, and healthy women. Interestingly, the vaginal flora of patients in the VVC_BV group exhibited structural similarities to that of the VVC group, and its potentially functional characteristics resembled those of the BV and VVC groups. Finally, Lactobacillus crispatus was found in high abundance in healthy samples, greatly contributing to the stability of the vaginal environment. For the further study of L. crispatus , we isolated five strains of L. crispatus from healthy samples and evaluated their capacity to inhibit G. vaginalis biofilms and produce lactic acid in vitro to select the potential probiotic candidate for improving vaginitis in future clinical studies. Overall, we successfully identified bacterial biomarkers of different vaginitis and characterized the dynamic shifts in vaginal flora between patients with BV and healthy females. This research advances our understanding and holds great promise in enhancing clinical approaches for the treatment of vaginitis.
IMPORTANCE
Vaginitis is one of the most common gynecological diseases, mostly caused by infections of pathogens such as Candida albicans and Gardnerella vaginalis . In recent years, it has been found that the stability of the vaginal flora plays an important role in vaginitis. Furthermore, the abundant Lactobacillus -producing rich lactic acid in the vagina provides a healthy acidic environment such as Lactobacillus crispatus . The metabolites of Lactobacillus can inhibit the colonization of pathogens. Here, we collected the vaginal samples of patients with bacterial vaginitis (BV), vulvovaginal candidiasis (VVC), and BV combined with VVC to discover the differences and relationships among the different kinds of vaginitis by metagenomic sequencing. Furthermore, because of the importance of L. crispatus in promoting vaginal health, we isolated multiple strains from vaginal samples of healthy females and chose the most promising strain with potential probiotic benefits to provide clinical implications for treatment strategies.
... Candida spp. are the most common fungal infections during pregnancy, with an increased rate of 30% compared with 20% in nonpregnant women [1,2]. ...
Vulvovaginitis with Candida spp. is the most common infection in women and the rate is increased during pregnancy. Antifungal prescription in pregnant women continues to present challenges and the decision must balance the risk of fetal toxicity with the benefits to the fetus and mother. Starting from the idea that clotrimazole is the most recommended antifungal in candidal vaginitis in pregnancy, we tested the sensitivity of different species of Candida spp. to other azoles, polyenes, and antimetabolites. This retrospective study (January to June 2019) assessed 663 pregnant women hospitalized for various pregnancy-related symptoms in which samples of phage secretion were taken. The laboratory results confirmed 21% of cases, indicating 140 positive mycologic samples. In this study, vaginal candidiasis was mostly related to the first trimester of pregnancy (53.57%,) and less related in the last trimester (17.14%). Candida albicans was the most frequent isolated strain in this study, accounting for 118 cases, followed by 16 strains of Candida glabrata and 6 cases of Candida krusei. The highest sensitivity for C. albicans was found in azoles, mostly in miconazole (93.2%), while C. krusei was completely resistant to polyene with low sensitivity in antimetabolites and even in some azoles, such as fluconazole. In our study, higher resistance rates to flucytosine were found, with C. glabrata and C. krusei exhibiting greater resistance than C. albicans.
... Although less commonly reported, the highly antifungal-resistant emerging pathogen C. auris was described in one case of VVC (35). In a study with VVC murine model, although single isolate of each NAC species was tested, the preliminary data indicated that most NAC species are incapable of forming hyphae and do not elicit robust immunopathology in vivo (36), but NAC do actively contribute to symptomatic VVC (37,38). While significant attention has been given to C. albicans-induced host immune response, little is known regarding the interaction of vaginal epithelial cells and clinical NAC species. ...
Vulvovaginal candidiasis (VVC) is characterized by symptomatic inflammatory responses in the vagina caused by Candida albicans and non-albicans Candida (NAC) species. The epidermal growth factor receptor (EGFR) -mitogen-activated protein kinase (MAPK) signaling pathway has been linked to immune responses of oral mucosa after C. albicans exposure, but whether this pathway plays a similar response in vaginal epithelial cells is not known. Here, we observed that phosphorylation of EGFR and p38 was continuously activated in vaginal epithelial cells by C. albicans strain SC5314. This differs markedly from oral epithelial cells, which respond in a biphasic manner in order to properly discriminate the morphology of C. albicans. When compared with SC5314, a highly azole-resistant C. albicans isolate 1052 can induce a stronger phosphorylated signal of EGFR and p38, while clinically-isolated NAC strains including C. tropicalis, C. glabrata, C. parapsilosis and C. auris trigger higher levels of phosphorylated ERK1/2 and c-Fos than C. albicans. Inhibition of EGFR significantly reduces inflammatory response and epithelial damage induced by C. albicans both in vitro and in vivo, while inhibition of p38 leads to significant repair of epithelial damage triggered by both C. albicans and NAC species. These results confirm the importance of the EGFR-MAPK signaling in VVC pathogenesis and highlight the remarkable immunogenic differences between C. albicans and NAC species in host-microbe interactions.
... India (20.0%), Gabon (28.52%), and Ghana (36.5%) [5,[10][11][12][13]. Higher prevalence rates have been observed in Tanzania (45.7%), ...
Background
: Vulvovaginal candidiasis (VVC) is the second most common infection of the genital tract affecting millions of women worldwide. Data concerning the distribution and antifungal resistance of Candida species responsible of VVC vary among countries and population studied. Objectives: The aim of this work was to determine the prevalence, species distribution and antifungal susceptibility patterns of Candida species among symptomatic women over a 20-year period.
Methods
: A total of 5,820 unique samples were retrospectively identified. Out of them, 1,046 (18 %) were diagnosed with VVC.
Results
: Women between 18 and 30 years had the highest prevalence rate of VVC (21 %). Women aged less than 18 years and greater than 51 years had the highest prevalence rates of vaginal bacterial infections. Thirty-five (3.3 %) women presented recurrent VVC. The most common yeast isolated was C. albicans, followed by C. glabrata, C. krusei, and C. parapsilosis. Non-Candida albicans species (NAC) were more significantly isolated among women aged 51 or above, than in women included in other groups (p < 0.01). Resistance to fluconazole and amphotericin B was infrequent in C. albicans strains. Resistance to fluconazole and amphotericin B was infrequent in C. albicans strains. NAC species presented higher resistance rates against fluconazole (30 %) and voriconazole (25 %). C. krusei and C. glabrata isolates showed lower MICs than most of the strains against amphotericin B (1 mg/L) and flucytosine (1 mg/L).
Conclusions
: Our findings indicated that continued surveillance on Candida species distribution and non-susceptibility rates to antifungals should be routinely reported to help the selection of the most appropriate drug, to avoid the emergence of resistant strains, and to improve the patient's outcomes.
... This study showed a lower prevalence rate than previous studies from India (46.6 %), Lebanon (44.8 %), Ghana (36.5 %), Uganda (35.5 %) and Sudan (33.5 %) [31][32][33][34][35]. However, the rate was two-to 10-fold higher than in studies conducted among pregnant women, women of reproductive age and sexually active women from Ghana (6.6 %) [36], Iran (6.7 %) [37], Dubai (13.88 %) [38] and Ankara (2.81 %) [39]. ...
Objective:
Vaginal candidiasis is the most common opportunistic fungal infection, largely associated with a woman's psychological and economic status. Recently, the rate of disease progression has increased extensively; however, region-specific studies are very limited. This study aimed to understand variation in hydrolytic activities and antifungal susceptibility of Candida isolates from vaginal discharge.
Study design:
The present study was aimed to understand the variation of hydrolytic activities and antifungal susceptibility of Candida isolates from vaginal discharge.
Results:
In total, 34 different Candida isolates were collected: C. albicans (n = 17; 50 %), C. glabrata (n = 6; 17.64 %), C. tropicalis (n = 4; 11.76 %) and C. parapsilosis (n = 7; 20.58 %). All isolates were primarily identified and confirmed by basic microbiological methods followed by the VITEK-2 system. Antifungal susceptibility of the isolates were evaluated using yeast antifungal susceptibility testing cards. The isolates of C. albicans, C. glabrata, C. tropicalis and C. parapsilosis were 100 % susceptible to amphotericin B. The non-albicans isolates presented 100 % of proteolytic and lipolytic activity compared with C. albicans. Eight (47.06 %) C. albicans isolates showed positive esterase activity (Pz<1), whereas nine (52.94 %) were negative to esterase (Pz = 1). Of the 34 Candida isolates, 28 (82.35 %) were found to be moderate-to-strong biofilm producers: 14 C. albicans, three C. glabrata, six C. parapsilosis and five C. tropicalis.
Conclusion:
This study clarified the antifungal susceptibility and virulence behaviour of Candida isolates; this will be of use in the selection of antifungal agents for Candida prophylaxis.
... Prevalence of VC in the UAE is increasing and the frequency of drug resistance to Candida glabrata, Candida tropicalis and Candida krusei is high [16][17][18][19]. The quality of life of young women is acutely influenced by RVVC [20]. ...
Vaginal infections are one of the major reasons women visit a gynecologist. Increased resistance to conventional antibiotics is one of the main factors mitigating the development of new antimicrobial agents, especially those of natural origin. In traditional Persian medicine, Trachyspermum ammi has been claimed to clear vagina from excessive discharge. Therefore, in this study, the antimicrobial activity of Ajwain essential oil was evaluated against some vaginal pathogens. The essential oil of ajwain was picked up and the minimum inhibitory and bactericidal concentrations (MIC and MBC) were revealed. The most frequently detected microorganisms involved in genital infections including Candida spp., Gardnerella vaginalis, Escherichia coli, Staphylococcus aureus, Streptococcus agalactiae and Lactobacillus acidophilus were considered. Evaluation of the essential oil of Trichomonas vaginalis was done by calculation of percent of growth inhibition. The essential oil showed a remarkable activity against the studied bacteria and fungi with MIC at a range of 0.0315 - 0.5 mg/ml and MBC at a range of 0.125 - 4 mg /ml. The highest inhibition and bactericidal activity was observed in S. agalactiae and G. vaginalis. 100% inhibition of T. vaginalis growth was shown at a concentration of 2000 μg/ml after 48 h by essential oil. The antimicrobial activity of the essential oil was more than that of thymol. Supposedly essential oil of Trachyspermum ammi fruit could inhibit vaginal pathogens growth .Further preclinical and clinical studies are required to confirm the efficacy of this natural agent in vaginitis.
