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Radwan IT, El-Sherbiny IM, Metwally NH. Synergistic and potential antifungal properties of tailored, one pot multicomponent monoterpenes co-delivered with fluconazole encapsulated nanostructure lipid carrier. Sci Rep 2024; 14:14382. [PMID: 38909063 PMCID: PMC11193721 DOI: 10.1038/s41598-024-63149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 05/24/2024] [Indexed: 06/24/2024] Open
Abstract
Frequent and variant infections are caused by the virtue of opportunistic fungi pathogens. Candidiasis, aspergillosis, and mucormycosis are pathogenic microorganisms that give rise to vast fungal diseases that alternate between moderate to fatal in severity. The use of fluconazole as an antifungal drug was limited due to the acquired resistance in some types of Candida and other fungal species. This study aims to consolidate fluconazole's biological effectiveness against several pathogenic fungi. Six active monoterpenes (MTs) of carvacrol, linalool, geraniol, α-terpinene, citronellal, and nerolidol were selected and encapsulated in nanostructure lipid carrier (NLC) with (NLC-Flu-MTs) and/without (NLC-MTs) fluconazole in one nanoformulation to determine if they will act synergistically or not? The synthesized nanoformulation NLC-Flu-MTs and NLC-MTs exhibited very good particle size of 144.5 nm and 138.6 nm for size and zeta potential values of (- 23.5 mV) and (- 20.3 mV), respectively. Transmission electron microscope investigation confirmed that the synthesized NLCs have regular and spherical shape. The abundance and concentration of the six released monoterpenes were determined, as a novel approach, using GC-MS with very good results and validity. In-vitro antifungal screening was done before and after nano co-delivery against seven pathogenic, and aggressive fungi of Candida tropicalis, Candida krusei, Candida glabrata, Geotrichum Candidum, Candidaalbicans, Aspergillus Niger, and mucor circinelloides. Inhibition Zone diameter (IZD) and the minimum inhibitory concentration (MIC) were measured. Nanoformulations NLC-Flu-MTs and NLC-MTs manifested potential and unique biological susceptibility against all the tested microorganisms with reduced (MIC) values, especially against Candida Tropicalis (MIC = 0.97 µg/ml) which represents 16-fold of the value shown by NLC-MTs (MIC = 15.6 µg/ml) and 64-fold of fluconazole free before nanoformulation (MIC = 62.5 µg/ml). The efficiency of nanomaterials, particularly NLC-Flu-MTs, has become evident in the diminishing value of MIC which affirmed the synergism between fluconazole and the other six monoterpenes.
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Affiliation(s)
- Ibrahim Taha Radwan
- Supplementary General Sciences Department, Faculty of Oral and Dental Medicine, Future University in Egypt, Cairo, 11835, Egypt
| | - Ibrahim M El-Sherbiny
- Center for Materials Science (CMS), Zewail City of Science and Technology, 6th of October, Giza, 12578, Egypt
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2
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Sobel JD. Treatment of vaginitis caused by non-albicans Candida species. Expert Rev Anti Infect Ther 2024; 22:289-296. [PMID: 38720183 DOI: 10.1080/14787210.2024.2347953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/23/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION In the face of increased frequency of non-albicans Candida vulvovaginitis (VVC) reported worldwide, there is a paucity of effective oral and topical antifungal drugs available. Drug selection is further handicapped by an absence of data of clinical efficacy of available antifungal drugs for these infections. AREAS COVERED In this review, attention is directed at the cause of drug shortage as well as increased frequency of non-albicans Candida (NAC) vulvovaginitis. There is widespread recognition of reduced in vitro azole drug susceptibility in NAC species. Moreover, antifungal susceptibility tests have not been standardized or validated for NAC isolates, hence clinicians rely on an element of empiricism especially given the absence of randomized controlled comparative studies targeting NAC species. Clinical spectrum of NAC species isolates is highly variable with ongoing difficulty in determining a causal role in symptomatic patients. EXPERT OPINION We have entered the era of demand for Candida species-specific therapy and although consensus treatment guidelines are emerging, new antifungal agents that target these multiple-azole resistant or relatively resistant vaginal NAC species are urgently needed.
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Affiliation(s)
- Jack D Sobel
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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3
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Fernandes Â, Azevedo N, Valente A, Dias M, Gomes A, Nogueira-Silva C, Henriques M, Silva S, Gonçalves B. Vulvovaginal candidiasis and asymptomatic vaginal colonization in Portugal: epidemiology, risk factors and antifungal pattern. Med Mycol 2022; 60:6575555. [PMID: 35482711 DOI: 10.1093/mmy/myac029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Vulvovaginal candidiasis (VVC) has been identified as a global issue of concern due to its clinical, social and economic implications. The emerging relevance of VVC makes it crucial to increase the knowledge on its epidemiological and etiological features in order to improve its prevention and treatment. Thus, this study aimed to reveal the incidence, microbiology, antifungal pattern and risk factors of VVC in Portugal. For that, high vaginal samples were collected from 470 symptomatic and asymptomatic participants; Candida spp. were identified with molecular techniques and their antifungal susceptibility was analysed with E-tests. The results revealed an incidence of VVC among women with vulvovaginitis of 74.4%. Furthermore, 63.7% of asymptomatic women were colonized with Candida spp. Importantly, women with history of recurrent vaginal infections, those who use over-the-counter antifungals, oral contraceptive pills and non-cotton underwear were found to be at significantly higher risk of developing VVC. Candida albicans was the most common species (59%), followed by Candida glabrata (27%), in a total of 8 distinct species, with similar distribution among colonized and infected participants. Of note, various isolates, especially of the most common species, showed low susceptibility towards fluconazole. In contrast, only few isolates showed low susceptibility towards caspofungin. Overall, this study suggests that the identification of species causing VVC and their antifungal susceptibility are urgently needed in clinical practice in order to improve the decision for the most adequate treatment. It also suggests that avoiding certain risk behaviours may prevent the development of VVC.
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Affiliation(s)
- Ângela Fernandes
- Family Health Unit (USF) +Carandá, Health Centre Group (ACeS) Cávado I, Braga, Portugal
| | - Nuno Azevedo
- Biofilm Research Laboratory Rosário Oliveira (LIBRO), Centre of Biological Engineering (CEB), University of Minho, 4710-057 Braga, Portugal.,LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
| | - Andreia Valente
- Biofilm Research Laboratory Rosário Oliveira (LIBRO), Centre of Biological Engineering (CEB), University of Minho, 4710-057 Braga, Portugal.,LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
| | - Marisol Dias
- Biofilm Research Laboratory Rosário Oliveira (LIBRO), Centre of Biological Engineering (CEB), University of Minho, 4710-057 Braga, Portugal.,LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
| | - Ana Gomes
- Family Health Unit (USF) +Carandá, Health Centre Group (ACeS) Cávado I, Braga, Portugal
| | - Cristina Nogueira-Silva
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; Life and Health Sciences Research Institute/3B's - PT Government Associate Laboratory, Braga/ Guimarães, Portugal; Department of Obstetrics and Gynaecology, Hospital de Braga, Braga, Portugal
| | - Mariana Henriques
- Biofilm Research Laboratory Rosário Oliveira (LIBRO), Centre of Biological Engineering (CEB), University of Minho, 4710-057 Braga, Portugal.,LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
| | - Sónia Silva
- Biofilm Research Laboratory Rosário Oliveira (LIBRO), Centre of Biological Engineering (CEB), University of Minho, 4710-057 Braga, Portugal.,National Institute for Agrarian and Veterinary Research, Vairão, 4485-655, Vila do Conde, Portugal
| | - Bruna Gonçalves
- Biofilm Research Laboratory Rosário Oliveira (LIBRO), Centre of Biological Engineering (CEB), University of Minho, 4710-057 Braga, Portugal.,LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
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Saracino IM, Foschi C, Pavoni M, Spigarelli R, Valerii MC, Spisni E. Antifungal Activity of Natural Compounds vs. Candida spp.: A Mixture of Cinnamaldehyde and Eugenol Shows Promising In Vitro Results. Antibiotics (Basel) 2022; 11:antibiotics11010073. [PMID: 35052950 PMCID: PMC8773119 DOI: 10.3390/antibiotics11010073] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 01/09/2023] Open
Abstract
Candida spp. are commensal organisms of the skin, mucous membranes, gastrointestinal tract, blood, and vagina of animals and humans. In recent decades, the incidence of human fungal infections has increased, with Candida spp. (mainly C. albicans) infections being the most frequent, and the treatment of fungal infections is still a clinical challenge. Colonization of the human gastrointestinal tract by Candida spp. is significant because infections (e.g., candidemia and vulvovaginal candidiasis) frequently arise from commensal microorganisms. The aim of this study was to test in vitro the antifungal activity and the eventual synergistic effect of five pure components of essential oils: cinnamaldehyde, α-pinene, limonene, eucalyptol, and eugenol. These compounds were tested on 18 Candida strains (15 C. albicans, 2 C. glabrata, and 1 C. lusitaniae) derived from a culture collection of vaginal clinical strains. Methods: Fungistatic activity was evaluated using the disk diffusion method. For fungicidal activity, microdilution and time–kill curve protocols were set up. The checkerboard method was chosen to evaluate a possible synergistic effect of these compounds when mixed. Results: Cinnamaldehyde and eugenol gave the best results, inhibiting all the Candida strains and showing a highly additive effect (FICI 0.625). The cinnamaldehyde inhibition zone (IZ), MIC, and MFC means were 69 mm, 50.05 mg/L, and 109.26 mg/L respectively. Cinnamaldehyde led to the total loss of viable Candida cells within 4 h. Eugenol IZ, MIC, and MFC means were 35.2 mm, 455.42 mg/L, and 690.09 mg/L, respectively. Eugenol led to the total loss of viable fungal cells within 1 h. Treatment with α-pinene inhibited 88.9% of Candida strains, with an IZ mean of 21.2 mm, a MIC mean of 195.41 mg/L, and a MFC mean of 251.27 mg/L; this compound led to the total loss of viable fungal cells only after 24 h. Limonene inhibited only 33.3% of the tested strains and eucalyptol did not produce an inhibition halo, so these compounds were not tested further. Conclusions: These characteristics, together with the well-known safety of cinnamaldehyde and eugenol for human use, make these two natural compounds the perfect candidates for the treatment of candidiasis. This was a pilot study, the purpose of which was to evaluate the best composition of a mixture to be used against intestinal and vulvovaginal candidiasis; in vivo studies are needed to confirm these very encouraging results.
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Affiliation(s)
- Ilaria Maria Saracino
- Microbiology Unit, Department of Specialized, Experimental and Diagnostic Medicine, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (C.F.); (M.P.)
