Assessment of the capacity of Lactobacillus to inhibit the growth of uropathogens and block their adhesion to vaginal epithelial cells

Probiotic and prebiotic influence beyond the intestinal tract

Probiotics and prebiotics have long been appreciated for their positive influences on gut health. Research on the mechanisms and effects of these agents shows that their impact reaches beyond the intestine. Effects on the microecology and pathology of the oral cavity, stomach, and vaginal tract have been observed. Likely mediated through immune influences, systemic effects such as reduced severity of colds or other respiratory conditions, impact on allergy incidence and symptoms, and reduced absences from work or daycare have also been noted. These observations, among others, suggest a broader spectrum of influence than commonly considered for these unique substances.

Probiotics prophylaxis in children with persistent primary vesicoureteral reflux

Probiotics, beneficial living microorganisms, have been proven to be effective in preventing gastrointestinal infections, but their effect in preventing urinary tract infection (UTI) is inconclusive. A prospective randomized controlled study was done to compare the preventive effect of probiotics with conventional antibiotics in children with persistent primary vesicoureteral reflux (VUR). One hundred twenty children who had had persistent primary VUR after antibiotic prophylaxis for 1 year were randomly allocated into a probiotics (Lactobacillus acidophilus 10(8) CFU/g 1 g b.i.d., n = 60) or an antibiotics (trimethoprim/sulfamethoxazole 2/10 mg/kg h.s., n = 60) prophylaxis group during the second year of follow-up. The incidence of recurrent UTI was 18.3% (11/60) in the probiotics group, which was not different from 21.6%(13/60) in the antibiotic group (P = 0.926). The causative organisms of recurrent UTI were not significantly different between the two groups (P = 0.938). Even after stratification by VUR grade, age, gender, phimosis, voiding dysfunction and renal scar, the incidence of recurrent UTI did not differ significantly between the two groups (P > 0.05). The development of new renal scar was not significantly different between the two groups (P > 0.05). In conclusion, probiotics prophylaxis was as effective as antibiotic prophylaxis in children with persistent primary VUR.

Protective effect of vaginal Lactobacillus paracasei CRL 1289 against urogenital infection produced by Staphylococcus aureus in a mouse animal model

Urogenital infections of bacterial origin have a high incidence among the world female population at reproductive age. Lactobacilli, the predominant microorganisms of the healthy vaginal microbiota, have shown a protective effect against the colonization and overgrowth of urogenital pathogens that increased the interest for including them into probiotics products assigned to restore the urogenital balance. In the present work, we determined in a mouse animal model the capability of Lactobacillus paracasei CRL 1289, a human vaginal strain with probiotic properties, to prevent the vaginal colonization of a uropathogenic strain of Staphylococcus aureus. Six-week-old female BALB/c mice, synchronized in their estral cycle, were intravaginally inoculated with two doses of 10(9) lactobacilli before challenging them with a single dose of 10(5) or 10(7) CFU of S. aureus. The vaginal colonization of both microorganisms and the effect on the vaginal structure were determined at 2, 5, and 7 days after pathogen inoculation. Control mice and those challenged only with the pathogen showed an insignificant lactobacilli population, whereas 10(5) lactobacilli/mL of vaginal homogenate were recovered at 2 days after challenge from the L. paracasei CRL 1289 and the probiotic + pathogen groups, decreasing this number on the following days. The treatment with L. paracasei CRL 1289 decreased significantly the number of staphylococci recovered at 2 and 5 days when mice were challenged only with 10(5) CFU of pathogen. The inoculation of S. aureus produced a remarkable inflammatory response and structural alterations in the vaginal mucosa that decreases in a significant manner when the mice were protected with L. paracasei CRL 1289. The results obtained suggest that this particular Lactobacillus strain could prevent the onset of urogenital infections by interfering with the epithelial colonization by uropathogenic S. aureus.

Adherence of Lactobacillus crispatus to vaginal epithelial cells from women with or without a history of recurrent urinary tract infection

PURPOSE

Lactobacillus crispatus strain CTV-05 is a vaginal probiotic proposed for use in women with recurrent urinary tract infection to reduce vaginal colonization with Escherichia coli and the risk of urinary tract infection. However, the ability of this probiotic strain to adhere to the target mucosa, vaginal epithelial cells, has not been assessed in women with recurrent urinary tract infection. We measured the adherence of L. crispatus strain CTV-05 to vaginal epithelial cells collected from more than 100 premenopausal women with (cases) and without (controls) a history of recurrent urinary tract infection. We also examined the effects of relevant host factors on bacterial adherence.

