Prevalence of vulvovaginal candidiasis in pregnancy at three health centers in Burkina Faso

Prospective Cohort Study of Treatment Outcomes of Vaginal Discharge Syndrome in Women in Windhoek, Namibia

BACKGROUND

Syndromic treatment is the standard of care for vaginal discharge syndrome (VDS) in resource-constrained settings. However, the outcomes of VDS treatment have not been well documented. This study aimed to determine the incidence, risk factors, and microbial etiology of treatment failure in women with VDS.

METHODS

This prospective cohort study of women with VDS was conducted between September 2021 and March 2022 at Katutura Intermediate Hospital in Windhoek, Namibia. Microbiological analyses of sexually transmitted infections (STIs; Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis , Mycoplasma genitalium ), bacterial vaginosis, and vulvovaginal candidiasis (VVC) were performed. Treatment outcomes were assessed at 7 and 30 days after treatment, followed by microbial investigation in case of treatment failure.

RESULTS

One hundred nine women were enrolled, and 94 (86%) completed the follow-up. At baseline, 58 of 109 women (53%) were diagnosed with STI, 47 of 109 (43%) with bacterial vaginosis, and 45 of 109 (41%) with VVC. Candida albicans (33 of 45; 73%) was the main pathogen in VVC, with fluconazole resistance detected in 8 of 33 isolates (24%); 10 of 12 (80%) of non- albicans Candida species showed resistance. The incidence of treatment failure was 3.6 per 100 person-years at 7 days and 1.0 per 100 person-years at 30 days of follow-up; 17 of 94 women (18%) had recurrent VDS, and 12 of 94 women (13%) had persistent VDS. Vulvovaginal candidiasis (odds ratio, 4.3; 95% confidence interval, 1.7-11; P = 0.002) at baseline was associated with treatment failure.

CONCLUSIONS

Treatment failure after syndromic management of VDS is common in resource-constrained settings. Access to diagnostic testing, including fungal culture and susceptibility testing, is recommended to improve outcomes.

Second trimester vaginal Candida colonization among pregnant women attending antenatal care in Bukavu, Democratic Republic of the Congo: prevalence, clinical correlates, risk factors and pregnancy outcomes

Introduction

Vaginal Candida colonization (CC) can lead to vulvovaginal candidiasis, the second most prevalent vaginal condition worldwide, and has been associated with adverse birth outcomes. However, no data on CC in the Democratic Republic of the Congo are available. We investigated the prevalence, Candida species, clinical correlates, risk factors and pregnancy outcomes in women with CC in the second trimester of pregnancy.

Material and methods

In Bukavu, the Democratic Republic of the Congo, pregnant women were recruited during antenatal care between 16 and 20 weeks of gestation from January 2017 to October 2017 and followed until delivery. Sociodemographics, sexual behavioral, hygienic and clinical characteristics, microbiological data and pregnancy outcomes were collected. Candida detection and speciation was performed with microscopy (Gram-stained smears and wet-mount) and/or quantitative PCR. Multivariate regression models were used to estimate the different associations with CC.

Results

The prevalence of CC by wet mount, microscopy of Gram-stain smears and qPCR was 27.9%, 28.1% and 38.2%, respectively. C. albicans was the most prevalent Candida species (91.0%). Previous genital infections, an intermediate vaginal microbiota, bacterial vaginosis, and the use of pit toilets were risk factors for CC. Clinically, CC was associated with itching only. Women with CC had twice the odds for preterm birth, if Candida concentration was high, the odds were four times higher.

Conclusions

In Bukavu, the Democratic Republic of the Congo, the prevalence of CC was high and associated with microbiological and modifiable risk factors. Screening and treatment for CC during antenatal care should be investigated as a possible strategy to reduce preterm birth.

Vulvovaginitis in pregnant women

• The balanced vaginal microbiome is the main factor defending the vaginal environment against infections. Lactobacilli play a key role in this regard, maintaining the vaginal pH within the normal range (3.8 to 4.5). •Hormonal and immune adaptations resulting from pregnancy influence changes in the vaginal microbiome during pregnancy. •An altered vaginal microbiome predisposes to human immunodeficiency virus (HIV) infection. •Bacterial vaginosis is the main clinical expression of an imbalanced vaginal microbiome. •Vulvovaginal candidiasis depends more on the host's conditions than on the etiological agent. •Trichomonas vaginalis is a protozoan transmitted during sexual intercourse. •The use of probiotics is not approved for use in pregnant women.