- Correspondence:
| | - Claudio Foschi
- Microbiology Unit, Department of Specialized, Experimental and Diagnostic Medicine, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (C.F.); (M.P.)
| | - Matteo Pavoni
- Microbiology Unit, Department of Specialized, Experimental and Diagnostic Medicine, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (C.F.); (M.P.)
| | - Renato Spigarelli
- Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (R.S.); (M.C.V.); (E.S.)
| | - Maria Chiara Valerii
- Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (R.S.); (M.C.V.); (E.S.)
| | - Enzo Spisni
- Department of Biological, Geological and Environmental Sciences, University of Bologna, 40126 Bologna, Italy; (R.S.); (M.C.V.); (E.S.)
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5
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Seeniammal S, Selvakumar M, Nirmaladevi P. Clinicomycological study of vulvovaginal candidiasis. Indian J Sex Transm Dis AIDS 2021; 42:57-61. [PMID: 34765939 PMCID: PMC8579598 DOI: 10.4103/ijstd.ijstd_49_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/11/2018] [Accepted: 12/30/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Vaginal candidiasis is one of the most common vaginal infections in women of reproductive age group caused by Candida species of fungi, a normal inhabitant of vagina. Aims: The aim is to study the culture characteristics, species prevalence, and drug sensitivity of vulvovaginal candidiasis (VVC) among females with genital pruritus and discharge per vaginum who are proved to have Candida infection by a vaginal smear study. Materials and Methods: A prospective study was done on female patients aged 18 years attending the Sexually Transmitted Diseases Clinic of the Department of Dermato-Venereo-Leprology (DVL), Tirunelveli Medical College, with complaints of genital pruritus and vaginal discharge over a period of 1½ years from 2013 to 2015. After clinical examination, vaginal discharge was smeared for wet mount, potassium hydroxide mount, and Gram stain. Those with pseudohyphae were chosen for culture, speciation, and drug sensitivity. Results: The most common age group affected was 18–35 years. The most common predisposing factor was HIV infection-induced immunosuppression (48.7%), followed by antibiotic usage and diabetes mellitus. Clinical presentation of VVC was similar in HIV-positive and HIV-negative patients. Recurrent VVC makes up 12% of total cases with most common species being Candida albicans whereas Candida glabrata among the non-C. albicans. Drug sensitivity pattern of C. albicans showed the highest sensitivity to nystatin 85.7%, followed by triazoles (75%–85%) with ketoconazole being more resistant (40%–60%), and was similar in C. albicans and non-C. albicans. Limitations: Exclusion of unmarried and pregnant women and lack of follow-up were limitations in our study. Conclusions: According to our study, elimination of predisposing factors, speciation of fungus, and treatment based on drug sensitivity pattern will reduce the incidence of VVC.
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Affiliation(s)
- S Seeniammal
- Department of Dermato-Venereo-Leprology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India
| | - M Selvakumar
- Department of Dermato-Venereo-Leprology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India
| | - P Nirmaladevi
- Department of Dermato-Venereo-Leprology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India
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Anh DN, Hung DN, Tien TV, Dinh VN, Son VT, Luong NV, Van NT, Quynh NTN, Van Tuan N, Tuan LQ, Bac ND, Luc NK, Anh LT, Trung DM. Prevalence, species distribution and antifungal susceptibility of Candida albicans causing vaginal discharge among symptomatic non-pregnant women of reproductive age at a tertiary care hospital, Vietnam. BMC Infect Dis 2021; 21:523. [PMID: 34082699 PMCID: PMC8176683 DOI: 10.1186/s12879-021-06192-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022] Open
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06192-7.
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Affiliation(s)
- Do Ngoc Anh
- Department of Medical Parasitology, Vietnam Military Medical University, Hanoi, Vietnam. .,Laboratory of Parasitology and Medical Mycology, 103 Military Hospital, Hanoi, Vietnam.
| | - Dao Nguyen Hung
- 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Tran Viet Tien
- 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Vu Nhat Dinh
- 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Vu Tung Son
- Department of Epidemiology, Vietnam Military Medical University, Hanoi, Vietnam
| | | | - Nguyen Thi Van
- Laboratory of Parasitology and Medical Mycology, 103 Military Hospital, Hanoi, Vietnam
| | - Nguyen Thi Nhu Quynh
- Department of Medical Parasitology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Van Tuan
- Department of Medical Parasitology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Le Quoc Tuan
- Department of Medical Parasitology, Vietnam Military Medical University, Hanoi, Vietnam.,Laboratory of Parasitology and Medical Mycology, 103 Military Hospital, Hanoi, Vietnam
| | - Nguyen Duy Bac
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Khac Luc
- Department of Medical Parasitology, Vietnam Military Medical University, Hanoi, Vietnam.,Laboratory of Parasitology and Medical Mycology, 103 Military Hospital, Hanoi, Vietnam
| | - Le Tran Anh
- Department of Medical Parasitology, Vietnam Military Medical University, Hanoi, Vietnam.,Laboratory of Parasitology and Medical Mycology, 103 Military Hospital, Hanoi, Vietnam
| | - Do Minh Trung
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi, Vietnam.
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Development of health education model (vaginal hygiene) in vaginal candidiasis prevention in pregnant women. ENFERMERIA CLINICA 2021. [PMID: 32545037 DOI: 10.1016/j.enfcli.2019.10.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The danger of VVC for pregnant women are: premature birth, premature rupture of the membranes, low birth weight. In America, 75% of women during reproduction have experienced VVC. Between 40-50% have recurrent infections and 5-8% have chronic candida infections. The purpose of this study is to obtain more comprehensive information regarding the development of models of health education (vaginal hygiene) in the prevention of vaginal candidiasis in pregnant women. METHODS The design used is Literature review. Articles were collected through Cochrane, Science Direct, Pubmed, Elseiver, Proquest (Links are from the library of unhas.ac.id) Pubmed, WHO, CDC, Google Scholar. The keywords used were VVC, prevention, audio-visual, modules, pregnant women. After collecting the article then article synthesis was made. RESULTS Based on the articles collected, the result shows the lack of development of the health education model, namely the provision of modules and audio-visuals in the prevention of early VVC in pregnant women. Thus, through the provision of health education in the form of audio-visual and modules needed in the prevention of vaginal discharge of VVC in pregnant women. CONCLUSION The development of models of health education (vaginal hygiene) can effectively prevent vaginal candidiasis by providing audio-visual and modules to pregnant women.
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Sasani E, Rafat Z, Ashrafi K, Salimi Y, Zandi M, Soltani S, Hashemi F, Hashemi SJ. Vulvovaginal candidiasis in Iran: A systematic review and meta-analysis on the epidemiology, clinical manifestations, demographic characteristics, risk factors, etiologic agents and laboratory diagnosis. Microb Pathog 2021; 154:104802. [PMID: 33741400 DOI: 10.1016/j.micpath.2021.104802] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/08/2021] [Indexed: 11/24/2022]
Abstract
Vulvovaginal candidiasis is a global issue of concern due to its association with economic costs, sexually transmitted infections, and ascending genital tract diseases. This infection affects 75% of women on at least one occasion over a lifetime. The present systematic review and meta-analysis is the first to determine the prevalence of vulvovaginal candidiasis in Iranian women. We searched national (SID, IranDoc, Iranmedex, and Magiran) and international (PubMed, Scopus, Google Scholar, and web of science) databases for studies published between May 2000 until May 2020 reporting the epidemiologic features of vulvovaginal candidiasis in Iranian women. Inclusion and exclusion criteria were defined to select eligible studies. Data were extracted and presented according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The results of the meta-analysis were visualized as a forest plot representing the prevalence estimates of each study. Heterogeneity was also analyzed using the I2, and Chi2 statistics. The literature search revealed 1929 studies, of which 39 studies met the eligibility criteria, consisting of 10536 women with vulvovaginal symptoms from 24 different cities covering all parts of Iran. The city with the highest number of studies was Tehran (5/39). The overall prevalence of vulvovaginal candidiasis among Iranian women was 47% (95% CI, 0/38-0/55%) and Candida albicans was the most prevalent etiologic agent. The use of oral contraceptive pills (OCPs) was the predominant risk factor for developing vulvovaginal candidiasis and vaginal cheese-like discharges were the predominant clinical manifestation in Iranian women suffering from vulvovaginal candidiasis. The 25-34-year-old age group has the highest prevalence. A high level of I2 (I2 = 98.7%, P = 0.000) and Chi2 (Chi2 = 2993.57, P < 0.001) was obtained among studies, which provides evidence of notable heterogeneity between studies. The present meta-analysis revealed a high prevalence of vulvovaginal candidiasis in Iranian women. Given that this infection is associated with the enhanced susceptibility to sexually transmitted diseases (HIV, chlamydia, genital herpes, genital warts, gonorrhea, hepatitis, syphilis, and trichomoniasis) and also is related to the increased probability of preterm birth, congenital cutaneous candidiasis, preterm labor, and infertility, taking preventive measures such as awareness of patients as well as monitoring and controlling of the syndrome are essential.
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Affiliation(s)
- Elahe Sasani
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zahra Rafat
- Department. of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Keyhan Ashrafi
- Department. of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Yahya Salimi
- Social Developing & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Milad Zandi
- Department of Medical Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saber Soltani
- Department of Medical Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshid Hashemi
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Molecular Characterization and Antifungal Susceptibility of Candida Species Isolated From Vulvovaginitis in Jahrom City, South of Iran. Jundishapur J Microbiol 2020. [DOI: 10.5812/jjm.106825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Vulvovaginal candidiasis (VVC) is a significant health issue due to Candida spp. Although Candida albicans is considered a major causative agent of vaginal candidiasis, non-albicans species have increased during previous decades. Objectives: This research aimed at molecular identification and assessing antifungal susceptibility of VVC isolated Candida spp. Methods: A professional physician examined two hundred and ninety-five suspected females with vaginitis. The specimens were collected by sterile cotton swabs. Swabs were inoculated on Sabouraud dextrose agar plates and then incubated for 48 - 72 hours at 35°C. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect all Candida species. Broth microdilution, according to the M27-A3 and M27-S4 CLSI documents, were employed for determining the antifungal susceptibility tests of caspofungin (CAS), voriconazole (VRC), itraconazole (ITC), fluconazole (FLU), clotrimazole (CLO), ketoconazole (KTO), amphotericin B (AMB), and nystatin (NYS). Results: A total of 295 females suspected of vulvovaginal candidiasis were examined. The culture results were positive in 50.5% (149 of 295) of specimens. According to molecular identification techniques, C. albicans 133/149 (89.2%), C. glabrata 8/149 (5.4%), and C. kefyr 2/149 (1.4%) were the main species. A mixed infection of C. albicans and C. glabrata 6/149 (4 %) was detected. The geometric mean values to all Candida strains were in increasing order as the following: CAS, 0.075 µg/mL; VRC, 0.091 µg/mL; ITC, 0.15 µg/mL; AMB, 0.22 µg/mL; CLO, 0.23 µg/mL; KTO, 0.28 µg/mL; NYS, 0.88 µg/mL; FLU, 1.48 µg/mL. Further, the MIC ranges of all Candida isolates to the tested antifungal agents were in increasing order as follows: CAS: 0.031 - 0.25 µg/mL, KTO and ITC: 0.031 - 2 µg/mL, VRC: 0.031 - 4 µg/mL, CLO and AMB: 0.031 - 8 µg/mL, NYS: 0.06 - 4 µg/mL, and FLU: 0.12 - 128 µg/mL. Conclusions: We reported 1 (7.2 %) C. glabrata isolate resistance to FLU and 2 (14.3%) C. glabrata isolates susceptible-dose-dependent (SDD) to CAS. We also reported 6 (4.5%), 5 (3.8%), and 2 (1.5%) C. albicans resistance to ITC, FLU, and AMB, respectively, but 100% C. albicans susceptible to CAS and VRC.