MATERIALS AND METHODS

Bacterial adherence assays were performed by combining L. crispatus CTV-05 with exfoliated vaginal epithelial cells collected from 51 case women and 51 controls.

RESULTS

L. crispatus CTV-05 adhered in high numbers to vaginal epithelial cells from women with recurrent urinary tract infection (mean adherence of 50.5 lactobacilli per vaginal epithelial cell) and controls (mean adherence of 39.4 lactobacilli per vaginal epithelial cell). Adherence was significantly higher using vaginal epithelial cells from women with a maternal history of urinary tract infection (p = 0.036) and a nonsecretor phenotype (p < 0.001), but was not significantly affected by recent spermicide use, oral contraceptive use, menstrual cycle phase or sexual activity.

CONCLUSIONS

L. crispatus strain CTV-05 is highly adherent to vaginal epithelial cells collected from a large sample of premenopausal women with or without a history of recent recurrent urinary tract infection. These data strongly support further evaluation of this probiotic in clinical trials of women with recurrent urinary tract infection.

Probiotics for prevention of recurrent urinary tract infections in women: a review of the evidence from microbiological and clinical studies

Recurrent urinary tract infections (UTIs) afflict a great number of women around the world. The use of probiotics, especially lactobacilli, has been considered for the prevention of UTIs. Since lactobacilli dominate the urogenital flora of healthy premenopausal women, it has been suggested that restoration of the urogenital flora, which is dominated by uropathogens, with lactobacilli may protect against UTIs. This review is based on a search of PubMed for relevant articles. Many in vitro studies, animal experiments, microbiological studies in healthy women, and clinical trials in women with UTIs have been carried out to assess the effectiveness and safety of probiotics for prophylaxis against uropathogens. Most of them had encouraging findings for some specific strains of lactobacilli. Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 (previously called L. fermentum RC-14) seemed to be the most effective among the studied lactobacilli for the prevention of UTIs. L. casei shirota and L. crispatus CTV-05 have also shown efficacy in some studies. L. rhamnosus GG did not appear to be quite as effective in the prevention of UTIs. The evidence from the available studies suggests that probiotics can be beneficial for preventing recurrent UTIs in women; they also have a good safety profile. However, further research is needed to confirm these results before the widespread use of probiotics for this indication can be recommended.

[Recurrent urinary tract infections]

Recurrent urinary tract infections (RUTI) are a frequent clinical problem in sexually active young women, pregnant or postmenopausal women and in patients with underlying urological abnormalities. The present chapter reviews RUTI based on their classification: relapses, which usually occur early (< 1 month), are caused by the same microorganism and are associated with underlying urological abnormalities, and reinfections, which usually occur later and are caused by a new distinct microorganism (or by the same microorganism usually located in the rectum or uroepithelial cells). The pathogenesis of RUTI is reviewed and the risk factors associated with RUTI in premenopausal women (usually related to sexual activity), postmenopausal women (in whom estrogen deficiency has a significant effect on the vaginal Lactobacillus flora), and in pregnant women are discussed. Likewise, an extensive review of the distinct therapeutic strategies to prevent RUTI is provided: self-treatment of cystitis, continuous antibiotic prophylaxis, postcoital antibiotic prophylaxis, topical vaginal estrogens, Lactobacillus, cranberry juice, intravesical administration of non-virulent E. coli strains and vaccines, among others. Several diagnostic-therapeutic algorithms are included. These algorithms are based on the type of urinary infection (relapse-reinfection), on the type of patient (young, postmenopausal, or pregnant women) and on the number of episodes of RUTI.

Influence of probiotic vaginal lactobacilli on in vitro adhesion of urogenital pathogens to vaginal epithelial cells

AIMS

Lactobacilli, the predominant micro-organisms of the vaginal microbiota, play a major role in the maintenance of a healthy urogenital tract by preventing the colonization of pathogenic bacteria. The aim of the present study was to assess the ability of four vaginal Lactobacillus strains, previously selected for their probiotic features, to block in vitro the adherence of three human urogenital pathogens to vaginal epithelial cells (VEC).