... Often, prolonged antifungal regimens or alternative treatment approaches (e.g., vaginal boric acid suppositories) are required for clearance [24,25]. Given reduced therapeutic efficacy, recent reports suggesting increased incidence rates of NAC-associated VVC are somewhat unsettling [26,27]. However, such reports should be taken with caution, as symptomatic VVC can mimic several disease states of the lower FRT and the ability to distinguish Candida as a true pathogen from an asymptomatic colonizer can be difficult. ...
Candida albicans, along with other closely related Candida species, are the primary causative agents of vulvovaginal candidiasis (VVC)—a multifactorial infectious disease of the lower female reproductive tract resulting in pathologic inflammation. Unlike other forms of candidiasis, VVC is a disease of immunocompetent and otherwise healthy women, most predominant during their child-bearing years. While VVC is non-lethal, its high global incidence and profound negative impact on quality-of-life necessitates further understanding of the host and fungal factors that drive disease pathogenesis. In this review, we cover the current state of our understanding of the epidemiology, host response, fungal pathogenicity mechanisms, impact of the microbiome, and novel approaches to treatment of this most prevalent human candidal infection. We also offer insight into the latest advancements in the VVC field and identify important questions that still remain.
... VVC is an infection caused by Candida species like C. glabrata,C. tropicalis and C. krusei that affects millions of women every year [6][7][8][9][10]. Trichomoniasis is caused by Tricho-It seems that ethanolic extract of Quercus infectoria gall could inhibit the growth of vaginal pathogens. ...
Vaginal infections are one of the most common reasons a woman visits a gynecologist. The increased resistance to conventional antibiotics is one of the main reasons for searching and developing new antimicrobial agents, especially those of natural origin. In traditional Persian medicine, the gall of Quercus infectoria has been claimed to eliminate vagina and cervix from excessive discharge. So, the aim of the present study was to evaluate the antimicrobial activity of ethanolic extract of Quercus infectoria gall as well as its active constituent, gallic acid, against some vaginal pathogens. In this study, the ethanolic extract of Quercus infectoria gall was obtained by maceration and standardized based on amount of gallic acid. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of this extract as well as its active compound, gallic acid, were determined against Candida spp., Gardnerella vaginalis, Escherichia coli, Staphylococcus aureus, Streptococcus agalactiae, Trichomonas vaginalis and Lactobacillus acidophilus. The results demonstrated remarkable activity of ethanolic extract of Quercus infectoria gall against investigated pathogens with MIC and MBC in the range between 0.125 mg/ml and 16 mg/ml. The most inhibitory and bactericidal activity was observed on Streptococcus agalactiae and Staphylococcus aureus. The effects of gall dried ethanolic extract on Trichomonas vaginalis showed 100 % inhibition of the parasitic growth with concentration of 800 µg/ml after 24 h incubation. The antimicrobial and anti-trichomonas activity of extract was more than gallic acidIt seems that ethanolic extract of Quercus infectoria gall could inhibit the growth of vaginal pathogens. Further preclinical and clinical studies are required to confirm the efficacy of this natural extract in vaginitis.
... There is need to draw the attention of clinicians in our environment to this situation so that they can sought improve treatment via different approaches, which may include the combination (synergistic) of antifungals as evidence has shown that combinatory therapy contributes to reducing toxicity and could be an alternative for treatment of candidiasis due to C. albicans [58,59]. However, the possibility of some system bias cannot be excluded due to the potential reasons of the different specimen, test method, and regional disparity [60,61]. ...
Introduction: Candida albicans is one of the most important aetiological agents causing vaginal candidiasis in pregnant women. Most women will experience at least one episode during their reproductive years. Antifungal resistance is a particular problem with Candida infections. Some types of Candida are increasingly resistant to the first-line and second-line antifungal medications. Objective: To investigate the azole susceptibility of Candida albicans (C. albicans) from pregnant vulvovaginal candidiasis patients and to detect ERG11 gene in these azole resistance isolates. Methods: Forty-one clinical isolates of C. albicans were collected. Azole susceptibility was tested in vitro using microdilution techniques. The ERG11 genes of 27 isolates of C. albicans (All resistant to azoles) were amplified using PCR method. Original Research Article Abdu et al.; ISRR, 8(2): 1-11, 2019; Article no.ISRR.51113 2 Results: Of the 67 isolates recovered, 41(61.19%) were C. albicans, of which 27 (65.85%) each, and 25(60.98%) were resistant to Fluconazole, Voriconazole, and Nystatin respectively. In total, ERG11 genes were detected among 24(88.89%) of 27 C. albicans azole resistant isolates. Conclusions: Twenty four ERG11 genes were detected among 27 azole resistant C. albicans isolates, which indicates a possible relation with the increase in resistance to azole drugs and the recurrence of vulvovaginal candidiasis.
... B37.9 Кандидоз неуточненный N77.1 Вагинит, вульвит и вульвовагинит при инфекционных и паразитарных болезнях N76.0 Острый вагинит N73.3 Подострый и хронический вагинит В структуре инфекционной патологии нижнего отдела гениталий частота встречаемости ВВК составляет от 30 до 45% [2,3]. Количество случаев заболеваемости увеличивается у женщин после начала половой жизни, однако может встречаться у девочек-подростков [4] и у женщин в пери-и постменопаузе, хотя частота обнаружения кандид снижается на 7% с каждым годом [5,6]. ...
The article represents the main problems of diagnosis and treatment of patients with vulvovaginal candidiasis (VVC). It is noted that C. albicans causes candidiasis in 75-80% of cases. Clinical forms of VVC include acute VVC and chronic (recurrent) vulvovaginal candidiasis (HRVVC). The main diagnostic approaches in the treatment and prevention of disease recurrence are described. The article presents data on the use of Clotrimazole vaginal cream 2% (Esparma) to treat VVC.
... In addition, our results show that among the NCAC species, the majority species is C. famata (4.2%) which differs from the results of several studies. In most epidemiological studies, C. glabrata, a NCAC, has been identified as the most prevalent causative agent of genitourinary candidiasis [22,27,28]. Again, the distribution of NCAC species depends on the geographical location and the selective pressures exerted by the antibiotics used in certain regions. ...
Background:
Vulvovaginal candidiasis (VVC) is one of the most common lower genital tract infections in women; this unpleasant and extremely embarrassing pathology is one of the main reasons for gynaecological consultation. In Gabon, the prevalence of VVC remains poorly described even though VVC is known to be the leading gynaecological condition in several countries. This retrospective cross-sectional study sought to assess the prevalence of VVC among symptomatic women in southeastern Gabon.
Methods:
Clinical samples were collected from patients suspected to have VVC during a 2-year period (from January 2016 to December 2017). Gram staining of vaginal smears provided indications of vaginal flora and confirmed the presence of yeast. Sabouraud-chloramphenicol and chromID Candida media were used to isolate yeast, and species identification was performed using morphological tests and the Vitek 2 Compact automated system.
Results:
For the 873 patients included in this study, the prevalence of VVC was 28.52%. Eleven Candida species were identified, with greater representation of Candidaalbicans (82.73%) than of Non C. albicanscandida (NCAC) (17.27%), which were distributed as follows: Candidafamata (4.02%), Candida spp. (3.61%), Candidarugosa (3.21%), Candidalipolytica (1.61%), Candidaparapsilosis (1.61%), Candidaglabrata (1.21%), Candidatropicalis (0.80%), Candidakrusei (0.40%), Candidadubliniensis (0.40%), and Candidasphaerica (0.40%).
Conclusion:
This study offers the first estimation of VVC among Gabonese women in childbearing age with the symptoms. It showed that VVC is very common in Gabon. C. albicans as the most commonly represented species.
... Several studies have shown that prevalence of Candida among pregnant women is higher than that in nonpregnant women, and it tends to increase with the progression of the pregnancy [4][5][6][7]. Some emerging data have also suggested that VVC during pregnancy might be associated with increased risk of complications, such as premature rupture of membranes, preterm labor, chorioamnionitis, and congenital cutaneous candidiasis [8]. ...
Objective:
Candida species colonize the vagina in at least 20% of women, with rates rising to 30% during pregnancy. This study aimed at determining the prevalence and risk factors of vulvovaginal candidiasis (VVC) in pregnant women at 35-37 weeks of gestation. It also aims at finding possible correlations between VVC and vaginal colonization by other agents, such as Group B Streptococcus (GBS) and bacterial vaginosis.
Methodology:
Over a one-year period, high vaginal swabs were collected from pregnant women during their regular antenatal checkup in different polyclinics in Beirut and South Lebanon. Swabs were examined microscopically, cultured on Sabouraud Dextrose Agar, and Candida isolates were identified using Chromatic Candida medium and Germ Tube Test.
Results:
VVC was detected in 44.8% of samples, with C. glabrata (44.4%) and C. albicans (43.4%) being the most isolated species. Approximately, half of pregnant women (57.7%) were coinfected with Candida and bacterial vaginosis, while 26% of them carried simultaneously Candida spp. and GBS. No significant correlation was found between the occurrence of VVC and demographic, clinical, medical, and reproductive health characteristics of pregnant women. In contrast, participants with previous miscarriages and those being hospitalized during the past 12 months were more susceptible to develop vaginal C. krusei infection in comparison to other Candida species (p=0.0316 and p=0.0042, respectively).
Conclusion:
The prevalence of VVC in pregnant women is an increasing trend in our community. Therefore, routine medical examination and regular screening for candidiasis in the antenatal care program is highly recommended to manage the disease and its complications.