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Rodríguez-Cerdeira C, Martínez-Herrera E, Carnero-Gregorio M, López-Barcenas A, Fabbrocini G, Fida M, El-Samahy M, González-Cespón JL. Pathogenesis and Clinical Relevance of Candida Biofilms in Vulvovaginal Candidiasis. Front Microbiol 2020; 11:544480. [PMID: 33262741 PMCID: PMC7686049 DOI: 10.3389/fmicb.2020.544480] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/23/2020] [Indexed: 12/30/2022] Open
Abstract
The ability of Candida spp. to form biofilms is crucial for its pathogenicity, and thus, it should be considered an important virulence factor in vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC). Its ability to generate biofilms is multifactorial and is generally believed to depend on the site of infection, species and strain involved, and the microenvironment in which the infection develops. Therefore, both cell surface proteins, such as Hwp1, Als1, and Als2, and the cell wall-related protein, Sun41, play a critical role in the adhesion and virulence of the biofilm. Immunological and pharmacological approaches have identified the NLRP3 inflammasome as a crucial molecular factor contributing to host immunopathology. In this context, we have earlier shown that Candida albicans associated with hyphae-secreted aspartyl proteinases (specifically SAP4-6) contribute to the immunopathology of the disease. Transcriptome profiling has revealed that non-coding transcripts regulate protein synthesis post-transcriptionally, which is important for the growth of Candida spp. Other studies have employed RNA sequencing to identify differences in the 1,245 Candida genes involved in surface and invasive cellular metabolism regulation. In vitro systems allow the simultaneous processing of a large number of samples, making them an ideal screening technique for estimating various physicochemical parameters, testing the activity of antimicrobial agents, and analyzing genes involved in biofilm formation and regulation (in situ) in specific strains. Murine VVC models are used to study C. albicans infection, especially in trials of novel treatments and to understand the cause(s) for resistance to conventional therapeutics. This review on the clinical relevance of Candida biofilms in VVC focuses on important advances in its genomics, transcriptomics, and proteomics. Moreover, recent experiments on the influence of biofilm formation on VVC or RVVC pathogenesis in laboratory animals have been discussed. A clear elucidation of one of the pathogenesis mechanisms employed by Candida biofilms in vulvovaginal candidiasis and its applications in clinical practice represents the most significant contribution of this manuscript.
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Affiliation(s)
- Carmen Rodríguez-Cerdeira
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Health Research Institute, SERGAS-UVIGO, Vigo, Spain.,Department of Dermatology, Hospital do Meixoeiro and University of Vigo, Vigo, Spain.,European Women's Dermatologic and Venereologic Society, Tui, Spain.,Psychodermatology Task Force of the Ibero-Latin American College of Dermatology (CILAD), Buenos Aires, Argentina
| | - Erick Martínez-Herrera
- Psychodermatology Task Force of the Ibero-Latin American College of Dermatology (CILAD), Buenos Aires, Argentina.,Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Mexico
| | - Miguel Carnero-Gregorio
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Health Research Institute, SERGAS-UVIGO, Vigo, Spain.,Department of Molecular Diagnosis (Array & NGS Division), Institute of Cellular and Molecular Studies, Lugo, Spain
| | - Adriana López-Barcenas
- European Women's Dermatologic and Venereologic Society, Tui, Spain.,Psychodermatology Task Force of the Ibero-Latin American College of Dermatology (CILAD), Buenos Aires, Argentina.,Section of Mycology, Department of Dermatology, Manuel Gea González hospital, Mexico City, Mexico
| | - Gabriella Fabbrocini
- European Women's Dermatologic and Venereologic Society, Tui, Spain.,Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Monika Fida
- European Women's Dermatologic and Venereologic Society, Tui, Spain.,Department of Dermatology, University of Medicine, Tirana, Tirana, Albania
| | - May El-Samahy
- European Women's Dermatologic and Venereologic Society, Tui, Spain.,Department of Dermatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - José Luís González-Cespón
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Health Research Institute, SERGAS-UVIGO, Vigo, Spain
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11
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Farhan MA, Moharram AM, Salah T, Shaaban OM. Types of yeasts that cause vulvovaginal candidiasis in chronic users of corticosteroids. Med Mycol 2020; 57:681-687. [PMID: 30544194 DOI: 10.1093/mmy/myy117] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/19/2018] [Accepted: 11/05/2018] [Indexed: 12/22/2022] Open
Abstract
The current study aims to compare between the types of yeasts that cause vulvovaginal candidiasis (VVC) in women using corticosteroid medication compared to nonusers and estimate their sensitivity to available commercial antifungal agents. In a descriptive analytical cross-sectional study, we recruited 41 chronic corticosteroid users diagnosed clinically to have VVC from Women's Health Hospital, Assiut University, Egypt. Forty-seven age-matched women with VVC were recruited as a control group. Full history and clinical examination were performed. Vaginal sterile swab obtained from the vagina of each participant was subjected to direct Gram-stained smear examination as well as a culture on Sabouraud's glucose agar and HiCrome Candida agar. Further identification of the isolates was done using traditional methods. Fifty out of 88 samples (56.8%) were positive in culture including 25 samples (61%) from corticosteroid users group and 25 (53.2%) from noncorticosteroid users with no statistically significant difference (P = .302). The chronic corticosteroid users had more incidence of recurrent VVC as compared to nonusers (65.9% vs 40.4%, respectively) (P = .015). There was a significantly higher rate of non-Candida albicans (NCA) infections in corticosteroid users compared with nonusers (48% vs 20%, respectively) (P = .036). A higher significant difference in resistance of the isolates against clotrimazole (P = .003) and ketoconazole (P = .017) was demonstrated in corticosteroid users compared to nonusers. Thus, chronic corticosteroid use causes frequent attacks of VVC and increases the frequency of infection by NCA strains. Also, it increases resistance to common antifungal agents especially azole group.
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Affiliation(s)
- Mohammed A Farhan
- Department of Medical Microbiology, Faculty of Science, Ibb University, Ibb, Yemen.,Assiut University Mycological Centre (AUMC), Assiut University, Assiut, Egypt
| | - Ahmed M Moharram
- Assiut University Mycological Centre (AUMC), Assiut University, Assiut, Egypt.,Department of Botany and Microbiology, Faculty of Science, Assiut University, Assiut, Egypt
| | - Tareq Salah
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Omar M Shaaban
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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12
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Hosseini SS, Joshaghani H, Shokohi T, Ahmadi A, Mehrbakhsh Z. Antifungal Activity of ZnO Nanoparticles and Nystatin and Downregulation of SAP1-3 Genes Expression in Fluconazole-Resistant Candida albicans Isolates from Vulvovaginal Candidiasis. Infect Drug Resist 2020; 13:385-394. [PMID: 32104010 PMCID: PMC7025901 DOI: 10.2147/idr.s226154] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/17/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose Antifungal resistance and virulence properties of Candida albicans (C. albicans) are growing health problems worldwide. The present study aims to investigate the effect of Zinc Oxide (ZnO) nanoparticles and Nystatin on SAP1-3 genes expression in C. albicans isolates of females with Vulvovaginal Candidiasis (VVC) isolated from Sayad Shirazi Obstetrics and Gynecology Hospital in Northeastern Iran during 2017–2018. Patients and Methods In this descriptive-analytic study, vaginal samples were collected from 280 VVC women. 196 (70%) of C. albicans isolates were identified by phenotypic and ITS genotypic methods. Susceptibility to Fluconazole C. albicans isolates was determined by the disk diffusion method. Detection of ERG11 gene was done by RT-PCR technique. Results It was revealed that PCR amplified the ERG11 gene in all of the Fluconazole-resistant isolates. Real-time PCR was used to survey the effects of 3±1.7µg/mL concentrations of ZnO nanoparticles and Nystatin on expression of SAP1-3 genes before and after treatment. 186 (95%) susceptible C. albicans and 10 (5%) Fluconazole-resistant C. albicans isolates from VVC were exposed to sub-minimum inhibitory concentrations (Sub-MIC) of ZnO-np (range=0.02–12 μg/mL). Sub-MIC concentration was used for each strain, which reduced the expression of SAP1-3 genes to 1.8 MIC in the vaginal swabs. The observed reduction in gene expression was significant for both ZnO nanoparticles and Nystatin (P=0.01 and P=0.07, respectively). Conclusion ZnO as antifungal agent can well reduce the growth and gene expression of SAP1-3 in the pathogenesis of VVC.
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Affiliation(s)
- Seyededeh Sedigheh Hosseini
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran.,Department of Laboratory Sciences, Faculty of Paramedicine, Gorgan University of Medical Sciences, Gorgan, Iran
| | - Hamidreza Joshaghani
- Department of Clinical Biochemistry, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Tahereh Shokohi
- Department of Medical Mycology and Parasitology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Ahmadi
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zahra Mehrbakhsh
- Department of Biostatistics and Epidemiology, School of Health, Golestan University of Medical Sciences, Gorgan, Iran
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13
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Yeast Engineering for New Antifungal Compounds: A Contextualized Overview. Fungal Biol 2020. [DOI: 10.1007/978-3-030-41870-0_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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De Gregorio PR, Silva JA, Marchesi A, Nader-Macías MEF. Anti-Candida activity of beneficial vaginal lactobacilli in in vitro assays and in a murine experimental model. FEMS Yeast Res 2019; 19:5300136. [PMID: 30689833 DOI: 10.1093/femsyr/foz008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/23/2019] [Indexed: 01/04/2023] Open
Abstract
Vulvovaginal candidiasis (VVC) is one of the most frequent infections affecting women worldwide. Healthy vaginal microbiota is dominated by lactobacilli, which form a strong defense line against pathogens. In this work, in vitro antimicrobial properties of thirty vaginal Lactobacillus strains were evaluated against eleven Candida vaginal clinical isolates, employing three different methods. Also, the effect of intravaginal (i.va.) administrations (preventive, therapeutic and preventive-therapeutic) of L. reuteri CRL1324 or L. rhamnosus CRL1332 strains against the i.va. challenge with Candida albicans C2 (C.a.) was evaluated in a murine experimental model. From the results of agar overlay and liquid medium assays the selected lactobacilli strains have shown to inhibit the growth of at least one Candida strain. The inhibition was mainly due to the effect of organic acids. Anti-Candida activity was not evidenced in the agar plate diffusion method. In the experimental murine model, only preventive-therapeutic administration of both lactobacilli was able to significantly reduce viable C.a. numbers recovered in vaginal washes and the leukocyte influx induced by the fungi. In conclusion, lactobacilli exhibited in vitro and in vivo antimicrobial effects on Candida, suggesting that they could be promising candidates for protection against VVC.