METHODS AND RESULTS

Three types of assays were performed in order to determine the inhibitory effect of lactobacilli on adhesion of urogenital pathogens to VEC: blockage by exclusion (lactobacilli and VEC followed by pathogens), competition (lactobacilli, VEC and pathogens together) and displacement (pathogens and VEC followed by the addition of lactobacilli). Bacterial adhesion to VEC was quantified by microscopy (x1000) after Gram's stain. All the strains were able to inhibit by exclusion and competition the adhesion of Staphylococcus aureus to VEC but none was able to decrease the attachment of Escherichia coli by neither of the mechanisms assayed. Only Lactobacillus acidophillus CRL 1259 and Lactobacillus paracasei CRL 1289 inhibited the attachment of Group B streptococci (GBS) to VEC by exclusion and competition respectively.

CONCLUSIONS

Lactobacillus of vaginal origin were able to inhibit the attachment of genitouropathogenic Staph. aureus and GBS to the vaginal epithelium.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results support the probiotic potential of these Lactobacillus strains as anti-infective agents in the vagina and encourage further studies about their capacity to prevent and manage urogenital tract infections in females.

Probiotics to prevent urinary tract infections: the rationale and evidence

For over 30 years, urologists have recognized in females, that urinary pathogens almost always infect the host through ascension from the rectum, vagina to the urethra and bladder. Likewise, the Lactobacillus organisms that predominate in the vagina of healthy women, spread from the rectum and perineum and form a barrier in the vagina to bladder entry by uropathogens. The concept of artificially boosting the lactobacilli numbers through probiotic instillation has long been conceived, but only in recent years shown to be possible. Not all lactobacilli are effective, and to date clinical efficacy only exists for Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri B-54 and RC-14. These strains are only commercially available in Austria, and therefore for most urologists, while some probiotic organisms may reduce the recurrences of bladder cancer or oxaluria, no probiotics can be recommended widely to prevent UTI at present.

[Pathogenesis of urinary tract infections]

"Uropathogenic Escherichia coli" has been the term used to describe E. coli strains able to cause urinary tract infections. Their molecular characterization has demonstrated that these strains are the same as those causing infections in non-urinary extraintestinal locations, and it has been proposed thus the more inclusive term "extraintestinal pathogenic E. coli" or "ExPEC" to use. ExPEC derive mainly from the phylogenetic B2 group and harbor genes that codify virulence, such as fimH, papA, papG allele II, kspM II, hlyA, cnf1, fyuA, iutA, and traT, which are grouped in pathogenicity islands (PAIs). The vaginal ecosystem and especially Lactobacillus, as well as intestinal populations of E. coli, coitus and the physiological and anatomical conditions of the urinary tract also play a major role in the pathogenesis of urinary tract infections. The persistence of E. coli in bladder "biofilms" or "pods" or in the fecal reservoir could explain recurrent infections in young women.

Her choice: Dealing with lactobacilli, vaginitis, and antibiotics

Vulvovaginal candidiasis is a common problem for women, yet there are many gaps in knowledge about candida's pathogenesis, immunity, and its reputed association with antibiotic use. Women often self-diagnose and self-manage the problem, yet one of the most common folk remedies used, the probiotic lactobacillus, has no biologically plausible mechanism to explain any beneficial actions and no rigorous evidence to support its effectiveness. This paper explores these issues and summaries potential areas for further research.

Preventive and therapeutic administration of an indigenous Lactobacillus sp. strain against Proteus mirabilis ascending urinary tract infection in a mouse model

Probiotics are increasingly being considered as non-pharmaceutical and safe potential alternatives for the treatment and prevention of a variety of pathologies including urinary tract infections. These are the most common infections in medical practice and are frequently treated with antibiotics, which have generated an intense selective pressure over bacterial populations. Proteus mirabilis is a common cause of urinary tract infections in catheterised patients and people with abnormalities of the urinary tract. In this work we isolated, identified and characterised an indigenous Lactobacillus murinus strain (LbO2) from the vaginal tract of a female mouse. In vitro characterisation of LbO2 included acid and bile salts tolerance, growth in urine, adherence to uroepithelial cells and in vitro antimicrobial activity. The selected strain showed interesting properties, suitable for its use as a probiotic. The ability of LbO2 to prevent and even treat ascending P. mirabilis urinary tract infection was assessed using an experimental model in the mouse. Kidney and bladder P. mirabilis counts were significantly lower in mice preventively treated with the probiotic than in non-treated mice. When LbO2 was used for therapeutic treatment, bladder counts of treated mice were significantly lower although no significant differences were detected in P. mirabilis kidney colonisation of treated and non-treated animals. These results are encouraging and prompt further research related to probiotic strains and the basis of their effects for their use in human and animal health.