... VVC is an infection caused by Candida species like C. glabrata,C. tropicalis and C. krusei that affects millions of women every year [6][7][8][9][10]. Trichomoniasis is caused by Tricho-It seems that ethanolic extract of Quercus infectoria gall could inhibit the growth of vaginal pathogens. ...
Vaginal infections are one of the most common reasons a woman visits a gynecologist. The increased resistance to conventional antibiotics is one of the main reasons for searching and developing new antimicrobial agents, especially those of natural origin. In traditional Persian medicine, the gall of Quercus infectoria has been claimed to eliminate vagina and cervix from excessive discharge. So, the aim of the present study was to evaluate the antimicrobial activity of ethanolic extract of Quercus infectoria gall as well as its active constituent, gallic acid, against some vaginal pathogens. In this study, the ethanolic extract of Quercus infectoria gall was obtained by maceration and standardized based on amount of gallic acid. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of this extract as well as its active compound, gallic acid, were determined against Candida spp., Gardnerella vaginalis, Escherichia coli, Staphylococcus aureus, Streptococcus agalactiae, Trichomonas vaginalis and Lactobacillus acidophilus. The results demonstrated remarkable activity of ethanolic extract of Quercus infectoria gall against investigated pathogens with MIC and MBC in the range between 0.125 mg/ml and 16 mg/ml. The most inhibitory and bactericidal activity was observed on Streptococcus agalactiae and Staphylococcus aureus. The effects of gall dried ethanolic extract on Trichomonas vaginalis showed 100 % inhibition of the parasitic growth with concentration of 800 µg/ml after 24 h incubation. The antimicrobial and anti-trichomonas activity of extract was more than gallic acid. It seems that ethanolic extract of Quercus infectoria gall could inhibit the growth of vaginal pathogens. Further preclinical and clinical studies are required to confirm the efficacy of this natural extract in vaginitis.
... However, the etiology and pathogenesis of VVC are not clear. According to present epidemiological studies, the prevalence and incidence of reproductive tract infections vary between countries and ethnicities [9,10]. Even in similar population groups, the epidemiological features of the low reproductive tract infections are different [11]. ...
Purpose. To explore risk factors of vulvovaginal candidiasis (VVC) among women of reproductive age in Xi’an district and then to offer reference for clinical prevention and treatment of VVC. Methods. Patients from the outpatient department of gynecology and obstetrics in the First Affiliated Hospital of Xi’an Jiaotong University from June 2016 to May 2017 were recruited strictly according to the inclusion and exclusion criteria. Participants diagnosed as simple VVC were assigned to the case group, while women who underwent routine gynecological examination and had normal vaginal microflora were assigned to the control group. Then we conducted a questionnaire survey of the two groups and used the logistic regression model to explore the related risk factors of VVC. Results. In the present study, ninety-seven cases were sample VVC patients and eighty-seven cases were healthy women. This cross-sectional study showed that occasionally or never drinking sweet drinks (odds ratio [OR] =0.161, 95% confidence interval [CI] =0.056-0.462, P=0.001), occasionally or never eating sweet foods (OR=0.158, 95%CI=0.054-0.460, P=0.001), and the use of condom (OR=0.265, 95%CI=0.243-0.526, P=0.001) were regarded as protective factors for VVC. In addition, sedentary life style (OR=7.876, 95%CI=1.818-34.109, P=0.006), frequently wearing tights (OR=6.613, 95%CI=1.369-27.751, P=0.018), frequent intravaginal douching (OR=3.493, 95%CI=1.379-8.847, P=0.008), having the first sexual encounter when under 20 years old (OR=2.364, 95%CI=1.181-7.758, P=0.006), the number of sexual partners being over two (OR=3.222, 95%CI=1.042-9.960, P=0.042), history of curettage (OR=3.471, 95%CI=1.317-9.148, P=0.012), history of vaginitis (OR=8.999, 95%CI=2.816-28.760, P
... Rathod et al. [123] expressed doubts on the often quoted figures in various publications, and contended that these are higher than the true magnitude of the problem [123]. Recent reports though indicate that the incidence of genital candidiasis is increasing [124]. Cognisant of global increases in some of the key risk factors thereof, such as diabetes mellitus, antibiotic use, and changing individual life-styles and more liberal sexual behaviours and practices which may increase the risk thereto, this assertion may not be far-fetched. ...
... [3] Vaginal candidiasis continues to be a world health problem to women. [4] Candidal infections are common in hospitalized patients and elderly people, and are difficult to control. [5] About 50% of adults have Candida yeasts in their mouth and it is responsible for superficial easily treated infections. ...
Candida is a serious life-threatening pathogen, particularly with immunocompromised patients. Candida infections are considered as a major cause of morbidity and mortality in a broad range of immunocompromised patients. Candida infections are common in hospitalized patients and elderly people. The difficulty to eradicate Candida infections is owing to its unique switch between yeast and hyphae forms and more likely to biofilm formations that render resistance to antifungal therapy. Plants are known sources of natural medicines. Several plants show significant anti-Candida activities and some of them have lower minimum inhibitory concentration, making them promising candidates for anti-Candida therapy. However, none of these plant products is marketed for anti-Candida therapy because of lack of sufficient information about their efficacy, toxicity, and kinetics. This review revises major plants that have been tested for anti-Candida activities with recommendations for further use of some of these plants for more investigation and in vivo testing including the use of nanostructure lipid system. © 2017 Pharmacognosy Reviews | Published by Wolters Kluwer - Medknow.
... The yeasts, in particular C. albicans, are well adapted to the human body and are capable of colonization with no signs of disease in conditions of physiological equilibrium 1,2 . However, under conditions that disrupt the delicate balance between the host and this commensal fungus, a parasitic relationship may occur, resulting in the development of infections termed candidiasis, including VVC [2][3][4] . Predisposing host factors, including immunosuppressive diseases such as HIV infection, are very important in the development of VVC [4][5][6] . ...
ABSTRACT Vulvovaginal candidiasis (VVC) in HIV-infected (HIV+) women is a serious public health problem. However, little is known about the virulence mechanisms of vaginal Candida albicans from HIV+ women in the post-highly active antiretroviral therapy (HAART) era. Here, we report a comparative analysis of the expression of key virulence factors and genetic variability of 26 vaginal C. albicans strains isolated from HIV+ women undergoing HAART and 18 from HIV-uninfected (HIV-) women. In general, we observed that C. albicans from HIV+ women receiving HAART showed lower expression of virulence factors compared with C. albicans from HIV- women, except for the proteinase activity which is highly expressed. The results in HIV-women further suggest that virulence factors appear to be expressed in response to the yeast stress, in the presence of an adequate immune response. Furthermore, the RAPD results showed a high heterogeneity among isolates from both groups of women. These findings in HIV+ women using HAART will help to improve the monitoring of vaginal yeast infections and the quality of life of patients.
... В структуре инфекционной патологии нижнего отдела гениталий частота встречаемости ВВК составляет от 30 до 45% [1,2]. Количество случаев заболеваемости увеличивается у женщин после начала половой жизни, однако может встречаться у девочек-подростков [3] и у женщин в пери-и постменопаузе, хотя частота обнаружения кандид снижается на 7% с каждым годом [4,5]. ...
The article tells about the key problems of diagnosis and treatment of patients with vulvovaginal candidiasis (VVC). Candida albicans causes 75--80% of candidiasis cases. Clinical forms of VVC include: Candida-carrying, acute VVC, chronic (recurrent) vulvovaginal candidiasis (CRVVC). The main diagnostic approaches to the treatment and prevention of recurrence of the disease are described. The authors presented data on the efficacy of the antifungal medication Diflucan in the fight against VVC.
... However, the possibility of some system bias cannot be excluded due to the potential reasons of the different specimen, test method, and regional disparity. [5,13,14,17,19,20] There were several limitations in this study. First, some uncommon species may be absent using chromogenic culture media as a prequalification test limits the variety of species that can grow. ...
Background: Vulvovaginal candidiasis (VVC) was a common infection associated with lifelong harassment of woman's social and sexual life. The purpose of this study was to describe the species distribution and in vitroCandidaCandida spp.) isolated from patients with VVC over 8 years.
Methods: Species which isolated from patients with VVC in Peking University First Hospital were identified using chromogenic culture media. Susceptibility to common antifungal agents was determined using agar diffusion method based on CLSI M44-A2 document. SPSS software (version 14.0, Inc., Chicago, IL, USA) was used for statistical analysis, involving statistical description and Chi-square test.
Results: The most common strains were Candida (C.) albicans, 80.5% (n = 1775) followed by C. glabrata, 18.1% (n = 400). Nystatin exhibited excellent activity against all species (
... The most frequently isolated spp. are C. glabrata, C. krusei, C. parapsilosis and C. tropicalis (Ferrer 2000;Sobel 2003;Diba et al., 2012;Faraji et al., 2012;Mendling and Brasch 2012;Hamad et al., 2014). Candida glabrata is the second most abundant species, causing approximately 5-15% of cases of vaginal candidiasis, particularly recurrent cases (Ferrer 2000;Diba et al., 2012). ...
In vitro evaluation of specific anti-Candida albicans sera antibodies based on synthetically prepared complement receptor 3-related protein (CR3-RP) mimicking the structure of native complement receptor 3 in a cohort of 72 patients with atopy and recurrent Candida vulvovaginitis (RVC) revealed effective humoral response against Candida CR3-RP. The most significant have been IgM and IgA isotype antibodies (33 and 47% positive cases, respectively). The quantitative evaluation of anti-CR3RP isotype antibodies was confronted with results of commercial ELISA anti-C. albicans antibodies diagnostics based on C. albicans cell wall mannan and β-glucan antigens, the most significant correlation being observed with anti-CR3-RP IgM and anti-β-D-glucan IgM (r(2) = 0.624) followed by isotype IgA (r(2) = 0.381). The immunogenicity and immunoreactivity of CR3RP antigen in RVC patients' sera had been evaluated with regard to the results reached by counterimmunoelectrophoresis and heterogeneous enzyme immunoassay. Obviously, synthetically prepared CR3-RP mimicking the Candida cell-wall-derived structure moiety represents a promising immunological tool not only for Candida serodiagnostics, but also prospectively for follow-up of targeted antifungal therapy and as promising Candida vaccine candidate.