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Affiliation(s)
- Priscilla Romina De Gregorio
- Centro de Referencia para Lactobacilos (CERELA)-CONICET, Chacabuco 145, 4000. San Miguel de Tucumán, Tucumán, Argentina
| | - Jessica Alejandra Silva
- Centro de Referencia para Lactobacilos (CERELA)-CONICET, Chacabuco 145, 4000. San Miguel de Tucumán, Tucumán, Argentina
| | - Antonella Marchesi
- Centro de Referencia para Lactobacilos (CERELA)-CONICET, Chacabuco 145, 4000. San Miguel de Tucumán, Tucumán, Argentina
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15
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Kiasat N, Rezaei-Matehkolaei A, Mahmoudabadi AZ. Microsatellite Typing and Antifungal Susceptibility of Candida glabrata Strains Isolated From Patients With Candida Vaginitis. Front Microbiol 2019; 10:1678. [PMID: 31417505 PMCID: PMC6685060 DOI: 10.3389/fmicb.2019.01678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/08/2019] [Indexed: 01/30/2023] Open
Abstract
Vulvovaginal candidiasis (VVC) is a yeast infection with a global reach and millions of dollars are spent annually for its diagnosis and treatment. Recently, Candida glabrata with different degrees of antifungal resistance has been considered as the second most common cause of vaginal infections. The aim of the present study is to determine the antifungal susceptibility and molecular epidemiology profiles of C. glabrata isolates from patients with VVC. Sixty-one C. glabrata isolates were examined for antifungal susceptibility using the EUCAST broth microdilution method. Moreover, microsatellite length polymorphism (MLP) was used for typing the C. glabrata isolates using six microsatellite markers. Overall, 13, 3.3, and 0% of the isolates were non-wild types to itraconazole, posaconazole, and voriconazole, respectively. Sixty (98.4%) isolates were an intermediate phenotype to fluconazole and only one isolate was fluconazole resistant. Microsatellite length polymorphism with a discriminatory power of 0.964 identified 35 distinct types and 24 singleton genotypes. The assessment of the population genetic structure revealed that the non-wild-type population had a moderate genetic differentiation compared to the wild type population (FST = 0.1457). It was also found that the most common genotypes were G27 (eight strains), G12 (six strains), and G4 (five strains). We found that eight strains were resistant/a non-wild phenotype to itraconazole. Five out of eight (62.5%) resistant/non-wild phenotype strains correlated to a predominant genotype (GT27) and the rest belonged to GT11 (12.5%), GT29 (12.5%), and GT28 (12.5%). The current study is the first molecular epidemiology study in the southwest of Iran and demonstrates the antifungal susceptibility profiles of C. glabrata in it. This study shows a wide range of the genetic diversity of C. glabrata (35 different genotypes) from VVC in the southwest of Iran. The majority of the non-wild isolates had a dominant genotype or genotypes related to this dominant genotype (clonal cluster one).
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Affiliation(s)
- Neda Kiasat
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Rezaei-Matehkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Zarei Mahmoudabadi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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16
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Maraki S, Mavromanolaki VE, Stafylaki D, Nioti E, Hamilos G, Kasimati A. Epidemiology and antifungal susceptibility patterns of Candida isolates from Greek women with vulvovaginal candidiasis. Mycoses 2019; 62:692-697. [PMID: 31132175 DOI: 10.1111/myc.12946] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 01/12/2023]
Abstract
Vulvovaginal candidiasis (VVC) is a common infection of the genital tract affecting millions of women worldwide. Data on epidemiological trends of VVC in Greece are scarce. This study was undertaken to evaluate the prevalence of VVC among symptomatic women in Crete, Greece, identify the Candida species involved and determine their susceptibility to antifungals. Over a 6-year period (2012-2017), 10 256 symptomatic women with vaginitis were evaluated. Isolation of yeasts was performed on Sabouraud dextrose agar with chloramphenicol, and the isolates were identified using the API 20 C AUX and/or the Vitek 2 YST card. Susceptibility of the isolates to amphotericin, fluconazole, voriconazole and flucytosine was determined by the Vitek 2 automated system. The results were interpreted according to Clinical and Laboratory Standards criteria. Vaginal swab cultures of 1217 (11.9%) women yielded Candida species. Recurrent VVC was documented in 62 (5.1%) of them. Candida albicans was the most frequently isolated species (75.6%), followed by Candida glabrata (13.6%). Overall, resistance rates to amphotericin B, fluconazole, voriconazole and flucytosine were 0.2%, 6.6%, 1.4% and 2.1%, respectively. Fluconazole resistance of C. albicans significantly increased in the second period of the study (2015-2017) (P = 0.031). This study demonstrated that VVC is a common infection among women in our region, with C. albicans being the predominant species involved. Although resistance to antifungals was infrequent, resistance to fluconazole among C. albicans isolates was found to significantly increase with time. Continued surveillance of changes in species distribution and susceptibility to antifungals are necessary to guide treatment.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | | | - Dimitra Stafylaki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - Eleni Nioti
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - George Hamilos
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - Anna Kasimati
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
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17
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Isolation of Different Species of Candida in Patients with Vulvovaginal Candidiasis from Damavand, Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2018. [DOI: 10.5812/archcid.59291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Makanjuola O, Bongomin F, Fayemiwo SA. An Update on the Roles of Non- albicans Candida Species in Vulvovaginitis. J Fungi (Basel) 2018; 4:E121. [PMID: 30384449 PMCID: PMC6309050 DOI: 10.3390/jof4040121] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 02/08/2023] Open
Abstract
Candida species are one of the commonest causes of vaginitis in healthy women of reproductive age. Vulvovaginal candidiasis (VVC) is characterized by vulvovaginal itching, redness and discharge. Candida albicans, which is a common genito-urinary tract commensal, has been the prominent species and remains the most common fungal agent isolated from clinical samples of patients diagnosed with VVC. In recent times, however, there has been a notable shift in the etiology of candidiasis with non-albicans Candida (NAC) species gaining prominence. The NAC species now account for approximately 10% to as high as 45% of VVC cases in some studies. This is associated with treatment challenges and a slightly different clinical picture. NAC species vaginitis is milder in presentation, often occur in patients with underlying chronic medical conditions and symptoms tend to be more recurrent or chronic compared with C. albicans vaginitis. C. glabrata is the most common cause of NAC-VVC. C. tropicalis, C. krusei, C. parapsilosis, and C. guilliermondii are the other commonly implicated species. Treatment failure is common in NAC-VVC, since some of these species are intrinsically resistant or show low susceptibilities to commonly used antifungal agents. This article reviews the etiology, pathogenesis, clinical features, diagnosis, and management of NAC vulvovaginitis.
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Affiliation(s)
- Olufunmilola Makanjuola
- Department of Medical Microbiology and Parasitology, University of Ibadan, Ibadan 200284, Nigeria.
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Gulu University, Gulu P.O. Box 166, Uganda.
| | - Samuel A Fayemiwo
- Department of Medical Microbiology and Parasitology, University of Ibadan, Ibadan 200284, Nigeria.
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.
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19
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Naeimi B, Mirhendi H, Khamisipour G, Sadeghzadeh F, Ahmadi B. Candida africana in recurrent vulvovaginal candidiasis (RVVC) patients: frequency and phenotypic and genotypic characteristics. J Med Microbiol 2018; 67:1601-1607. [PMID: 30248002 DOI: 10.1099/jmm.0.000834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Up to 75 % of all women develop vulvovaginal candidiasis (VVC), with symptoms such as vulvar erythema, pruritus and abnormal vaginal discharge. Despite the global distribution of Candida africana, its role in recurrent vulvovaginal candidiasis (RVVC) is still unclear and requires further investigation. Here, we report on the frequency of C. africana among clinical isolates from patients with RVVC in Bushehr in southern Iran. METHODOLOGY Isolated Candida strains were identified by ITS-PCR-RFLP. Hyphal wall protein 1 (HWP1) was amplified to differentiate C. africana and the resulting sequences were subjected to phylogenetic analyses with a view to identifying similarities and differences in nucleotides. RESULTS Ten out of 119 strains originally identified as C. albicans turned out to be C. africana. Pairwise nucleotide alignment of HWP1 DNA sequences showed 100 % similarity between C. africana strains. Inter-species variation between Iranian C. africana HWP1 sequences and the only three available C. africana type sequences in GenBank revealed 99.7-100 % nucleotide similarity. Phylogenetic analysis of the HWP1 DNA sequences of 10 Iranian C. africana isolates, the 3 C. africana sequences available in GenBank and 2 representative Iranian C. albicans sequences revealed that all 11 Iranian C. africana strains formed a well-supported cluster separated from the remaining C. africana. CONCLUSION In our sample, C. africana was only isolated from 7.8 % of the patients with RVVC. While size polymorphisms in HPW1 genes allowed us to differentiate C. africana from C. albicans, no evidence of sequence variation within the Iranian C. africana isolates was observed.
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Affiliation(s)
- Behrouz Naeimi
- 1The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Hossein Mirhendi
- 2Departments of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Khamisipour
- 3Department of Hematology, Faculty of Allied Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Farzaneh Sadeghzadeh
- 4Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bahram Ahmadi
- 4Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
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20
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Sobel JD, Suprapaneni S. Candida parapsilosis Vaginal Infection-a New Site of Azole Drug Resistance. Curr Infect Dis Rep 2018; 20:43. [PMID: 30151658 DOI: 10.1007/s11908-018-0649-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Evaluation of pathogenicity of an uncommon vaginal Candida species, Candida parapsilosis with particular references to susceptibility to conventional antifungal agents. RECENT FINDINGS C. parapsilosis vaginal isolates usually present in asymptomatic women as commensals but may induce vulvovaginal symptoms indistinguishable from C. albicans requiring antifungal therapy; however, recent experience reveals clinically relevant resistance to the azole class of antimycotics. CONCLUSION Clinicians are required to determine a causal relationship between vaginal isolates of C. parapsilosis before prescribing antifungal agents, recognizing the possibility of fluconazole resistance to explain refractory symptomatology.