Antifungal medication use during early pregnancy and the risk of congenital heart defects in the National Birth Defects Prevention Study, 1997-2011

BACKGROUND

Fungal infections are common among pregnant people. Recent studies suggest positive associations between oral antifungals used to treat fungal infections and congenital heart defects (CHDs).

METHODS

We estimated associations between first trimester antifungal use and 20 major, specific CHDs using data from the National Birth Defects Prevention Study (NBDPS), a multi-site, case-control study that included pregnancies with estimated delivery dates from October 1997 through December 2011. Infants with CHDs ("cases") were ascertained from 10 birth defect surveillance programs. Live born infants without major birth defects ("controls") were randomly selected from birth records or hospital discharge lists. First trimester antifungal use was self-reported via maternal interview. We estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) using logistic regression with Firth's penalized likelihood.

RESULTS

First trimester antifungal use was reported by 148/11,653 (1.3%) case and 123/11,427 (1.1%) control participants. We estimated AORs for 12 CHDs; six had AORs >1.5 (tetralogy of Fallot, double outlet right ventricle with transposition of the great arteries [DORV-TGA], atrioventricular septal defect, hypoplastic left heart syndrome, pulmonary atresia, muscular ventricular septal defect), and one (pulmonary valve stenosis) had an AOR <0.7. All CIs included the null, except for DORV-TGA.

CONCLUSIONS

First trimester antifungal use was rare. We observed some positive associations for several specific CHDs in our analysis, although the CIs largely included the null. Results do not support a large increase in risk, but smaller increases in risk for certain CHD cannot be ruled out.

Antifungal medication use during pregnancy and the risk of selected major birth defects in the National Birth Defects Prevention Study, 1997-2011

PURPOSE

Recent studies suggest increased birth defect risk associated with maternal use of specific oral antifungals. We estimated associations between first-trimester antifungal use and selected non-cardiac birth defects using National Birth Defects Prevention Study (NBDPS) data.

METHODS

Participants with a pregnancy affected by a study-eligible birth defect ("cases") were ascertained from 10 birth defect surveillance programs; participants who delivered livebirths without a major birth defect ("controls") were randomly selected from birth records or hospital discharge lists. First-trimester antifungal use was self-reported via maternal interview. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for birth defects with ≥5 exposed cases using logistic regression. We estimated crude ORs and exact 95% CIs for birth defects with 3-4 exposed cases. Additionally, we conducted a probabilistic bias analysis of exposure misclassification.

RESULTS

Our analysis included 19 624 cases and 11 427 controls; 257 (1.3%) cases and 123 (1.1%) controls reported first-trimester antifungal use. Of those who reported antifungals, 62.6% of cases and 64.2% of controls reported topical antifungals; 10.1% of cases and 4.9% of controls reported oral antifungals. We observed the strongest associations for encephalocele and Dandy-Walker malformation and modestly elevated estimates for several other defects. Bias-adjusted estimates were similar to the main analysis.

CONCLUSION

First-trimester antifungal use was positively associated with several birth defects in our analysis, although CIs were imprecise. Further study is warranted to investigate associations between antifungal use and birth defects, including potential bias due to confounding by indication.

Synergistic Anticandidal Effectiveness of Greenly Synthesized Zinc Oxide Nanoparticles with Antifungal Agents against Nosocomial Candidal Pathogens

The high prevalence of fungal resistance to antifungal drugs necessitates finding new antifungal combinations to boost the antifungal bioactivity of these agents. Hence, the aim of the present investigation was to greenly synthesize zinc oxide nanoparticles (ZnO-NPs) using an aqueous leaf extract of Salvia officinalis and investigate their antifungal activity and synergistic efficiency with common antifungal agents. The biofabricated ZnO-NPs were characterized to detect their physicochemical properties. A disk diffusion assay was employed to investigate the antifungal effectiveness of the greenly synthesized ZnO-NPs and evaluate their synergistic patterns with common antifungal agents. The Candida tropicalis strain was detected to be the most susceptible strain to ZnO-NPs at both tested concentrations of 50 and 100 µg/disk, demonstrating relative suppressive zones of 19.68 ± 0.32 and 23.17 ± 0.45 mm, respectively. The minimum inhibitory concentration (MIC) of ZnO-NPs against the C. tropicalis strain was 40 µg/mL, whereas the minimum fungicidal concentration (MFC) was found to be 80 µg/mL. The highest synergistic efficiency of the biogenic ZnO-NPs with terbinafine antifungal agent was detected against the C. glabrata strain, whereas the highest synergistic efficiency was detected with fluconazole against the C. albicans strain, demonstrating relative increases in fold of inhibition area (IFA) values of 6.82 and 1.63, respectively. Moreover, potential synergistic efficiency was detected with the nystatin antifungal agent against the C. tropicalis strain with a relative IFA value of 1.06. The scanning electron microscopy (SEM) analysis affirmed the morphological deformations of candidal cells treated with the biosynthesized ZnO-NPs as the formation of abnormal infoldings of the cell wall and membranes and also the formation of pores in the cell wall and membranes, which might lead to the leakage of intracellular constituents. In conclusion, the potential synergistic efficiency of the biogenic ZnO-NPs with terbinafine, nystatin, and fluconazole against the tested candidal strains highlights the potential application of these combinations in formulating novel antifungal agents of high antimicrobial efficiency. The biogenic ZnO nanoparticles and antifungal drugs exhibit powerful synergistic efficiency, which highlights their prospective use in the formulation of efficient antimicrobial medications, including mouthwash, ointments, lotions, and creams for effective candidiasis treatment.