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... This discovery had important diagnostic consequences since this new species, like C. albicans, produces chlamydospores and germ-tubes and can still be misidentified as such by using biochemical tests and/or conventional identification methods Yazdanpanah and Khaithir, 2014). Nevertheless, current epidemiological data showed that C. dubliniensis is much more prevalent in oropharyngeal infections (Wahab et al., 2014) than in invasive candidiasis (Pfaller et al., 2014) and it is rarely implicated in vaginal infections (Gumral et al., 2011;Hamad et al., 2014;Shan et al., 2014). However, C. dubliniensis can be easily distinguished from C. albicans by a number of molecular methods that have been reviewed in detail by Ells et al. (2011). ...
Vulvovaginal candidiasis (VVC) remains a prevalent fungal disease, characterized by challenges, such as increased fungal resistance, side effects of current treatments, and the rising prevalence of non-albicans Candida spp. naturally more resistant. This study aimed to propose a novel therapeutic approach by investigating the antifungal properties and toxicity of 2-hydroxychalcone (2-HC) and 3′-hydroxychalcone (3′-HC), both alone and in combination with fluconazole (FCZ) and clotrimazole (CTZ). A lipid carrier (LC) was also developed to deliver these molecules. The study evaluated in vitro anti-Candida activity against five Candida species and assessed cytotoxicity in the C33-A cell line. The safety and therapeutic efficacy of in vivo were tested using an alternative animal model, Galleria mellonella. The results showed antifungal activity of 2-HC and 3′-HC, ranging from 7.8 to 31.2 as fungistatic and 15.6 to 125.0 mg/L as fungicide effect, with cell viability above 80% from a concentration of 9.3 mg/L (2-HC). Synergistic and partially synergistic interactions of these chalcones with FCZ and CTZ demonstrated significant improvement in antifungal activity, with MIC values ranging from 0.06 to 62.5 mg/L. Some combinations reduced cytotoxicity, achieving 100% cell viability in many interactions. Additionally, two LCs with suitable properties for intravaginal application were developed. These formulations demonstrated promising therapeutic efficacy and low toxicity in Galleria mellonella assays. These results suggest the potential of this approach in developing new therapies for VVC.
Background and objectives: Vulvovaginal candidiasis is known to be a global issue of concern due to its association with economic costs, sexually transmitted diseases, and the escalation of genital tract infections. This study aimed to determine the prevalence, species distribution and risk factors associated with Candida species causing vulvovaginal candidiasis.
Subjects and Methods: Non-pregnant women attending routine antenatal visits at Al-Olaifi-Family Center in Sana'a were enrolled in a cross-sectional study conducted from June 2018 to March 2019. Laboratory work was carried out at the National Center of Public Laboratories (NCPHL). Vaginal swabs were sampled from participants after oral consent was obtained. The swabs were inoculated in Sabouraud glucose agar supplemented with chloramphenicol and incubated at 37°C for 24 to 48 h under aerobic conditions in order to perform a fungal culture. Candida species were determined by culturing on HiCrome Candida differential Agar at 35°C for 48 h to produce species-specific colours. Data on demographic, clinical, and risk factors were collected in a pre-designed questionnaire.
Results: A total of 190 non-pregnant women were included. The prevalence of VVC was 22.1%. Candida albicans accounted for 16.3% and non-Candida albicans accounted for 5.8% of the isolates, mainly C. glabrata (3.2%), C. rugosa (1.05%), C. lipolytica (1.05%), and C. dubliniensis (0.53%). When VVC risk factors were considered, there were significant risk factors with age group 30-34 years (33.3%, odds ratio=2.1) and age group ≥35 years (62.5%, odds ratio=10.3), residence in a rural area (39.5%, OR=3.3), negative emotions (30.2%, OR=2.3), underwear replacement over 1 day (29.3%, OR=4.2), impure cotton underwear (29.4%, OR=4.9), while Condom use and vulvar cleaning before or after sexual life were found to be highly significant protective factors against VVC (p=0.008, 0.03, respectively).
Conclusions: Guidelines for the management of VVC syndrome in Yemen should be revised to include a protocol specifically for women over 30 years of age. VVC undoubtedly poses a significant threat to women's reproductive health. Risk factors for VVC are varied, and include ages, health habits, history of the disease, and other aspects. It is necessary to take appropriate measures to avoid risk factors and to help reduce the prevalence of VVC among women of childbearing age.
PREVALENCE OF DIFFERENT HEPATITIS B VIRUS GENOTYPES AND RISK FACTORS ASSOCIATED AMONG SELECTED YEMENI PATIENTS WITH CHRONIC HEPATITIS B INFECTION
ABSTRACT
Background and objectives: Vulvovaginal candidiasis is known to be a global issue of concern due to its association with economic costs, sexually transmitted diseases, and the escalation of genital tract infections. This study aimed to determine the prevalence, species distribution and risk factors associated with Candida species causing vulvovaginal candidiasis. Subjects and Methods: Non-pregnant women attending routine antenatal visits at Al-Olaifi-Family Center in Sana'a were enrolled in a cross-sectional study conducted from June 2018 to March 2019. Laboratory work was carried out at the National Center of Public Laboratories (NCPHL). Vaginal swabs were sampled from participants after oral consent was obtained. The swabs were inoculated in Sabouraud glucose agar supplemented with chloramphenicol and incubated at 37°C for 24 to 48 h under aerobic conditions in order to perform a fungal culture. Candida species were determined by culturing on HiCrome Candida differential Agar at 35°C for 48 h to produce species-specific colours. Data on demographic, clinical, and risk factors were collected in a pre-designed questionnaire. Results: A total of 190 non-pregnant women were included. The prevalence of VVC was 22.1%. Candida albicans accounted for 16.3% and non-Candida albicans accounted for 5.8% of the isolates, mainly C. glabrata (3.2%), C. rugosa (1.05%), C. lipolytica (1.05%), and C. dubliniensis (0.53%). When VVC risk factors were considered, there were significant risk factors with age group 30-34 years (33.3%, odds ratio=2.1) and age group ≥35 years (62.5%, odds ratio=10.3), residence in a rural area (39.5%, OR=3.3), negative emotions (30.2%, OR=2.3), underwear replacement over 1 day (29.3%, OR=4.2), impure cotton underwear (29.4%, OR=4.9), while Condom use and vulvar cleaning before or after sexual life were found to be highly significant protective factors against VVC (p=0.008, 0.03, respectively). Conclusions: Guidelines for the management of VVC syndrome in Yemen should be revised to include a protocol specifically for women over 30 years of age. VVC undoubtedly poses a significant threat to women's reproductive health. Risk factors for VVC are varied, and include ages, health habits, history of the disease, and other aspects. It is necessary to take appropriate measures to avoid risk factors and to help reduce the prevalence of VVC among women of childbearing age. Keywords: Candida, Vulvovaginal candidiasis, VVC, Epidemiology, Risk factors, Sana’a, Yemen.
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Vulvovaginal candidiasis (VVC) is a common infection among women of childbearing age, and few of these women experience recurrent vulvovaginal candidiasis (RVVC). The study was aimed at determining the virulent factors, and antifungal susceptibility of the Candida species isolated from women with RVVC attending the Nkawie Government Hospital, Ashanti-Region, Ghana. Over a 6–month period (October 2016 to March 2017), a total of 288 women with RVVC were evaluated. Isolation of the yeast was performed after the inoculation of the vaginal specimens onto Sabouraud Dextrose Agar (SDA), and incubated for 24-48 hours at 37 o C. The isolates were identified by standardized conventional methods. The enzymatic activities of esterase, phospholipase, haemolysis and biofilm production were evaluated for the identification of the yeast isolates. Susceptibility to antifungal agents was determined by using the Kirby-Bauer disk diffusion method. Azole resistant isolates were further tested for ERG11 gene which encodes the enzyme ( cytochrome P450 lanosterol 14-α-demethylase ) by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Vaginal swabs cultures of 200 women (64.4) from 288 samples yielded Candida species. Candida albicans was the commonest isolated specie (33.0%), followed by Candida glabrata (29.5 %), Candida tropicalis (23.0%), and Candida krusei (15.5%). Hemolysin production, phospholipase enzyme activity, and biofilms formation were found in 84.5%, 83%, 77.5%.of the isolates respectively. Most phospholipase producing Candida isolates also formed biofilms. All Candida spp isolated were susceptible to itraconazole while majority of them were resistant to voriconazole. ERG11 genes were detected in 11.1% of Azole resistant Candida species. There is a significant increase in the rate of antifungal resistance among the Candida isolates to fluconazole and voriconazole. There is need for continuous surveillance as well as antifungal susceptibility testing on the Candida spp to guide therapy. A larger epidemiological study is also advocated to determining the degree of spread of ERG11 genes.
Abnormal vaginal discharge is a representative attribute of vulvovaginal infections (VVI). Frequent episodes of these infections are referred to as recurrent VVI (RVVI). The most common types of RVVI are vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV). These infections are a significant cause of HIV acquisition and reproductive morbidity and hence have become a leading public health concern. The disturbances in vaginal ecosystem are the key events in the development of these disease conditions. The development of RVVI has been shown to be influenced by various host-related and behavioural risk factors. Traditional techniques used for detection of RVVI pathogens are based on the physiological and morphological characteristics. However, precise recognition of different clinical isolates is often found lengthy and complex. Therefore, many automatic as well as manual systems have been developed for the rapid identification of these opportunistic pathogens, though some of these methods were found to have considerable sensitivity issues. These limitations have been addressed by the development of various molecular typing techniques, which permits the early detections of these pathogens. However, incomplete understanding of pathophysiology of RVVI is a significant hurdle in the development of optimal treatment and prevention approaches. This chapter provides a comprehensive compilation of the present status of knowledge regarding etiology, diagnosis, treatment and management of RVVI. Systematic investigations in this particular area can provide better understanding of RVVI, further contributing to novel target recognition for more proficient therapeutic advances against these clinically relevant infections.