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Affiliation(s)
- J D Sobel
- Division of Infectious Diseases, Wayne State University School of Medicine, 540 E. Canfield St., 1241 Scott Hall, Detroit, MI, 48201, USA.
| | - S Suprapaneni
- Division of Infectious Diseases, Wayne State University School of Medicine, 540 E. Canfield St., 1241 Scott Hall, Detroit, MI, 48201, USA
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21
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Yaralizadeh M, Abedi P, Namjoyan F, Fatahinia M, Nezamivand Chegini S. A comparison of the effects of Lawsonia inermis (Iranian henna) and clotrimazole on Candida albicans in rats. J Mycol Med 2018; 28:419-423. [PMID: 29891221 DOI: 10.1016/j.mycmed.2018.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Candida albicans may cause vaginal infections in women. The aim of this study was to compare the antifungal effect of Lawsonia inermis with that of clotrimazole on rats. METHODS A total of 35female Wistar rats were randomly assigned into 5groups. Four groups were infected vaginally with C. albicans and one group was not (negative control). The four infected groups received the following treatments: two groups received vaginal creams of 2% or 4% of L. inermis, one group received 1% clotrimazole and one infected group did not receive any treatment (positive control). The hydro-ethanolic henna extract was prepared from the powder of henna leaves using maceration method. Samples were taken for culture from the vaginae of all rats before the treatment, one and two weeks after treatment. An ANOVA test was used to analyze the data. RESULTS Before the treatment, the mean colony forming units (CFU) was 213.6±10.08 and 334.42±20.32 in the 2% and 4% henna groups, respectively, 312.7±28.32 in the clotrimazole group, 233.85±8.15 in the positive control group, and zero in the negative control group. The mean CFUs were zero for all groups except for the 2% henna and positive control groups (P<0.001) one week after the treatment and zero in all groups except for the positive control group two weeks after the treatment (P<0.001). CONCLUSION L. inermis (henna) in form of vaginal cream could treat C. albicans infections in female rats; however, 4% henna was more effective and had an effect similar to that of clotrimazole.
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Affiliation(s)
- M Yaralizadeh
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - P Abedi
- Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - F Namjoyan
- Marine natural Pharmaceutical Research Center, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - M Fatahinia
- Department of Medical Mycology, Health Research Institute, Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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22
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Obiero J, Rulisa S, Ogongo P, Wiysonge CS. Nifuratel-Nystatin combination for the treatment of mixed infections of bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis. Hippokratia 2018. [DOI: 10.1002/14651858.cd013012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jael Obiero
- Institute of Primate Research; Department of Reproductive Health and Biology; Nairobi Kenya
| | - Stephen Rulisa
- University of Rwanda; Department of Obstetrics and gynecology, School of Medicine and Pharmacy; BP 655 Kigali Rwanda
| | - Paul Ogongo
- Institute of Primate Research; Tropical and Infectious Diseases; P.O Box 24481 -00502, Karen Nairobi Kenya
| | - Charles S Wiysonge
- South African Medical Research Council; Cochrane South Africa; Francie van Zijl Drive, Parow Valley Cape Town Western Cape South Africa 7505
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Candida albicans - Biology, molecular characterization, pathogenicity, and advances in diagnosis and control – An update. Microb Pathog 2018; 117:128-138. [DOI: 10.1016/j.micpath.2018.02.028] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/04/2018] [Accepted: 02/13/2018] [Indexed: 12/16/2022]
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Abbasi Nejat Z, Farahyar S, Falahati M, Ashrafi Khozani M, Hosseini AF, Faiazy A, Ekhtiari M, Hashemi-Hafshenjani S. Molecular Identification and Antifungal Susceptibility Pattern of Non-albicans Candida Species Isolated from Vulvovaginal Candidiasis. IRANIAN BIOMEDICAL JOURNAL 2018; 22:33-41. [PMID: 28688376 PMCID: PMC5712382 DOI: 10.22034/ibj.22.1.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Vulvovaginal candidiasis (VVC) is an important health problem caused by Candida spp. The aim of this study was molecular identification, phylogenetic analysis, and evaluation of antifungal susceptibility of non-albicans Candida isolates from VVC. Methods Vaginal secretion samples were collected from 550 vaginitis patients at Sayyad Shirazi Medical and Educational Center of Gorgan (Golestan Province, Iran) from May to October 2015. Samples were analyzed using conventional mycological and molecular approaches. Clinical isolates were analyzed with specific PCR using CGL primers, and the internal transcribed spacer region and the D1-D2 domain of the large-subunit rRNA gene were amplified and sequenced. Susceptibility to amphotericin B, fluconazole, itraconazole, and clotrimazole was determined by the guidelines of the Clinical and Laboratory Standard Institute. Results In total, 35 non-albicans Candida isolates were identified from VVC patients. The isolates included 27 strains of Candida glabrata (77.1%), 5 Candida krusei (Pichia kudriavzevii; 14.3%), 2 Candida kefyr (Kluyveromyces marxianus; 5.7%), and 1 Candida lusitaniae (Clavispora lusitaniae; 2.9%). The fungicides itraconazole and amphotericin B were effective against all species. One isolate of C. glabrata showed resistance to fluconazole and clotrimazole, and 26 isolates of C. glabrata indicated dose-dependent susceptibility to fluconazole. C. lusitaniae was susceptible in a dose-dependent manner to fluconazole and resistant to clotrimazole. Conclusion Non-albicans Candida spp. are common agents of vulvovaginitis, and C. glabrata is the most common species in the tested patients.
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Affiliation(s)
- Ziba Abbasi Nejat
- International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Farahyar
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Microbial Biotechnology Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehraban Falahati
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahtab Ashrafi Khozani
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Aga Fateme Hosseini
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Azamsadat Faiazy
- 5Department of Gynecology, Sayyad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Masoome Ekhtiari
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saeideh Hashemi-Hafshenjani
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Comparison of the Effects of Juglans nigra Green Husk and Clotrimazole on Candida albicans in Rats. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.58151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Xie HY, Feng D, Wei DM, Mei L, Chen H, Wang X, Fang F. Probiotics for vulvovaginal candidiasis in non-pregnant women. Cochrane Database Syst Rev 2017; 11:CD010496. [PMID: 29168557 PMCID: PMC6486023 DOI: 10.1002/14651858.cd010496.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Vulvovaginal candidiasis (VVC) is estimated to be the second most common form of infection after bacterial vaginosis. The ability of probiotics in maintaining and recovering the normal vaginal microbiota, and their potential ability to resist Candidas give rise to the concept of using probiotics for the treatment of VVC. OBJECTIVES To assess the effectiveness and safety of probiotics for the treatment of vulvovaginal candidiasis in non-pregnant women. SEARCH METHODS We searched the following databases to October 2017: Sexually Transmitted Infections Cochrane Review Group's Specialized Register, CENTRAL, MEDLINE, Embase and eight other databases. We searched in following international resources: World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, Web of Science and OpenGrey. We checked specialty journals, reference lists of published articles and conference proceedings. We collected information from pharmaceutical companies and experts in the field. SELECTION CRITERIA Randomized controlled trials (RCT) using probiotics, alone or as adjuvants to conventional antifungal drugs, to treat VVC in non-pregnant women. Trials recruiting women with recurrent VVC, coinfection with other vulvovaginal infections, diabetes mellitus, immunosuppressive disorders or taking immunosuppressant medication were ineligible for inclusion. Probiotics were included if they were made from single or multiple species and in any preparation type/dosage/route of administration. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for eligibility and quality and extracted data. We resolved any disagreements through consensus. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS Ten RCTs (1656 participants) met our inclusion criteria, and pharmaceutical industry funded none of these trials. All trials used probiotics as adjuvant therapy to antifungal drugs. Probiotics increased the rate of short-term clinical cure (risk ratio (RR) 1.14, 95% confidence interval (CI) 1.05 to 1.24, 695 participants, 5 studies, low quality evidence) and mycological cure (RR 1.06, 95% CI 1.02 to 1.10, 969 participants, 7 studies, low quality evidence) and decreased relapse rate at one month (RR 0.34, 95% CI 0.17 to 0.68, 388 participants, 3 studies, very low quality evidence). However, this effect did not translate into a higher frequency of long-term clinical cure (one month after treatment: RR 1.07, 95% CI 0.86 to 1.33, 172 participants, 1 study, very low quality evidence; three months after treatment: RR 1.30, 95% CI 1.00 to 1.70, 172 participants, one study, very low quality evidence) or mycological cure (one month after treatment: RR 1.26, 95% CI 0.93 to 1.71, 627 participants, 3 studies, very low quality evidence; three months after treatment: RR 1.16, 95% CI 1.00 to 1.35, 172 participants, one study, very low quality evidence). Probiotics use did not increase the frequency of serious (RR 0.80, 95% CI 0.22 to 2.94; 440 participants, 2 studies, low quality evidence). We found no eligible RCTs for outcomes as time to first relapse, need for additional treatment at the end of therapy, patient satisfaction and cost effectiveness. AUTHORS' CONCLUSIONS Low and very low quality evidence shows that, compared with conventional treatment, the use of probiotics as an adjuvant therapy could increases the rate of short-term clinical and mycological cure and decrease the relapse rate at one month but this did not translate into a higher frequency of long-term clinical or mycological cure. Probiotics use does not seem to increase the frequency of serious or non-serious adverse events. There is a need for well-designed RCTs with standardized methodologies, longer follow-up and larger sample size.
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Affiliation(s)
- Huan Yu Xie
- People's Hospital of Deyang CityDepartment of Obstetrics and GynecologyNo. 173, Tai Shan North RoadDeyangSichuanChina618000
| | - Dan Feng
- Cheng du Women & Children's Central HospitalDepartment of Obstetrics and GynecologyNo. 1617, Riyue AvenueChengduSichuanChina610091
| | - Dong Mei Wei
- West China Second University Hospital, West China Women's and Children's HospitalDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
| | - Ling Mei
- West China Second University Hospital, West China Women's and Children's HospitalDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
| | - Hui Chen
- West China Second University Hospital, West China Women's and Children's HospitalDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
| | - Xun Wang
- West China Second University Hospital, West China Women's and Children's HospitalDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
| | - Fang Fang
- West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
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In Vitro Activity of Two Nanoparticles on Clinical Isolates of Candida parapsilosis, Showing Resistance Against Antifungal Agents in Children. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2017. [DOI: 10.5812/archcid.13853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Molecular Epidemiology and In Vitro Antifungal Susceptibility of Candida Isolates from Women with Vulvovaginal Candidiasis in Northern Cities of Khuzestan Province, Iran. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.12804] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Clinical and Mycological Study of Vulvovaginal Candidiasis (VVC); Identification of Clinical Isolates by Polymerase Chain Reaction-Fragment Size Polymorphyim (PCR-FSP) Technique. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2017. [DOI: 10.5812/archcid.62761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mtibaa L, Fakhfakh N, Kallel A, Belhadj S, Belhaj Salah N, Bada N, Kallel K. Vulvovaginal candidiasis: Etiology, symptomatology and risk factors. J Mycol Med 2017; 27:153-158. [PMID: 28314677 DOI: 10.1016/j.mycmed.2017.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/25/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine epidemiological, clinical and mycological characteristics of vulvovaginal candidiasis (VVC) in Tunisian population and to evaluate predisposing factors. PATIENTS AND METHODS In this retrospective study, 2160 vaginal swabs were performed over 2 years (January 2014-December 2015). It was carried out at the laboratory of Parasitology and Mycology, Rabta Hospital in Tunisia. After swab collecting, direct examination and culture on Sabouraud Chloramphenicol and Sabouraud Chloramphenicol Actidione media were implemented to research yeasts. Then identifying of yeast species was through chlamydosporulation test and auxanogram. For each patient, a questionnaire was filled noting age, medical and surgical history, symptoms and risk factors. Statistical analysis of data was performed on SPSS 16 using Khi2 test, P<0.05 was considered significant. RESULTS Direct examination was positive showed spore and/or pseudohypha in 24.72%. Candida albicans was isolated most frequently (76.61%) followed by Candida glabrata (17.18%). The maximum frequency of Candida-positive cultures was in 25-34 years old age group. Leucorrhea was the most common symptom (72.25%) followed by vulvar prurits (63.23%), dyspareunia (32.25%) and urinary burning (24.92%). Only pregnancy was correlated positively with VVC. CONCLUSION It appears from our study that VVC is relatively common in Tunisia. His diagnosis results from confrontation of anamnestic, clinical and mycological data. The knowledge of risk factors and their correction would be necessary to prevent the occurrence of VVC, especially in its recurrent form.