The probiotic approach: an alternative treatment option in urology

OBJECTIVE

The prophylactic and therapeutic use of probiotic microorganisms is a wide and still controversial field. The review paper is aimed to summarize recent findings on the health-benefiting effects of probiotics in urological diseases. The use of certain beneficial strains against urogenital infections, bladder cancer recurrence and renal stone formation is discussed.

METHODS

Literature search of PubMed documented publications and abstracts from meetings.

RESULTS

Various clinical trials have now been performed which substantiate the beneficial effects of the probiotic strains L. rhamnosus GR-1, L. fermentum RC-14 and L. crispatus CTV-05 against urogenital infections, such as urinary tract infections and bacterial vaginosis. The potential of L. casei Shirota to reduce the recurrence rate of bladder cancer is one of the most intriguing examples for the use of probiotics in medical practice. The use of O. formigenes in the prevention of calcium oxalate stone disease was only recently suggested and needs to be further investigated.

CONCLUSION

Clinical trials increasingly provide a profound scientific basis for the use of probiotics in medicinal practice including urology. Efforts to make probiotic products available which are validated according to the guidelines recommended by the WHO and FAO and produced according to Good Manufacturing Practice will contribute to the acceptance of probiotic therapy by both the physicians and the patients.

The effectiveness of live lactobacilli in combination with low dose oestriol (Gynoflor) to restore the vaginal flora after treatment of vaginal infections

OBJECTIVE

To evaluate the effectiveness of live lactobacilli in combination with low dose oestriol for restoration of the vaginal flora after anti-infective treatment.

DESIGN

The study was designed as a single centre, randomised, placebo-controlled, double-blind clinical trial.

SETTING

University Hospital.

SAMPLE

Three hundred and sixty women out of 1750 were randomised.

METHODS

Three hundred and sixty women with the complaints of vaginal infections (bacterial vaginosis, candidiasis, trichomoniasis or fluor vaginalis) were randomly assigned two to seven days after the end of the anti-infective therapy, to therapy with live lactobacilli in combination with low dose oestriol (study group, n= 240) or placebo (n= 120). The follow up visits occurred three to seven days and four to six weeks after the end of the restoration therapy.

MAIN OUTCOME MEASURES

The Normal Flora Index (NFI), which consists of numbers of lactobacilli, pathogenic microorganisms, leucocytes and vaginal pH, was used as the primary outcome of the study. Secondary outcomes included the total symptoms score, the degree of purity of the vaginal flora and the global assessment of the treatment by the investigator and the women.

RESULTS

During restoration therapy, the NFI increased significantly more in the study group than in the control group in both first and second control visits (P= 0.002 and P= 0.006, respectively). The degree of purity of the vaginal flora also increased significantly more in the study group compared with the control group (P < 0.0001 and P= 0.001, respectively). No serious adverse event was reported during restoration therapy.

CONCLUSION

Restoration of the vaginal flora can be significantly enhanced by the administration of live lactobacilli in combination with low dose oestriol.

Prophylaxis in Female Urinary Infections in Women

Recurrent urinary tract infections (UTI) in women cost billions of euro annually. E. Coli causes 70–95% of these infections and it has been observed, in vitro and in vivo, to have the capability to develop bacterial biofilms in the bladder: polysaccharide-rich matrix. At the present, the only way to overcome this mucopolysaccaride barrier is to administer long repeated cycles of chemotherapy. We submit prophylaxis to patients with recurrent UTI to sterilize urine for at least 6 consecutive months.

Materials and Methods

42 women with recurrent UTI have been selected according to: urine culture, vaginal swabs, and DNA-probe for Chlamydia, Gonococcus, Mycoplasma. After giving informed consent patients were assigned to treatment group A and B. For the first 10 days both groups received ciprofloxacin 500 mg bid, and then group A received ciprofloxacin 250 mg on alternate days and 1 cpr before every sexual intercourse. The group B received placebo in the same modality. Every sexual intercourse had to be safe. All the patients, after the initial screening, repeated an urine culture every 10 days for the first 6 months and every 20 days for the next 6 months. The statistical analysis was performed by chi-square test.

Results

44 patients finished the study. 23 pt of group A had sterile urine for the first 6 months of the study and 81% for the next 6 months; 1/23 had 2 episodes of symptomatic UTI. 71% of the 21 patients of group B had symptomatic bacteriuria 20 days after the first treatment (p<0.001). 16/21 patients had symptomatic UTI in the first 6 months of the study and the 90% in the 12 months of the study (p<0.001), in spite of every poussèe was treated with the same antibiotic scheme.