Vulvovaginal symptoms are among the most frequent gynaecologic problems encountered in the general practice as well as in the office of the gynecologist. Candida parapsilosis leads to symptomatic vulvovaginal candidiasis (VVC) in two‐thirds of colonized women. In some women, the use of oral contraceptives, corticosteroid, long‐term presence of an intrauterine contraceptive device, genetic factors, and oro‐genital sex are risk factors for Candida vulvovagintis. Recurrent vulvovaginal candidosis (RVVC) is defined as the occurrence of clinical episodes of vulvovaginal infection during one year, with at least one episode proven with unequivocal microscopy and/or positive fungal culture. Candida species treatment is indicated only in case of presence of symptoms. Ten to 20 percent of reproductive age women with Candida species are asymptomatic and do not require therapy. Patients having RVVC might need longer courses of therapy with subsequent maintaining dosing of fluconazole.
Vulvovaginal conditions are common in the mature female population. This reflects age-related changes in immunity and skin barrier function of vulvovaginal tissues. Vaginal atrophy is commonly complicated by dryness and inflammation which makes postmenopausal atrophic vaginitis a virtually ubiquitous condition. The differential of vaginitis includes inflammatory, infectious, and malignant diseases, and drug hypersensitivity. Atrophic vaginitis is treated with estrogen replacement therapy. Vulvovaginal malignant melanoma occurs predominantly in postmenopausal women and carries a poor prognosis. Similarly, the incidence of vulvovaginal malignancies such as squamous cell carcinoma and extramammary Paget disease rises exponentially after 65 years of age. Early diagnosis of these malignancies is of utmost importance. Lichen sclerosus et atrophicus and vulvovaginal candidosis are among the most common postmenopausal vulvovaginal conditions. Lichen sclerosus et atrophicus is associated with significant morbidity, and its management can be challenging. The incidence of vulvovaginal candidosis increases in patients on estrogen replacement therapy.
Clinical aspect: Multiple yellowish to white pustules surrounded by erythema may be observed in bacterial and candidal vulvovaginitis, respectively. Yeast infections are characterized by tiny multiple elements scattered throughout the involved areas (Figures 6.1.1 through 6.1.3). Bacterial infections frequently involve the follicular openings when the hair-bearing vulvar skin is implicated (folliculitis) (Figure 6.1.4). Pruritus and burning are commonly reported symptoms.
Clinical aspect: Typical aflegmasic flaccid and fragile bullae, soon turning to nonspecific erythematous, superficial and oozing abrasions (Figures 5.1.1 through 5.1.3), may develop on the mucosa of the inner labia and vestibule or on vulvar skin. Severe burning, soreness, and pain are constantly reported. Flaccid blisters and erosions may also occur elsewhere on distant skin or mouth.
Introduction: Vaginal candidiasis is a common genital tract infection in women caused by variety of Candida species. C. albicans is the most common species that are isolated from candidiasis, but in recent years other pathogenic Candida, such as C. glabrata, C. parapsilosis and C. tropicalis have been significantly increased. This study was performed with aim to identify the variety of candida species in women with Candida vaginitis. Methods: This cross-sectional study was performed on 158 patients with symptoms of vaginitis referred to health centers of Mashhad University of Medical Sciences in 2013-2014. Positive cultures were collected from patients and were identified by using different diagnostic tests such as germ tube test, culture in Candida CHROM agar and corn meal agar with tween 80 medium, and assimilation test by API 20C AUX kit. Analysis of data was performed using SPSS statistical software (version 16) and chi-square test. PResults: In this study, 77.7% Candida albicans, 9% C. parapsilosis, 7% C. glabrata, 4% C. tropicalis and 1% C. kefir were isolated. Age group of 28-37 years had the highest rates of infection (%48.43). Among pregnant, the highest frequency was related to C. albicans (%86/66) and then, C. glabrata (%6.66), and in non-pregnant women, C. albicans (%71.4) and then, C. glabrata (%11.90). Conclusion: In this study, a significant increase was observed in the amount of C. glabrata and C. parapsilosis.
To identify the predominant species and the role of sexual partners in the maintenance of recurrent vulvovaginitis by Candida spp.
A prospective study of 830 patients aged 18 to 65 years with yeast vaginitis was performed between August 2007 and March 2012. Patients with diabetes mellitus, AIDS or taking corticosteroids, antibiotics or hormone therapy and immunosuppressed patients, patients using vaginal douches, spermicides or intrauterine devices were excluded from the study. Candida species were identified by phenotypic and genotypic methods. The chi-square test was used to correlate the presence of Candida spp. in male partners with the recurrence of vaginitis.
The fungal agent was isolated from a total of 40 women, 24 with recurrent vaginitis and from 15 of their sexual partners, 10 of whom were asymptomatic while 5 were symptomatic. There was agreement of the species found in the couple in 100% of recurrences. C. albicans (62.4 and 60%), C. glabrata (29.1 and 33.3%) and C. guilliermondii species were identified. Candida tropicalis (4.1%) was isolated from only one patient. Candida albicans was isolated from the remaining 16 women who had uncomplicated vaginitis. C. glabrata was isolated from only two of the asymptomatic partners.
There was a predominance of C. albicans and symptomatic or asymptomatic partners can play an important role as a reservoir and source of transmission of yeast, especially in cases of recurrent vulvovaginitis.
Review Article, based on clinical experience, and challenges in mamanging patients presenting with RVVC in the context of a developing country, with limited resources and competing health priorities
Objective: The purpose of this study was to determine the prevalence, species distribution and antifungal susceptibility profile among oral cavity isolates of Candida species from diabetic and non-diabetic subjects. The contribution of smoking and dental status to the prevalence and distribution of Candida species was also evaluated. Results: Positive yeast was detected in 58.3% of diabetics compared with 30% in healthy controls (P<0.001). C. albicans was the most prevalent species in both diabetics (81.8%) and controls (76.9%) followed by C. tropicalis, C. parapsilosis and C. glabrata. C. kefyr and C. krusei were isolated only from diabetics at a combined rate of 1.3%. Candida was detected more frequently in diabetic denture wearers than in control counterparts in all anatomic sampled sites (P<0.05). The frequency of Candida isolation was significantly higher in smokers than in the non-smokers in both diabetics and controls (P<0.001). All C. albicans recovered from diabetics and controls were susceptible to amphotericin B, ketoconazole, itraconazole and fluconazole. Non-albicans Candida isolates were shown to have higher azole MIC values than C. albicans isolates. Conclusions: Our findings show that smoking and continuously worn dentures, promote oral candidal colonization in diabetics.
Vulvovaginal candidiasis is a common clinical finding among women especially the sexually active
group, even though there has been a sustained increase in both the variety and potency of antifungal
drugs over the past three decades. The disease apparently appears not to have sufficiently yielded to
these breakthroughs nevertheless. The study was therefore set up to ascertain the prevalence of
vaginal candidiasis among women in Jos. The study was retrospective in nature: Data generated from
analysis of endocervical and high vaginal swab (ECS/HVS) specimens by the Microbiology laboratory of
Jos University Teaching Hospital (JUTH) for a period of five years (July 1999 - June 2004) was compiled.
Samples were collected, transported, stored and processed using standard laboratory procedures.
Additional information was obtained from patients’ case notes in the records department. Results were
analyzed using Epi Info 6 statistical software. The prevalence of Candida infection was found to be
29.1% (n = 2458); no isolate was recovered from those less than 10 years of age, while the peak agegroup
of infection was 30 - 39 years 11.8% (n = 997); the age-group 20 - 49 years accounted for over
25% of the entire infections. Common clinical manifestations were: Nil symptoms, 24.7% (n = 607);
itching and rashes, 29.4% (n = 723). Due to the importance of the results, sex education workshops
should be conducted for adolescents and young adults in order to educate them on the clinical
importance of candidal infections.
Candida africana was previously proposed as a new species within the Candida albicans species complex, together with C. albicans and C. dubliniensis, although further phylogenetic analyses better support its status as an unusual variant within C. albicans. Here we show that C. africana can be distinguished from C. albicans and C. dubliniensis by pyrosequencing of a short region of ITS2, and we have evaluated its occurrence in clinical samples by pyrosequencing all
presumptive isolates of C. albicans submitted to the Mycology Reference Laboratory over a 9-month period. The C. albicans complex constituted 826/1,839 (44.9%) of yeast isolates received over the study period and included 783 isolates of C. albicans, 28 isolates of C. dubliniensis, and 15 isolates of C. africana. In agreement with previous reports, C. africana was isolated exclusively from genital specimens, in women in the 18-to-35-year age group. Indeed, C. africana constituted 15/251 (6%) of “C. albicans” isolates from female genital specimens during the study period. C. africana isolates were germ tube positive, grew significantly more slowly than C. albicans and C. dubliniensis on conventional mycological media, could be distinguished from the other members of the C. albicans complex by appearance on chromogenic agar, and were incapable of forming chlamydospores. Here we present the detailed evaluation
of epidemiological, phenotypic, and clinical features and antifungal susceptibility profiles of United Kingdom isolates of
C. africana. Furthermore, we demonstrate that C. africana is significantly less pathogenic than C. albicans and C. dubliniensis in the Galleria mellonella insect systemic infection model.
It is thought that widespread use of 'over-the-counter' azoles may increase the incidence of resistant Candida species such as Candida glabrata. Infections with species other than Candida albicans frequently do not respond to standard azole treatments. Intravaginal nystatin is an option but is no longer available in the UK. In this paper, the authors review the prevalence of non-albicans candida over the past 5 years, and assess the efficacy of amphotericin and flucytosine vaginal cream in the treatment of non-albicans VVC.