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Affiliation(s)
- L Mtibaa
- Laboratory of Parasitology-Mycology, Rabta Hospital, Jabbari street, 1007 Tunis, Tunisia.
| | - N Fakhfakh
- Laboratory of Parasitology-Mycology, Rabta Hospital, Jabbari street, 1007 Tunis, Tunisia
| | - A Kallel
- Laboratory of Parasitology-Mycology, Rabta Hospital, Jabbari street, 1007 Tunis, Tunisia
| | - S Belhadj
- Laboratory of Parasitology-Mycology, Rabta Hospital, Jabbari street, 1007 Tunis, Tunisia
| | - N Belhaj Salah
- Laboratory of Parasitology-Mycology, Rabta Hospital, Jabbari street, 1007 Tunis, Tunisia
| | - N Bada
- Laboratory of Parasitology-Mycology, Rabta Hospital, Jabbari street, 1007 Tunis, Tunisia
| | - K Kallel
- Laboratory of Parasitology-Mycology, Rabta Hospital, Jabbari street, 1007 Tunis, Tunisia
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Kalaiarasan K, Singh R, Chaturvedula L. Fungal Profile of Vulvovaginal Candidiasis in a Tertiary Care Hospital. J Clin Diagn Res 2017; 11:DC06-DC09. [PMID: 28511380 DOI: 10.7860/jcdr/2017/23578.9475] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/11/2016] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Vulvovaginal Candidiasis (VVC) is a common medical health problem of adult women. It is most commonly caused by Candida albicans. But there is a change in fungal profile. Sabouraud's Dextrose Agar (SDA) is the most common culture medium used where mixed fungal infection may be missed. It can be detected easily by using chromogenic culture medium. AIM To know the fungal profile of vulvovaginal candidiasis using Candida CHROMagar and antifungal susceptibility pattern in patients attending tertiary care hospital. MATERIALS AND METHODS Culture confirmed cases of VVC presented at Department of Obstetrics and Gynaecology of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India, from July 2015 to December 2015 were included in the cross-sectional study. Two high vaginal swabs were collected and inoculated on SDA and Candida CHROMagar (Hi-Media, Mumbai, India). After overnight incubation the colonies were counted and colour of the colonies were recorded from Candida CHROMagar. Candida spp. were identified by sugar fermentation and assimilation tests and other conventional tests. Antifungal susceptibility tests were performed by the disc diffusion method using fluconazole (25 μg) and voriconazole (1μg) as per the Clinical and Laboratory Standards Institute (CLSI - M44-A2) guidelines. RESULTS A total of 50 culture confirmed (23.7%) cases were detected from 211 clinically suspected VVC cases. Candida glabrata (45.1%) was the most common isolate, followed by Candidatropicalis (23.5%), Candida albicans (17.6%), Candida krusei (9.8%) and Candida parapsilosis (3.9%). One mixed infection of C. glabrata and C. albicans was identified on Candida CHROMagar. Mixed fungal infection was observed in 2% of positive culture and 0.5% of VVC cases. The antifungal susceptibility testing revealed that 15.7% and 9.8% isolates of Candida spp. were resistant and Susceptible Dose Dependent (S-DD) respectively to fluconazole. The increase resistant against fluconazole was because of increased isolation of C. glabrata strains. All strains of Candida spp. were susceptible to voriconazole. CONCLUSION C. glabrata was the most common causative agent of VVC in a tertiary care hospital. Chromogenic culture medium facilitates detection of mixed fungal infection. In vitro susceptibility testing should be used to guide the treatment especially in cases of non-albicans Candidiasis.
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Affiliation(s)
- Krishnapriya Kalaiarasan
- M.Sc (MLT), Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Rakesh Singh
- Associate Professor, Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Latha Chaturvedula
- Professor, Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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The Epidemiology of Candida Species Isolated From Urinary Tract Infections. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2016. [DOI: 10.5812/archcid.37743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Fornari G, Vicente VA, Gomes RR, Muro MD, Pinheiro RL, Ferrari C, Herkert PF, Takimura M, Carvalho NSD, Queiroz-Telles F. Susceptibility and molecular characterization of Candida species from patients with vulvovaginitis. Braz J Microbiol 2016; 47:373-80. [PMID: 26991298 PMCID: PMC4874609 DOI: 10.1016/j.bjm.2016.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 03/05/2015] [Indexed: 11/28/2022] Open
Abstract
Vulvovaginal candidiasis affects women of reproductive age, which represents approximately 15–25% of vaginitis cases. The present study aimed to isolate and characterize yeast from the patients irrespective of the presentation of clinical symptoms. The isolates were subjected to in vitro susceptibility profile and characterization by molecular markers, which intended to assess the distribution of species. A total of 40 isolates were obtained and identified through the CHROMagar, API20aux and by ITS and D1/D2 regions sequencing of DNAr gene. Candida albicans strains were genotyped by the ABC system and the isolates were divided into two genotypic groups. The identity of the C. albicans, C. glabrata, C. guilliermondii, C. kefyr and Saccharomyces cerevisiae isolates was confirmed by the multilocus analysis. The strains of Candida, isolated from patients with complications, were found to be resistant to nystatin but sensitive to fluconazole, amphotericin B and ketoconazole, as observed by in vitro sensitivity profile. The isolates from asymptomatic patients, i.e., the colonized group, showed a dose-dependent sensitivity to the anti-fungal agents, fluconazole and amphotericin B. However, the isolates of C. albicans that belong to distinct genotypic groups showed the same in vitro susceptibility profile.
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Affiliation(s)
- Gheniffer Fornari
- Graduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Laboratory of Microbiology and Molecular Biology-LabMicro, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Vania Aparecida Vicente
- Graduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Laboratory of Microbiology and Molecular Biology-LabMicro, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Renata Rodrigues Gomes
- Graduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Laboratory of Microbiology and Molecular Biology-LabMicro, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | | | | - Patricia Fernanda Herkert
- Graduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Laboratory of Microbiology and Molecular Biology-LabMicro, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | | - Flavio Queiroz-Telles
- Graduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Laboratory of Microbiology and Molecular Biology-LabMicro, Federal University of Paraná, Curitiba, Paraná, Brazil; Support and Diagnosis Unit, Mycology Laboratory, Federal University of Paraná, Brazil.
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Li C, Wang L, Tong H, Ge Y, Mei H, Chen L, Lv G, Liu W. Microsatellite analysis of genotype distribution patterns of Candida albicans vulvovaginal candidiasis in Nanjing, China and its association with pregnancy, age and clinical presentation. Arch Gynecol Obstet 2016; 294:291-7. [PMID: 26861467 DOI: 10.1007/s00404-016-4029-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 01/19/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To characterize the genotype distribution pattern of Candida albicans associated with vulvovaginal candidiasis (VVC) in Nanjing, China by microsatellite genotyping. METHODS A questionnaire was completed by each patient diagnosed with VVC. A total of 208 independent C. albicans was isolated from 208 patients. Microsatellite genotyping characterized the genotype distribution by analysis of the CAI locus marker. RESULTS PCR of CAI fragments showed the three major genotypes contained 30:45, 21:21 and 32:46 alleles among the 51 genotypes detected, accounting for 29.3, 13.0 and 12.0 % of 208 clinical isolates. Genotype distributions had a similar pattern among different clinical presentations (P = 0.219). In both groups of the (21-30) and (31-40) years, 30:45 was the most frequent genotype allele detected. In the (21-30) year females, 16.5 % of the isolated strains had the genotype 21:21, while the same genotype in the group of (31-40) years was 6.9 %. Genotype distributions were significant difference between the pregnant and non-pregnant women (P < 0.001). 30:45 was detected only one in the 23 pregnant women. CONCLUSIONS The results indicated a unique genotype distribution of C. albicans associated with VVC in Nanjing, eastern China and a different distribution pattern was also detected in pregnant women compared to non-pregnant women.
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Affiliation(s)
- Caixia Li
- Institute of Dermatology, Chinese Academy of Medical Science and Peaking Union Medical College and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, No 12 Jiangwangmiao St., Nanjing, 210042, China
| | - Le Wang
- Institute of Dermatology, Chinese Academy of Medical Science and Peaking Union Medical College and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, No 12 Jiangwangmiao St., Nanjing, 210042, China
| | - Hua Tong
- Department of Gynecology, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Yiping Ge
- Institute of Dermatology, Chinese Academy of Medical Science and Peaking Union Medical College and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, No 12 Jiangwangmiao St., Nanjing, 210042, China
| | - Huan Mei
- Institute of Dermatology, Chinese Academy of Medical Science and Peaking Union Medical College and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, No 12 Jiangwangmiao St., Nanjing, 210042, China
| | - Liangyu Chen
- Department of Gynecology, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Guixia Lv
- Institute of Dermatology, Chinese Academy of Medical Science and Peaking Union Medical College and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, No 12 Jiangwangmiao St., Nanjing, 210042, China
| | - Weida Liu
- Institute of Dermatology, Chinese Academy of Medical Science and Peaking Union Medical College and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, No 12 Jiangwangmiao St., Nanjing, 210042, China.