Conclusions

This kind of prophylaxis has few collateral effects, and it appears to be effective in the treatment of recurrent UTI in women.

Managing recurrent bacterial vaginosis

Bacterial vaginosis (BV) is the most frequently found condition of the female genital tract. It increases a woman's risk of acquiring HIV, is associated with increased complications in pregnancy, and may be involved in the pathogenesis of pelvic inflammatory disease. Yet there are many unanswered questions about its aetiology, making management of recurrent infection difficult and often idiosyncratic. This paper discusses the current knowledge and possible management of recurrent BV.

Novel approaches to prevention of urinary tract infections

Urinary tract infections are common clinical entities occurring in a variety of patient groups, most frequently caused by uropathogenic E. coli. Novel methods of preventing UTI currently under development are focused on three key approaches: (1) use of cranberry products, (2) restoration of the normal flora using Lactobacillus-based probiotic preparations, and (3) vaccine development. Although promising studies in each of these areas have been published or are ongoing, additional properly designed and powered clinical studies based on solid scientific evidence are needed.

Escherichia coli 83972 inhibits catheter adherence by a broad spectrum of uropathogens

OBJECTIVES

The presence of a nonpathogenic organism on the surface of a urinary catheter might impede catheter colonization by pathogens and thus prevent urinary tract infection. Previously, we reported that preinoculating urinary catheters with a nonpathogenic strain of Escherichia coli (83972) significantly impeded catheter colonization in vitro by gram-positive bacteria (Enterococcus faecalis). To explore this phenomenon further, we investigated in vitro whether E. coli 83972 could likewise inhibit catheter colonization by gram-negative and fungal uropathogens (Providencia stuartii, uropathogenic E. coli, and Candida albicans).

METHODS

For each of the three uropathogens tested, we examined three different incubation conditions: (a) E. coli plus uropathogen catheters were exposed to E. coli 83972 for 24 hours and then to a uropathogen for 30 minutes; (b) E. coli-alone catheters were incubated with E. coli for 24 hours and then in sterile broth for 30 minutes; and (c) uropathogen-alone catheters were incubated in sterile broth for 24 hours before the 30-minute incubation with the uropathogen. All catheters were subsequently incubated in sterile human urine for 24 hours. Catheters were then rinsed and sonicated to determine the numbers of adherent organisms per centimeter.

RESULTS

Pre-exposure of the catheter to E. coli 83972 in all cases significantly reduced the number of uropathogens colonizing the catheter surfaces.

CONCLUSIONS

E. coli 83972 significantly impedes catheter colonization by all tested bacterial and fungal pathogens. The broad applicability of this particular approach to bacterial interference in vitro invites further exploration in vivo.

Bacterial adherence to pharyngeal cells: in vitro studies with alpha-haemolytic streptococci and Haemophilus influenzae

We examined the adherence to pharyngeal cells of alpha-haemolytic Streptococci (AHS) and Haemophilus influenzae, representing normal flora and otitis media (OM) pathogens, respectively. The bacteria were incubated with epithelial cells brushed from the tonsils, adenoid or tubal orifice of children and adults. Adherence varied among the clinical isolates of AHS and H. influenzae. AHS adhered better to epithelial cells from a child compared with those sampled from an adult. The bacteria adhered better to cells from the tubal orifice compared with those sampled from the adenoid. The selective attachment of AHS to certain cells but not to others could not be correlated to apoptotic/necrotic cells versus viable cells. Incubation of epithelial cells with an isolate of AHS with good inhibitory activity against OM pathogens showed almost no adherence of bacteria to the epithelial cells after 12 and 24 h of incubation. If, however, an isolate of AHS with weak inhibitory activity was incubated with the cells, the bacteria that were attached to the epithelial cells from the beginning showed overgrowth in the broth and increasing attachment to the cells after 12 and 24 h. Thus the inhibitory activity of AHS could also affect the adherence of potential pathogens to the mucosal surfaces. The adherence pattern may at least partially explain the difference in susceptibility to OM between children and adults.

The potential role of probiotics in pediatric urology

PURPOSE

The application of select microbial strains to increase the host population of good bacteria is called probiotics, a term defined as "live microorganisms which when administered in adequate amounts confer a health benefit on the host." This review was done to evaluate the potential role that probiotic therapy may have in pediatric urology.

MATERIALS AND METHODS

Many children around the world die of diseases, such as gastrointestinal infection and HIV, while many have urinary tract infections that subsequently recur frequently in adulthood. Until recently the role of intestinal and urogenital (vaginal, urethral and perineal) microflora in health and disease has received scant attention. The data available in the literature on this topic were examined and a personal viewpoint is presented on how they may relate to urology.