Retrospective review of all vaginal yeast isolates collected from women attending a city centre sexual-health clinic between 2004 and 2008. The women prescribed amphotericin and flucytosine vaginal cream were identified through pharmacy records, and their clinical notes reviewed for treatment outcome.
Between 2004 and 2008, the number of isolates of all Candida species increased with increasing clinic workload, but the prevalence of non-albicans yeasts remained stable at between 0.87 and 1.06%. Eighteen patients were prescribed amphotericin and flucytosine vaginal cream. At follow-up, all 18 were clear of their initial yeast isolate on culture, but two had persistent symptoms and had positive cultures for C albicans.
There is no evidence of any increase in prevalence of non-albicans Candida species such as C glabrata. The authors have treated 18 women who had non-albicans VVC with amphotericin and flucytosine vaginal cream and achieved clearance of the non-albicans species in all of them.
Atypical oral Candida isolates were recovered from 60 HIV-infected and three HIV-negative individuals. These organisms were germ-tube-positive and produced abundant chlamydospores which were frequently arranged in triplets or in contiguous pairs. They belonged to C. albicans serotype A and had atypical carbohydrate assimilation profiles. Fingerprinting the genomic DNA of a selection of these organisms with the C. albicans-specific probe 27A and five separate oligonucleotides, homologous to eukaryotic microsatellite repeat sequences, demonstrated that they had a very distinct genomic organization compared to C. albicans and C. stellatoidea. This was further established by random amplified polymorphic DNA (RAPD) and karyotype analysis. Comparison of 500 bp of the V3 variable region of the large ribosomal subunit genes from nine atypical isolates and the corresponding sequences determined from C. albicans, C. stellatoidea, C. tropicalis, C. parapsilosis, C. glabrata, C. kefyr and C. krusei showed that they atypical organisms formed a homogeneous cluster (100% similarity) that was significantly different from the other Candida species analysed, but was most closely related to C. albicans and C. stellatoidea. These genetic data combined with the phenotypic characteristics of these atypical organisms strongly suggest that they constitute a novel species within the genus Candida for which the name Candida dubliniensis is proposed.
Due to the rising importance of Candida glabrata and other non-albicans Candida as principle human opportunistic pathogens, 356 women with abnormal vaginal discharge who attended a private obstetrics and gynecology clinic in Amman, Jordan, between January 1999 and February 2001 were examined. The isolation rate of Candida spp. from high-vaginal swabs was 44.9%. CHROMagar Candida and conventional mycological methods identified six isolated Candida spp., including C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, C. krusei, and C. kefyr. The percentages of C. albicans, C. glabrata, and C. tropicalis isolates were 43.1%, 32.5%, and 8.1%, respectively. C. albicans was isolated in combination with C. tropicalis and C. krusei in two patients. Statistical analysis of the present results clearly show an increase in the incidence of vulvovaginal candidiasis caused by C. glabrata in the two study periods, 1994-1996 and 1999-2001 (P = 0.0186). In contrast, comparing the proportions of vulvovaginal candidiasis caused by C. albicans in the two periods, there was no significant difference. These results may have significant clinical implications, as C. glabrata are innately less susceptible to most antifungal agents than C. albicans; these findings support viewing this organism as a major pathogen.
Candida dubliniensis is an emerging pathogen capable of causing oropharyngeal, vaginal and bloodstream infections. Although C. dubliniensis is similar to Candida albicans in several phenotypic characteristics, it differs from it with respect to epidemiology, certain virulence factors and the ability to develop resistance to fluconazole rapidly. In this study, the first seven isolations of C. dubliniensis from Kuwait are described, all originating from non-human immunodeficiency virus (HIV)-infected patients. The isolates were initially identified by the Vitek 2 yeast identification system, positive germ tube test, production of rough colonies and chlamydospores on Staib agar and by their inability to assimilate xylose, trehalose or methyl alpha-D-glucoside. The species identity of the isolates was subsequently confirmed by specific amplification of rDNA targeting the internally transcribed spacer 2 (ITS2), restriction endonuclease digestion of the amplified DNA and direct DNA sequencing of the ITS2. Using the E-test method, the MICs of C. dubliniensis test isolates were in the range 0.125-0.75 microg ml(-1) for fluconazole, 0.002-0.75 microg ml(-1) for itraconazole, 0.006-0.125 microg ml(-1) for ketoconazole, 0.002-0.5 microg ml(-1) for amphotericin B and 0.002-0.016 microg ml(-1) for voriconazole. Two of the isolates were resistant to 5-flucytosine (>32 microg ml(-1)), but none against fluconazole. The study reinforces the current view that C. dubliniensis has a much wider geographical and epidemiological distribution.
There are limited data regarding the antifungal susceptibility of yeast causing vulvovaginal candidiasis, since cultures are
rarely performed. Susceptibility testing was performed on vaginal yeast isolates collected from January 1998 to March 2001
from 429 patients with suspected vulvovaginal candidiasis. The charts of 84 patients with multiple positive cultures were
reviewed. The 593 yeast isolates were Candida albicans (n = 420), Candida glabrata (n = 112), Candida parapsilosis (n = 30), Candida krusei (n = 12), Saccharomyces cerevisiae ( n = 9), Candida tropicalis (n = 8), Candida lusitaniae (n = 1), and Trichosporon sp. (n = 1). Multiple species suggesting mixed infection were isolated from 27 cultures. Resistance to fluconazole and flucytosine
was observed infrequently (3.7% and 3.0%); 16.2% of isolates were resistant to itraconazole (MIC ≥ 1 μg/ml). The four imidazoles
(econazole, clotrimazole, miconazole, and ketoconazole) were active: 94.3 to 98.5% were susceptible at ≤1 μg/ml. Among different
species, elevated fluconazole MICs (≥16 μg/ml) were only observed in C. glabrata (15.2% resistant [R], 51.8% susceptible-dose dependent [S-DD]), C. parapsilosis (3.3% S-DD), S. cerevisiae (11.1% S-DD), and C. krusei (50% S-DD, 41.7% R, considered intrinsically fluconazole resistant). Resistance to itraconazole was observed among C. glabrata (74.1%), C. krusei (58.3%), S. cerevisiae (55.6%), and C. parapsilosis (3.4%). Among 84 patients with recurrent episodes, non-albicans species were more common (42% versus 20%). A ≥4-fold rise
in fluconazole MIC was observed in only one patient with C. parapsilosis. These results support the use of azoles for empirical therapy of uncomplicated candidal vulvovaginitis. Recurrent episodes
are more often caused by non-albicans species, for which azole agents are less likely to be effective.
Fungi are increasingly recognised as major pathogens in critically ill patients. Candida spp. and Cryptococcus spp. are the yeasts most frequently isolated in clinical practice. The most frequent filamentous fungi (moulds) isolated are Aspergillus spp., but Fusarium spp., Scedosporium spp., Penicillium spp., and Zygomycetes are increasingly seen. Several reasons have been proposed for the increase in invasive fungal infections, including the use of antineoplastic and immunosuppressive agents, broad-spectrum antibiotics, and prosthetic devices and grafts, and more aggressive surgery. Patients with burns, neutropenia, HIV infection and pancreatitis are also predisposed to fungal infection. The epidemiology and clinical features of fungal infections are reviewed, together with antifungal agents currently or soon to be available.
Invasive candidiasis (IC) is a leading cause of mycosis-associated mortality in the United States. We examined data from the National Center for Health Statistics and reviewed recent literature in order to update the epidemiology of IC. IC-associated mortality has remained stable, at approximately 0.4 deaths per 100,000 population, since 1997, while mortality associated with invasive aspergillosis has continued to decline. Candida albicans remains the predominant cause of IC, accounting for over half of all cases, but Candida glabrata has emerged as the second most common cause of IC in the United States, and several less common Candida species may be emerging, some of which can exhibit resistance to triazoles and/or amphotericin B. Crude and attributable rates of mortality due to IC remain unacceptably high and unchanged for the past 2 decades. Nonpharmacologic preventive strategies should be emphasized, including hand hygiene; appropriate use, placement, and care of central venous catheters; and prudent use of antimicrobial therapy. Given that delays in appropriate antifungal therapy are associated with increased mortality, improved use of early empirical, preemptive, and prophylactic therapies should also help reduce IC-associated mortality. Several studies have now identified important variables that can be used to predict risk of IC and to help guide preventive strategies such as antifungal prophylaxis and early empirical therapy. However, improved non-culture-based diagnostics are needed to expand the potential for preemptive (or early directed) therapy. Further research to improve diagnostic, preventive, and therapeutic strategies is necessary to reduce the considerable morbidity and mortality associated with IC.
Vaginitis is a very common cause for consultation in gynaecology. The effectiveness of first-line treatment depends on the pertinency of the diagnosis, most often based on clinic. Etiological diversity of vaginitis might explain the therapeutic failures of monotherapy due to an underestimation of bacterial and mixed vaginitis.
: To measure intravaginal practices among women of differing ages, ethnicities, and human immunodeficiency virus status and the association between intravaginal practices and bacterial vaginosis and candidiasis infection.
: Between 2008 and 2010, we recruited and followed sexually active women aged 18-65 years living in Los Angeles. At the enrollment and month 12 visit, participants completed a self-administered, computer-assisted questionnaire covering demographics, sexual behaviors, vaginal symptoms, and intravaginal practices over the past month. At each visit, bacterial vaginosis and candidiasis infection were diagnosed by Nugent criteria and DNA probe, respectively.
: We enrolled 141 women. Two thirds (66%) reported an intravaginal practice over the past month; 49% reported insertion of an intravaginal product (other than tampons) and 45% reported intravaginal washing. The most commonly reported practices included insertion of commercial sexual lubricants (70%), petroleum jelly (17%), and oils (13%). In univariable analysis, intravaginal use of oils was associated with Candida species colonization (44.4% compared with 5%, P<.01). In multivariable analysis, women reporting intravaginal use of petroleum jelly over the past month were 2.2 times more likely to test positive for bacterial vaginosis (adjusted relative risk 2.2, 95% confidence interval 1.3-3.9).