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Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Crit Rev Microbiol 2015; 42:905-27. [PMID: 26690853 DOI: 10.3109/1040841x.2015.1091805] [Citation(s) in RCA: 324] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Vulvovaginal candidiasis (VVC) is an infection caused by Candida species that affects millions of women every year. Although Candida albicans is the main cause of VVC, the identification of non-Candida albicans Candida (NCAC) species, especially Candida glabrata, as the cause of this infection, appears to be increasing. The development of VVC is usually attributed to the disturbance of the balance between Candida vaginal colonization and host environment by physiological or nonphysiological changes. Several host-related and behavioral risk factors have been proposed as predisposing factors for VVC. Host-related factors include pregnancy, hormone replacement, uncontrolled diabetes, immunosuppression, antibiotics, glucocorticoids use and genetic predispositions. Behavioral risk factors include use of oral contraceptives, intrauterine device, spermicides and condoms and some habits of hygiene, clothing and sexual practices. Despite a growing list of recognized risk factors, much remains to be elucidated as the role of host versus microorganisms, in inducing VVC and its recurrence. Thus, this review provides information about the current state of knowledge on the risk factors that predispose to VVC, also including a revision of the epidemiology and microbiology of VVC, as well as of Candida virulence factors associated with vaginal pathogenicity.
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Affiliation(s)
- Bruna Gonçalves
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Carina Ferreira
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Carlos Tiago Alves
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Mariana Henriques
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Joana Azeredo
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Sónia Silva
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
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Shaaban OM, Abbas AM, Moharram AM, Farhan MM, Hassanen IH. Does vaginal douching affect the type of candidal vulvovaginal infection? Med Mycol 2015; 53:817-27. [PMID: 26129887 DOI: 10.1093/mmy/myv042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 11/13/2022] Open
Abstract
The normal vaginal microbiota is a dynamic system that continually fluctuates under the environmental changes and different physiological conditions. Yeast infections of the vagina are caused by one of the species of fungus called Candida (C.). The study aimed to evaluate the types of mycobiota in women with vulvovaginal candidiasis (VVC) who were performing vaginal douching (VD) or not. Furthermore, it studied the antifungal sensitivity toward different fungi isolated from the vagina. In a cross-sectional study conducted in Assiut University Hospital, Egypt, women with VVC were interviewed regarding relevant history including the habit of VD. Vaginal swabs were obtained and processed by direct microscope and by culture on CHROMagar Candida and other differential media. The types of Candida in women with the habit of VD were compared with those not having this habit. We found that VD habit was practiced by 67.4% of women with VVC, and Candida albicans was the commonest (78.3%) type observed. There was no significant difference in the percentage of non-albicans types between women performing VD (23.6%) and those not reporting this habit (18.9%). Harboring non-albicans types were significantly increased in regular performers of VD compared with those who had this procedure only after sexual intercourse or after the end of menstruation (36.8%,12.5%, and 16.7%, respectively) (P = .048). Thus, vaginal douching does not influence the type of Candida infection involved in VVC. Frequent performance of VD increases the likelihood of having non-albicans types and the resistance to the common antifungal agents.
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Affiliation(s)
- Omar M Shaaban
- Assiut University, Obstetrics and gynecology, Assiut, Egypt
| | - Ahmed M Abbas
- Assiut University, Obstetrics and gynecology, Assiut, Egypt
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Hedayati MT, Taheri Z, Galinimoghadam T, Aghili SR, Yazdani Cherati J, Mosayebi E. Isolation of different species of Candida in patients with vulvovaginal candidiasis from sari, iran. Jundishapur J Microbiol 2015; 8:e15992. [PMID: 26034533 PMCID: PMC4449843 DOI: 10.5812/jjm.8(4)2015.15992] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/17/2014] [Accepted: 03/08/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Vulvovaginal Candidiasis (VVC) is a frequent, complex and cumbersome condition that can cause physical and psychological distress for the involved individual. Candida albicans was reported as the most common agent of VVC yet it seems that we are recently encountering changes in the pattern of Candida species in VVC. OBJECTIVES In this study we assessed different species of Candida isolated from patients with VVC, residing in Sari, Iran. PATIENTS AND METHODS Two hundred and thirty-four patients with vulvovaginitis were enrolled in this study. Samples were collected by a wet swab. Each vaginal swab was examined microscopically and processed for fungal culture. The identification of Candida species was done by morphological and physiological methods such as culture on CHROMagar Candida media and sugar assimilation test with the HiCandida identification kit (HiMedia, Mumbai, India). RESULTS Out of 234 patients with vulvovaginitis, 66 (28.2%) patients showed VVC. Of these patients, 16 (24.2%) had recurrent VVC (RVVC). The age group of 20 - 29 year-olds had the highest frequency of VVC (48.5%). Erythema concomitant with itching (40.9%) was the most prevalent sign in VVC patients. Fifty-seven (86.4%) of the collected samples had positive results from both microscopic examination and culture. In total, 73 colonies of Candida spp. were isolated from 66 patients with VVC. The most common identified species of Candida were C. albicans (42.5%), C. glabrata (21.9%) and C. dubliniensis (16.4%). In patients with RVVC and patients without recurrence, C. albicans and non-albicans species of Candida were frequent species, respectively. CONCLUSIONS The results of our study showed that non-albicans species of Candida are more frequent than C. albicans in patients with VVC. This result is in line with some recent studies indicating that non-albicans species of Candida must be considered in gynecology clinics due to the reported azole resistance in these species.
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Affiliation(s)
- Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, IR Iran
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
- Corresponding author: Mohammad Taghi Hedayati, Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran. Tel: +98-1513543088, Fax: +98-1513543087, E-mail:
| | - Zahra Taheri
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Tahereh Galinimoghadam
- Department of Gynecology, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Seyed Reza Aghili
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Jamshid Yazdani Cherati
- Department of Statistic, School of Health, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Elham Mosayebi
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, IR Iran
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Seifi Z, Zarei Mahmoudabadi A, Zarrin M. Extracellular enzymes and susceptibility to fluconazole in Candida strains isolated from patients with vaginitis and healthy individuals. Jundishapur J Microbiol 2015; 8:e20162. [PMID: 25861438 PMCID: PMC4386072 DOI: 10.5812/jjm.20162] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 06/16/2014] [Accepted: 06/20/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Extracellular phospholipase, proteinase, and coagulase are accounted as the major virulence factors in Candida albicans. Several reports showed that the incidence of resistance to fluconazole has risen during last two decades. OBJECTIVES The present study has investigated the extracellular enzymes of C. albicans and non-albicans species isolated from both patients with vaginitis and healthy women. In addition, susceptibility of the isolates was evaluated against fluconazole. PATIENTS AND METHODS Vaginal samples were collected using sterile cotton swabs and inoculated on CHROMagar Candida. Routine morphological tests and ID 32C and API 20C AUX Kits were used to identify species. Phospholipase, proteinase, and coagulase activity were determined by standard methods. Susceptibility to fluconazole was also evaluated using ATB Fungus 3 Kits. RESULTS The phospholipase activity was detected in 66.7% of the tested isolates recovered from patients with vaginitis. In the present study, phospholipase activity with higher Pz values (< 0.70) was more common in patients with vaginitis (28 of 66 isolates) whereas this rate in the normal individual was 13 of 42. Proteinase activity was detected in 74.2% and 61.9% of tested isolates recovered from patients and normal individuals, respectively. All tested isolates were negative for coagulase activity. In the present study, resistance to fluconazole was found in 34.8% of isolates. C. dubliniensis was the most common isolate (6 out of 11 isolates) that showed resistance to fluconazole. CONCLUSIONS Our results showed that C. albicans was the most frequently isolated from both patients with vaginitis and normal individual. In the present study, we could not find any correlation between extracellular activities and sources of isolates (patients and normal flora) and sensitivity or resistance to fluconazole.
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Affiliation(s)
- Zahra Seifi
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Ali Zarei Mahmoudabadi
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Health Research Institute, Infectious and Tropical Diseases Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Corresponding author: Ali Zarei Mahmoudabadi, Health Research Institute, Infectious and Tropical Diseases Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel: +98-6133330074, Fax: +98-6133332036, E-mail:
| | - Majid Zarrin
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
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Candida parapsilosis Sensu Stricto and the Closely Related Species Candida orthopsilosis and Candida metapsilosis in Vulvovaginal Candidiasis. Mycopathologia 2014; 179:111-8. [DOI: 10.1007/s11046-014-9821-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/30/2014] [Indexed: 12/11/2022]
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Martins N, Ferreira ICFR, Barros L, Silva S, Henriques M. Candidiasis: Predisposing Factors, Prevention, Diagnosis and Alternative Treatment. Mycopathologia 2014; 177:223-40. [DOI: 10.1007/s11046-014-9749-1] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 04/18/2014] [Indexed: 11/29/2022]
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Species distribution and susceptibility of Candida isolates from patient with vulvovaginal candidiasis in Southern China from 2003 to 2012. J Mycol Med 2014; 24:106-11. [PMID: 24746725 DOI: 10.1016/j.mycmed.2014.01.060] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/26/2013] [Accepted: 01/08/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the Candida species involved and the antifungal susceptibility of Candida species isolated from patients with vulvovaginal candidiasis (VVC). MATERIALS AND METHODS Candida organisms were cultured from samples obtained from patients with VVC at Gynecology Department of Peking University Shenzhen Hospital from April 2003 to September 2012. Antifungal susceptibility testing was performed using a commercial agar diffusion test. RESULTS A total of 3181 yeasts isolates, mostly Candida, were obtained from 3141 patients with VVC. Two species of Candida were isolated from each of 40 patients (1.3%, 40/3141). C. albicans were the predominant Candida species (2705 strains, 85.0%) in VVC, followed by C. glabrata (337 strains, 10.6%), C. parapsilosis (49 strains, 1.5%), C. tropicalis (31 strains, 1.0%), Saccharomyces cerevisiae (23 strains, 0.7%), C. krusei (15 strains, 0.5%), Candida famata (11 strains, 0.4%), Rhodotorula sp. (6 strains, 0.2%), and C. lusitaniae (2 strains, 0.1%). Antifungal susceptibility was tested in a total of 1942 strains from patients with VVC. All of the C. albicans isolates obtained were susceptible to nystatin. The resistant rate of C. albicans to fluconazole, itraconazole, miconazole, clotrimazole was 1.1% (18/1612), 2.2% (36/1612), 4.2% (68/1612), and 0.9% (14/1612). The resistant rate of non-albicans to fluconazole, itraconazole, miconazole, and clotrimazole was 11.8% (39/329), 2.5% (8/329), 1.8% (6/329), and 4.3% (14/329). CONCLUSIONS C. albicans was the predominant Candida species isolated from this series of patients with VVC. Resistance of vaginal C. albicans isolates to antifungal agents was infrequent.