RESULTS

There is mounting evidence that certain strains of lactobacilli and bifidobacteria have a major part in the maintenance and restoration of health in children and adults.

CONCLUSIONS

Implications for pediatric urology include a decreased risk of infection and stone disease as well as possible positive effects on preventing and managing inflammatory and some carcinogenic diseases.

Urinary tract infections cranberry juice, underwear, and probiotics in the 21st century

There is a substantial gap between the viewpoint of urologists and the rest of society regarding UTIs. Urologists spend little time and effort thinking about UTIs. In contrast, UTIs are a major issue for many women. There is substantial concern about "natural compounds" and probiotics that allow women to take charge of their health care. It is easy to understand this concern because UTIs are common, costly, and cause considerable morbidity.

Infection in the chronically critically ill: unique risk profile in a newly defined population

Although CCI is defined as prolonged ventilatory failure with tracheotomy stemming from preceding critical illness, the contention that multisystem debilities impact on most CCI patients' care and recovery is a central thesis of this volume. Perhaps reflecting the combined debilities inherent in CCI, infectious complications take their toll in morbidity, mortality, and persistent ventilatory insufficiency. Enhanced susceptibility to infection results from a potent admixture of barrier breakdown, exposure to virulent and resistant nosocomial pathogens, and postulated "immune exhaustion" that stems from the combined impact of comorbidities and the sequellae of critical illness. Strategies to improve outcome in CCI-related infection include standard measures of support especially nutrition, reducing environmental inoculum through pulmonary hygiene measures, skin care, and limiting barrier breaches, and appropriate antimicrobials directed at likely pathogens. Future stratification of patient risk on the basis of immune phenotype or genotype and potential immunomodulatory prophylaxis may be around the corner, as new prospects in the pharmaceutical armamentarium are presently undergoing testing.

Characterization of a cryptic plasmid from Lactobacillus fermentum KC5b and its use for constructing a stable Lactobacillus cloning vector

Lactobacillus fermentum KC5b, a strain originally isolated from the human vagina, contains a cryptic plasmid pKC5b. The sequence and genetic organization of the 4392-bp plasmid were determined. It contains two convergently oriented replicons, which are homologous to each other and to the stable replicon of the Enterococcus faecium plasmid pMBB1. The two replicons of pKC5b were used either individually or together to construct Lactobacillus-Escherichia coli shuttle plasmids. Only the plasmid pSP1 that carried both replicons transformed lactobacilli, suggesting a complementary function between the two replicons. Since the replicons had a high homology to those of other plasmids that replicate via a theta-like mechanism and no detectable single-stranded intermediates were found for the plasmid, it is possible that pKC5b may replicate via a theta-like mechanism. The new shuttle plasmid pSP1 has been transformed and stably maintained in several Lactobacillus strains. As an initial application, pSP1 was used to clone the S-layer protein gene (slpA) of Lactobacillus acidophilus ATCC 4356 into a heterologous vaginal Lactobacillus strain and achieved surface-bound expression of the protein.

[Role of Lactobacillus as protector against vaginal candidiasis]

BACKGROUND

To evaluate the possible protector role of Lactobacillus against vaginal candidiasis.

PATIENTS AND METHOD

In vitro studies performed to assess the capacity of 15 Lactobacillus strains to block the adhesion of two Candida albicans and one C. glabrata strain to vaginal epithelial cells and to inhibit the growth of these yeasts. Moreover, the presence of Lactobacillus was analyzed in 115 vaginal exudates from women with vaginal candidiasis.

RESULTS

Only 8 of the 15 lactobacilli studied significantly blocked the adhesion of C. albicans Y18 to vaginal cells. Lactobacilli from group III showed the greatest blocking capacity (62.9%), followed by group II (50.6%) and group I (26.1%). In solid assays, none of the 15 Lactobacillus strains studied was able to inhibit growth of the 3 yeasts. However, in liquid assays some lactobacilli evidenced a certain degree of inhibitory power against C. albicans Y17 (35.7%, 41.7% and 38.1% of light transmittance for Lactobacillus groups I, II and III, respectively). Lactobacillus was detected in 89.6% of women with vaginal candidiasis (by microscopy in 87.8% and by culture in 72.2%).

CONCLUSIONS

These results lead us to suggest that probably Lactobacillus provides protection against vaginal candidiasis.