: Intravaginal insertion of over-the-counter products is common among women in the United States and is associated with increased risk of bacterial vaginosis. The context, motivations for, and effects of intravaginal products and practices on vaginal health are of concern and warrant further study.
: III.
To identify yeastisolates in vaginal specimens to species level and determine their antifungal susceptibility patterns.
Cross-sectional laboratory-based study.
The Aga Khan University Hospital (AKUH), Nairobi.
Yeast isolates from high vaginal swabs presented to the laboratory for culture and sensitivity were identified to species level using the API Candida system and subjected to broth microdilution susceptibility testing.
Frequency tables and graphs were used to summarise the data. Susceptibility data was analysed by the non-parametric Fisher's exact test. P < 0.05 was considered statistically significant.
A total of 101 yeasts were studied. C. albicans was the prominent species (69.3%) followed by C. glabrata (12.9%), C. famata (5.0%), C. krusei (3.0%), Trichosporon species (3.0%) and S.cerevisiae (3.0%), C.parapsilosis (1.0%). Three (3.0%) of the isolates had profiles that fell between C. glabrata and C. famata. The percentages of C. albicans susceptible to flucytosine, amphotericin B, fluconazole and itraconazole were 94.3, 92.9, 100 and 90 respectively; that of non-albicans isolates were 93.5, 80.6, 77.4 and 29 respectively. There was no significant difference (p > 0.05) between the susceptibility of C. albicans and non-albicans isolates to flucytosine and amphotericin B, however there was a significant difference (p < 0.05) to fluconazole and itraconazole.
C. albicans was the predominant cause of vulvovaginal candidiasis in this study, and demonstrated good susceptibility to antifungal agents tested. A significant number of non-albicans yeasts were identified; these demonstrated reduced susceptibility to all drugs, in particular to the azoles which are commonly used for treatment of vaginal candidiasis. The isolation of non-albicans yeasts may have clinical implication given their reduced susceptibility to antifungals.
To establish the different etiologies of vaginitis and, especially, assess the distribution of responsible pathogens through a prospective study.
One hundred and sixty-nine women aged between 18 and 65 years (average age: 33.7 years old), consulting a physician for symptoms of vaginitis, were examined in 21 centers of gynaecology or infectious diseases. The clinical evaluation was completed by bacteriological sample that was tested for infections (including sexually transmitted infections (STIs)).
One hundred and eighteen patients (69.8%) had one or several infectious etiologies distributed as follows: 79 (46.7%) candidiasis (3 of which were caused by non albicans Candida), 37 (21.9%) bacterial vaginitis and 16 (9.5%) bacterial vaginosis. To be noticed that there were 38 cases of mixed etiologies out of the 118 infectious etiologies (32.2%), 3 of them were STIs.
Although candidiasis was the most common etiology in this study, it only represented less than 1 out of every two patients. Among the infectious etiologies, 1 out of 3 women presented a bacterial or mixed vaginitis. The etiological diversity of vaginitis leads to consider broad-spectrum treatment as first-line therapy and to prescribe a microbiological analysis in case of failure.
: This study aimed to explore the role of hormone replacement therapy (HRT) in susceptibility to vulvovaginal candidiasis (VVC) in a private vulval disease referral practice.
: Between January 2009 and December 2010, 149 healthy, nondiabetic patients with vulvar conditions were compared for significant differences in vaginal swab result, age, and diagnosis between those using and not using HRT. Detailed clinical data were collected from those with VVC.
: The mean ages of the HRT (n = 70) and non-HRT (n = 79) groups were 62.5 and 62.5 years, respectively. Positive cultures for Candida were found in 34 (48.5%) of 70 patients on HRT and in 2 (3%) of 79 subjects not on HRT (p < .001). Culture-positive, clinical VVC was identified in 34 (49%) of 70 patients on HRT and in 1 (1%) of 79 patients not on HRT (p < .001). Candida species (32 Candida albicans and 2 Candida glabrata) were isolated from the 34 VVC patients, and of these, 23 (67%) had a history of recurrent or chronic candidiasis before menopause. All 34 had been previously treated with antifungal therapy without ceasing HRT and had been unresponsive to treatment or had relapse after treatment. In 27 (79%) of 34 patients, HRT was suspended during treatment. Of those who remained on HRT during treatment or resumed it after treatment, prophylactic antifungal treatment was initiated in 15 (44%) to prevent recurrence. All patients responded to the antifungal treatment provided HRT was suspended or prophylactic treatment was used.
: Postmenopausal women taking HRT are significantly more prone to develop VVC than women who are not and those with VVC are likely to have been susceptible to it before menopause.
Vulvovaginal candidosis (VVC) is the second most common cause of vaginitis after bacterial vaginosis, and it is diagnosed in up to 40% of women with vaginal complaints in the primary care setting. Reliable diagnosis of VVC requires a correlation of clinical features with mycological evidence. The mycological methods used for diagnosis include microscopic examination, fungal culture, and antigen tests. Fungal culture can reveal the species of organism(s) responsible for the infection and provide epidemiological data. This report reviews current knowledge about the available diagnostic methods and tests that accurately diagnose VVC, and highlights the importance of fungal culture.
Candida africana differs from the common strains of C. albicans and C. dubliniensis morphologically, physiologically, genetically, and, in particular, clinically. This fungal pathogen is primarily recovered from genital specimens, especially in vaginal specimens. In this investigation, we reexamined 195 vaginal C. albicans isolates for the presence of C. africana and C. dubliniensis by using hyphal wall protein 1 (HWP1) gene polymorphisms. All study isolates were confirmed to be C. albicans, and none were verified as either C. africana or C. dubliniensis. In conclusion, the HWP1 gene polymorphisms offer a useful tool in the discrimination of C. africana, C. albicans, and C. dubliniensis. Further studies may highlight the pathogenesis and importance of this yeast in vulvovaginal candidiasis.
Non-albicans Candida species have increasingly been identified as the cause of vulvovaginitis. In vitro and in vivo data indicate that the various non-albicans Candida species identified in the lower genital tract differ considerably with regard to epidemiology, virulence or vaginal pathogenicity, and antimycotic drug susceptibility. Clinical experience indicates reduced virulence of these organisms in the lower genital tract, and their causal role in a symptomatic patient requires careful case-by-case determination rather than routine administration of antimycotic therapy. Accordingly, vaginal Candida isolates deserve species identification and consideration of pathogenic potential and antifungal susceptibility before therapeutic decisions are made.
The prevalence of vaginal yeast species has been studied in 140 women (41 pregnant, 66 infertile and 33 healthy controls) attending a gynaecological private clinic in Amman, Jordan. Yeast species were isolated from pregnant (68.2%), infertile (51.5%) and healthy control (48.4%) women. Patients manifesting one, two or three symptoms of vulvovaginitis were 22.1%, 26.8% or 24.2% respectively. Asymptomatic cases and cases with more than three symptoms were 22.4% and 4.5% respectively. Candida albicans was the dominant species (in 51.3% of the patients) followed by C. glabrata (17.9%). The percentage occurrence as well as the pattern of Candida species differed among the different groups of patients. Candida kefyr was found to be significantly higher in the infertile women. In vitro sensitivity tests using amphotericin B, nystatin, miconazole nitrate and chlorhexidine were carried out; amphotericin B was the most effective and miconazole nitrate the least.
Zusammenfassung. Die Prävalenz vaginaler Hefearten wurde an 140 Frauen (41 schwangere, 66 infertile und 33 gesunde Frauen) einer gynäkologischen Privatklinik in Amman, Jordanien, erhoben. Hefen wurden bei 68.2% der schwangeren, bei 51.5% der infertilen und bei 48.4% der gesunden Frauen isoliert. Patientinnen, die eins, zwei oder drei Vulvovaginitis-Symptome zeigten, wurden zu 22.1%, 26.8% bzw. 24.2% gefunden. Asymptomatische Frauen und solche mit mehr als 3 Symptomen wurden zu 22.4% bzw. 4.5% beobachtet. Die vorherrschende Hefeart war Candida albicans bei 51.3%, gefolgt von C. glabrata bei 17.9% der Patientinnen. Prozentsätze und Artenspektrum differierten bei den unterschiedlichen Patientinnengruppen. Candida kefyr war signifikant häufiger bei infertilen Frauen. Es wurde die Empfindlichkeit der Hefeisolate für Amphotericin B, Nystatin, Miconazol und Chlorhexidin geprüft; die Empfindlichkeitsrate war für Amphotericin B am höchsten und für Miconazol am geringsten.
Twelve women with vaginal Candida krusei infection were evaluated. In vitro antifungal susceptibility testing and molecular typing were performed. Patients infected
with C. krusei frequently had refractory vulvovaginal signs and symptoms that were otherwise indistinguishable from vaginitis due to other
yeasts. Patients were 32–63 years old and had previously received multiple courses of antimycotic agents, including fluconazole
and miconazole. The most active azole in vitro was clotrimazole, with a 90% minimum inhibitory concentration of 0.25 μg/mL.
Four of 6 patients treated with boric acid had clinical and mycological cure. Two dominant genotypes of C. krusei were identified via contour-clamped homogenous electrical field analysis. No major genotypic change was observed in successive
isolates from the same patient in most cases, suggesting that these refractory cases were relapses. C. krusei is a rare but important cause of refractory vaginitis and is unique because of its intrinsic resistance to fluconazole.