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Xie HY, Feng D, Wei DM, Chen H, Mei L, Wang X, Fang F. Probiotics for vulvovaginal candidiasis in non-pregnant women. Hippokratia 2013. [DOI: 10.1002/14651858.cd010496] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Huan Yu Xie
- People's Hospital of Deyang City; Department of Obstetrics and Gynecology; No. 173, Tai Shan North Road Deyang Sichuan China 618000
| | - Dan Feng
- West China Second University Hospital, West China Women's and Children's Hospital; Department of Obstetrics and Gynecology; No. 17, Section Three, Ren Min Nan Lu Avenue Chengdu Sichuan China 610041
| | - Dong Mei Wei
- West China Second University Hospital, West China Women's and Children's Hospital; Department of Obstetrics and Gynecology; No. 17, Section Three, Ren Min Nan Lu Avenue Chengdu Sichuan China 610041
| | - Hui Chen
- West China Second University Hospital, West China Women's and Children's Hospital; Department of Obstetrics and Gynecology; No. 17, Section Three, Ren Min Nan Lu Avenue Chengdu Sichuan China 610041
| | - Ling Mei
- West China Second University Hospital, West China Women's and Children's Hospital; Department of Obstetrics and Gynecology; No. 17, Section Three, Ren Min Nan Lu Avenue Chengdu Sichuan China 610041
| | - Xun Wang
- West China Second University Hospital, West China Women's and Children's Hospital; Department of Obstetrics and Gynecology; No. 17, Section Three, Ren Min Nan Lu Avenue Chengdu Sichuan China 610041
| | - Fang Fang
- West China Second University Hospital, West China Women's and Children's Hospital; Department of Obstetrics and Gynecology; No. 17, Section Three, Ren Min Nan Lu Avenue Chengdu Sichuan China 610041
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Andrioli J, Oliveira G, Oliveira FD, Oliveira MD, Uetanabaro A, Sousa Z. In vitro Antifungal Activity of Irlbachia purpurascens, Lantana macrophylla and Kielmeyera neglecta Extracts Against Candida Isolates Collected from Patients with Vulvovaginal Candidiasis. ACTA ACUST UNITED AC 2013. [DOI: 10.3923/rjmp.2013.141.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Maharlouei N, Barooti E, Sharif F, Hosseini H, Lankarani KB. Prevalence and risk factors of reproductive tract infections among a defined population of Iranian women. Sex Health 2013; 10:311-5. [PMID: 23702160 DOI: 10.1071/sh12193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/18/2013] [Indexed: 02/05/2023]
Abstract
Background
Reproductive tract infections are among the most prevalent gynaecological health concerns. The present study aimed to determine the prevalence and risk factors of reproductive tract infections among a defined population of Iranian women. Methods: A cross-sectional study was performed in Shiraz, Southern Iran, from 2007 to 2009. The study subjects were 28 484 vulnerable household women who were covered by the Imam Khomeini Relief Foundation insurance scheme. All the participants underwent vaginal speculum examinations and swab sampling. Vaginal discharge was collected for Gram staining, potassium hydroxide mount, wet mount and in a transport medium for culture and sensitivity testing. The frequency of reproductive tract infections and their risk factors were determined. Results: The mean age of the 28 484 women who participated in the study was 48.7 ± 10.1 (range: 13–104) years. According to the results, 13 472 (47.3%) subjects had reproductive tract infections. Moreover, vulvovaginal candidiasis was the most common infection in our population, accounting for 4718 subjects (16.6%), followed by trichomoniasis (11.2%) and bacterial vaginosis (10.6%). Furthermore, the number of pregnancies, being married and low educational levels (illiterate and under diploma level) were the risk factors for these infections, whereas the use of oral contraceptives and being employed were the protective factors. Conclusion: Almost half of the vulnerable Iranian women suffer from reproductive tract infections, with candidiasis and trichomoniasis being the most prevalent types. Based on the high prevalence of these infections, appropriate and precise screening programs should be taken into consideration for this specific population.
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Affiliation(s)
- Najmeh Maharlouei
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran
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Effectiveness of the association of 2 probiotic strains formulated in a slow release vaginal product, in women affected by vulvovaginal candidiasis: a pilot study. J Clin Gastroenterol 2012; 46 Suppl:S73-80. [PMID: 22955364 DOI: 10.1097/mcg.0b013e3182684d71] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Vulvovaginal candidiasis (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. Among Candida spp., Candida albicans is the most common infectious agent. The treatment of choice for uncomplicated VVC is achieved with single-dose or short-course therapy in over 90% of cases. Several topical and oral drugs are available, without evidence for superiority of any agent or route of administration. In any case, most classic treatments are unable to significantly offer a protection against possible recurrences. In recent years, probiotics are emerging as a new strategy to counteract VVC. In fact, they are well known for their ability to lower intravaginal pH, thus establishing a barrier effect against many types of yeasts. Some strains are also able to exert additional and more focused antagonistic activities mediated by specific molecules such as hydrogen peroxide and bacteriocins. For example, Lactobacillus fermentum LF5 (CNCM I-789) was successfully tested in 4 human trials involving a total of 340 women reporting VVC at enrollment. In any case, the way used to deliver probiotics to the vaginal environment represents a crucial point. The aim of this work was to first select 1 or more probiotic strains in vitro with an antagonistic activity on Candida yeasts and then to perform an in vivo human pilot study using an association of the most promising and active bacteria. METHODS For this purpose, 2 probiotic strains Probiotical S.p.A (Italy) were selected based on their strong in vitro inhibition activity toward 4 particular Candida species, namely C. albicans, Candida glabrata, Candida parapsilosis, and Candida krusei and subsequently tested in a human intervention pilot trial involving 30 women with VVC. The probiotics used, L. fermentum LF10 (DSM 19187) and Lactobacillus acidophilus LA02 (DSM 21717), were administered by means of slow release effervescent vaginal tablets (ActiCand 30 product). The main endpoint was the assessment of the establishment and maintenance of a barrier effect against Candida yeasts in women suffering from VVC. Thirty female subjects who were diagnosed with VVC by both microscopic examination and yeast culture were enrolled in the study and directed to apply a vaginal tablet once a day for 7 consecutive nights, followed by 1 tablet every 3 nights for a further 3-week application (acute phase) and, finally, 1 tablet per week to maintain a long-term vaginal colonization against possible recurrences. A medical examination of each patient was performed at enrollment (d₀), at the end of the first 4 weeks of treatment (d₂₈), and at the end of the second month of relapse prevention (d₅₆). The visual and microscopic examination was always accompanied by microbiological analyses of vaginal swabs to assess the presence of Candida. A statistical comparison was made between d₂₈, or d₅₆, and d0, and between d₅₆ and d₂₈ to quantify the efficacy against possible recurrences. RESULTS The administration of the product ActiCand 30 was able to significantly solve Candida yeast symptoms after 28 days in 26 patients out of 30 (corresponding to 86.6%, P<0.001). At the end of the second month, recurrences were recorded, albeit not particularly serious, in only 3 out of 26 patients (11.5%, P=0.083) who were found to have fully healed at the end of the first month of treatment. This is a further confirmation of the long-term barrier effect exerted by the product. CONCLUSIONS VVC has a very high incidence as 70% to 75% of women report at least 1 episode during the life. Many treatments are currently available but, despite a relatively high effectiveness in the relief of symptoms typically associated with acute infections, they are generally unable to offer a long-term protective barrier against possible recurrences. This study demonstrated the ability of ActiCand 30 to not only solve Candida infections in a very high percentage of women, but also to exert a long-term physiological defense due to the colonization of vaginal microbiota and adhesion of the mucosa to the epithelial cells. The special formulation of ActiCand 30, consisting of slow release effervescent vaginal tablets, is able to mediate 2 types of barrier effects, the first represented by the formation of an anaerobic environment due to the release of CO₂ and the second guaranteed by the colonization and adhesion to the vaginal epithelium of the 2 probiotics L. fermentum LF10 and L. acidophilus LA02.
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Kang D, Ran Y, Dai Y, Lama J. Direct extraction of DNA from positive transparent dressing and swab to identify Candida albicans infection in intertriginous Candidiasis in the inguinal region. Mycopathologia 2012; 174:519-21. [PMID: 22772509 DOI: 10.1007/s11046-012-9564-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 06/19/2012] [Indexed: 02/05/2023]
Abstract
We report a case of a patient infected by Candida albicans which was identified by direct extraction of DNA from a positive transparent dressing and a swab. The patient was a 32-year-old male who complained of erosion in his inguinal region. Large patches of erythema and erosion were present in his inguinal and perianal region, with soya-bean like residue discharge. He was diagnosed with erythrasma and treated with antibiotics but his clinical condition did not improve. KOH examination furnished a positive result for candidiasis. Morphologic characteristics confirmed his infection was caused by Candida albicans. Sequencing of the internal transcribed spacer (ITS) 1/4 polymerase chain reaction products, amplified from positive transparent dressing and cotton swab with discharge and from primary culture isolates, established the Candida albicans lineage. The patient was cured by treatment with itraconazole 200 mg twice a day orally in combination with topical wash with 2 % ketoconazole shampoo and topical use of 1 % naftifine-0.25 % ketoconazole cream.
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Affiliation(s)
- Daoxian Kang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu 610041, China.
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Mahmoudi Rad M, Zafarghandi AS, Amel Zabihi M, Tavallaee M, Mirdamadi Y. Identification of Candida species associated with vulvovaginal candidiasis by multiplex PCR. Infect Dis Obstet Gynecol 2012; 2012:872169. [PMID: 22791958 PMCID: PMC3389677 DOI: 10.1155/2012/872169] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 04/28/2012] [Accepted: 05/17/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Vulvovaginal candidiasis is a common infection. The aim of this study was to identify the species of vaginal Candida isolates by using multiplex PCR technique. METHODS 191 isolates from patients admitted to Mahdieh hospital were identified. The vaginal swab specimens were cultured on Sabouraud Dextrose Agar. The ITS1 region between the 18S and 5.8S rRNA genes and a specific DNA fragment within the ITS2 region were amplified. The multiplex PCR products were separated by electrophoresis in 2% agarose gel, visualized by staining with ethidium bromide, and photographed. Descriptive statistics, Chi-square test, and Spearman correlation were used to summarize the findings. RESULTS C. albicans and C. glabrata were the most common species isolated from the specimens. A mix of C. glabrata and C. albicans was the most common mixed infection isolated from the samples. The analysis revealed a significant positive association between older age and infection with C. glabrata isolates (Spearman's rho = 0.89, P = 0.015). CONCLUSION Multiplex PCR is a fast, yet reliable method to identify Candida species. C. albicans and then C. glabrata are the two most common causes of vulvovaginal candidiasis. The number of mixed fungal infections is higher among Iranian population compared to international reports.
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Affiliation(s)
- Mahnaz Mahmoudi Rad
- Skin Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Ameneh Sh Zafarghandi
- Department of Obstetrics and Gynecology, Mahdieh Educational Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Amel Zabihi
- Department of Obstetrics and Gynecology, Mahdieh Educational Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahkam Tavallaee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada V5A 1S6
| | - Yasaman Mirdamadi
- Skin Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
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