The aims of this study were to compare the genetic relatedness of: (i) sequential and single isolates of Candida strains from women with recurrent vaginal candidiasis (RVC); and (ii) Candida strains from women who had only one episode of infection within a 1-year period. In total, 87 isolates from 71 patients were cultured, speciated and genotyped by random amplification of polymorphic DNA (RAPD) analysis. Patients were categorized into three groups, namely those with: (i) a history of RVC from whom two or more yeast isolates were obtained (group A); (ii) a history of RVC from whom only a single isolate was obtained (group B); and (iii) a single episode of vaginal candidiasis within a 1-year period (group C). Six yeast species were detected: Candida albicans, Candida glabrata, Candida lusitaniae, Candida famata, Candida krusei and Candida parapsilosis. Interestingly, the prevalence of non-albicans species was higher in group A patients (50 %) than in patients in groups B (36 %) or C (18.9 %). Eighty RAPD profiles were observed, with a total of 61 polymorphic PCR fragments of distinct sizes. Clustering analysis showed that, overall, the majority of patients in group A had recurrent infections caused by highly similar, but not identical, sequential strains [mean pairwise similarity coefficient (S(AB)) = 0.721 +/- 0.308]. The range of mean S(AB) values for intergroup comparisons for C. albicans isolates alone was 0.50-0.56, suggesting that there was no significant relatedness between strains from different groups. Genetic similarity of C. albicans isolates from patients in group A was lower than that of C. albicans isolates from patients in group C (mean S(AB) = 0.532 +/- 0.249 and 0.636 +/- 0.206, respectively); this difference was statistically significant (P = 0.036). These results demonstrate that the cause of recurrent infections varies among individuals and ranges between strain maintenance, strain microevolution and strain replacement; the major scenario is strain maintenance with microevolution. They also show that C. albicans strains that cause recurrent infections are less similar to each other than strains that cause one-off infections, suggesting that the former may represent more virulent subtypes.
A clinical survey was carried out in seven cities in the southern part of Nigeria to determine the relative distribution of genitourinary Candida species in symptomatic patients reporting for diagnosis and treatment. Seven Candida species were identified using the CHROMagar Candida method and the API 20C System. Candida species were represented by Candida glabrata (33.7%), Candida albicans (20.1%), Candida tropicalis (18%), Candida guilliermondii (17.8%) Candida pseudotropicalis (5%), Candida parapsilosis (5%), and C. albicans var.stellatoidea (1.2%). The distribution of these species among the various age groups (15-20, 21-25, 26-30, 31-35, 36-40 and 41 plus years) was statistically insignificant. Out of the 517 positive samples, 182 (35%) were found in the age group 26-30 years, while age 41 plus had the lowest frequency (1.2%). The results presented show that C. albicans, usually reported to be the most frequently isolated species, is not the main species in the cities studied. With C. glabrata in preponderance, the finding supports recent studies reporting that several pathogenic non-C. albicans species are now being frequently isolated. The level of social activities, such as drug abuse and sexual promiscuity, may be important in the distribution frequency of Candida species in different age groups and locations.
Twenty-seven Candida albicans strains and 26 Candida dubliniensis strains, isolated from HIV patients, were tested for their adherence to buccal and vaginal epithelial cells. Both species showed important levels of adhesion to buccal and vaginal epithelial cells, although C. albicans showed the highest levels of adhesion. These results suggest that both Candida species are well adapted, in terms of adhesion capability, to the oral and vaginal environment.
We sought to investigate the prevalence and risk factors for vaginal yeast colonization over a 1-year period.
We conducted a longitudinal cohort study of 1,248 asymptomatic young women by collecting demographic and behavioral data at baseline, 4, 8, and 12 months.
Seventy percent of women were colonized by vaginal yeast at one or more visits, but only 4% were colonized at all 4 visits. Using an adjusted generalized estimating equation model, factors associated with vaginal yeast colonization were marijuana use in the previous 4 months, depomedroxyprogesterone acetate use in the past 4 months, sexual intercourse in the previous 5 days, and concurrent colonization with lactobacilli and group B streptococcus. Symptoms of pruritus and vulvovaginal burning were associated with yeast colonization, but antifungal use was not.
Recent sexual intercourse and use of injection contraceptives are risk factors for yeast colonization. Rates of antifungal use did not show an association with yeast colonization. The reporting of antifungal use by women lacking yeast colonization suggests that self-diagnosis is inaccurate.
II-2.
This study evaluated the phenotypic tests used to differentiate Candida albicans from Candida dubliniensis. A total of 55 isolates from vaginal secretions, oral cavity and hemoculture were studied. They were originally identified as C. albicans, based on their morphological and physiological characteristics. These isolates were tested for colony color development on CHROMagar Candida medium, growth at 45 degrees C on Sabouraud Dextrose agar, lipolytic activity on Tween 80 Agar medium and colony morphology and chlamydoconidia formation on Staib agar medium. Of the 55 isolates studied, seven yielded one or more phenotypic characteristics suggestive of Candida dubliniensis. These isolates were tested by PCR with specific primers for Candida dubliniensis and API ID 32. The seven isolates were confirmed as Candida albicans. All of these finding indicate that DNA based tests should be used for definitive identification of Candida dubliniensis.
Candida dubliniensis was first described as a novel species in 1995. This organism is very closely related to the important human yeast pathogen, Candida albicans. However, despite the very close phylogenetic relationship between C. albicans and C. dubliniensis and the fact that they share a large number of phenotypic traits, epidemiological and virulence model data indicate that the former is a far more successful pathogen. In order to investigate the molecular basis of the lower virulence of C. dubliniensis recent comparative genomic hybridisation studies have revealed the absence and divergence of specific genes implicated in candidal virulence. Data from the C. dubliniensis genome sequencing project will allow a complete comparison between the genomes of the two species to be performed and thus enhance our understanding of candidal virulence and how virulence has evolved in Candida species.
To compare the prevalence of asymptomatic oral candidal carriage in healthy volunteers with human immunodeficiency virus (HIV)-positive patients in China, as well as to investigate the relationship between CD4+ lymphocyte count and oral candidal colonization or oral candidiasis.
Oral candidal carriage and oral candidiasis were investigated in 101 patients with HIV-infection seen at Youan Hospital, Beijing, China. Two hundred and seventeen healthy volunteers were involved as a control. Culture from saliva was used to test for the presence of oral Candida. CD4+ lymphocyte count was measured by flow cytometry. All data were analyzed statistically by SAS.
Asymptomatic oral candidal carriage rate (28.6%) in HIV-positive group was similar to that in the healthy group (18.0%; P = 0.07). No significant difference in CD4+ lymphocyte count was found between oral Candida carriers and non-carriers among HIV-positive subjects (P = 0.89). However, the frequency of oral candidiasis increased with the decrease in CD4+ lymphocyte count (P < 0.0001), and pseudomembranous candidiasis was predominant in HIV-positive patients with CD4+ <200 cells microl(-1) (66.7%).
In HIV-positive subjects, asymptomatic oral candidal colonization is not related to CD4+ lymphocyte count of blood, and the carriage rate is similar to that in the healthy population. Oral candidiasis is more likely to be observed in HIV-positive patients who have a low CD4+ lymphocyte count.
The efficacy of yogurt treatment against vaginal candidosis (VC) was examined using an oestrogen-dependent vaginal candidosis (EDVC) murine model. The EDVC mouse model was constructed by inoculating mice with viable Candida albicans cells under pseudo-oestrus conditions. Vaginal fungal burden in the various mouse groups was evaluated at several time points following the induction of VC. Untreated and yogurt-treated naïve mice exhibited background levels of VC (<6000 CFU per mouse). Candida albicans colonisation in untreated EDVC mice was significantly higher (P < 0.05) than that in yogurt-treated EDVC mice at days 20-30. Metronidazole-treated naïve mice developed persistent C. albicans vaginal colonisation at significantly lower levels (P < 0.05) than that in untreated or metronidazole-treated EDVC mice. Lactobacillus was only detected in the reproductive tracts of yogurt-treated naïve and EDVC mice. These findings suggest that the presence of Lactobacillus in the reproductive tract can suppress C. albicans growth and the antibiotics may predispose to VC.
Yeasts and molds now rank among the most common pathogens in intensive care units. Whereas the incidence of Candida infections peaked in the late 1970s, aspergillosis is still increasing.
Review of the pertinent English-language literature.
Most factors promoting an invasive fungal infection are difficult to avoid because they are connected directly to treatment of the underlying disease. Antifungal treatment is often commenced on an empiric basis, whereas it might be preferable to adopt a strategy based on a diagnostic procedure able to demonstrate or exclude fungal disease. Polyenes have been the drugs of choice, but voriconazole is the new standard for aspergillosis. For invasive candidiasis, fluconazole is a more convenient option, with the new echinocandins or voriconazole as alternatives.
The incidence of invasive fungal infection is increasing, but so too are the choices of agents for therapy. For reasons of efficacy and safety, therapy with an echinocandin or azole antifungal agent is supplanting the use of polyenes.
Candida dubliniensis is very similar to Candida albicans in terms of genotypic and phenotypic characteristics. As the hormonal milieu of the vagina during pregnancy, characterised by a lack of maternal cell-mediated immunity, enhances Candida colonisation and serves as a risk factor for symptomatic expression, investigation into the isolation of C. dubliniensis in vaginal discharges of pregnant women with vulvovaginal candidosis was made. A total of 77 Candida isolates obtained from 60 patients positive for vulvovaginal candidosis collected from 218 pregnant women were investigated for C. dubliniensis subsistence. In total 41 Candida species phenotypically identified as C. albicans on the basis of a positive germ tube test and carbohydrate assimilation tests were screened for the presence of C. dubliniensis. Phenotypic tests for differentiation of C. dubliniensis from C. albicans, such as growth at 42 and 45 degrees C on Sabouraud dextrose agar, appearance on CHROMagar and colony morphology on Cornmeal-Tween-80 agar and Staib agar were carried out. Only one strain (2.43%) was phenotypically identified as C. dubliniensis. According to our study, a combination of at least five phenotypic methods is necessary for an exact diagnosis of C. dubliniensis. Large-scale studies of pregnant women are required to discover the aetiological importance of this yeast.