High diversity of yeast species and strains responsible for vulvovaginal candidiasis in South-East Gabon

OBJECTIVES

Candida albicans generally remains the principal pathogenic yeast responsible for vulvovaginal candidiasis (VVC), although with variable prevalence. In this study, we evaluated the evolution of the prevalence of the non-Candida albicans Candida (NCAC) species and investigated the genotypic diversity and the population genetic structure of the circulating C. albicans strains associated with VVC in the vicinity of Franceville (Gabon).

METHODS

A total of 110 independent isolates were identified using both MALDI-TOF MS and conventional techniques. The population genetic structure of the C. albicans strains was determined by multiple locus variable-number tandem repeat analysis using 4 microsatellite markers.

RESULTS

The mean and median age of the patients was 31 years. Seven patients had a mixed infection. C. albicans accounted for 62 % (n=68) of the total isolates. NCAC were dominated by C. glabrata, followed by P. kudriavzevii, C. parapsilosis, C. tropicalis, M. guilliermondii, and C. nivariensis. The cluster analysis revealed a high diversity, with a total of 50 different genotypes. The most represented genotype was shared by only four strains, while the vast majority (39 strains) had a unique MLVA pattern. Geographic clusters were not detected.

CONCLUSION

The study provides information on species distribution and possible changing epidemiology while reporting for the first time C. nivariensis in VVC in Africa. This study is also the first to investigate the genotypic diversity of the circulating C. albicans strains associated with VVC in Central Africa. Such analyses would help understand the molecular epidemiology of C. albicans.

Importance of Candida infection and fluconazole resistance in women with vaginal discharge syndrome in Namibia

BACKGROUND

Vaginal discharge syndrome (VDS) is a common condition. Clinical management targets sexually transmitted infections (STIs) and bacterial vaginosis (BV); there is limited focus on Candida infection as cause of VDS. Lack of Candida treatment coverage and, if present, antifungal resistance may result in VDS treatment failure. This study aimed to determine the prevalence of Candida infection, antifungal resistance, and coinfections in Namibian women with VDS.

METHODS

A cross-sectional study was performed using 253 vaginal swabs from women with VDS in Namibia. Demographic data was collected, and phenotypic and molecular detection of Candida species was performed followed by fluconazole susceptibility testing of Candida isolates. BV was diagnosed using Nugent score microscopy; molecular detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis was performed.

RESULTS

Candida species was detected in 110/253 women (43%). Ninety women (36%) had Candida albicans and 24 (9.5%) had non-albicans Candida species. The non-albicans species detected were 19 (17%) Candida glabrata, 4.0 (3.5%) Candida krusei, and 1.0 (0.9%) Candida parapsilosis. Candida albicans were more frequently isolated in younger (p = 0.004) and pregnant women (p = 0.04) compared to non-albicans Candida species. Almost all (98%) Candida albicans isolates were susceptible to fluconazole while all non-albicans Candida species were fluconazole resistant. STIs were diagnosed in 92 women (36%): 30 (12%) with C. trachomatis, 11 (4.3%) N. gonorrhoeae, and 70 (28%) T. vaginalis; 98 (39%) women had BV. Candida infection alone was diagnosed in 30 women (12%), combined with STIs in 42 women (17%) and was concurrent with BV in 38 women (15%). Candida infection was more often detected in swabs from women without C. trachomatis detected (6.4% vs. 16%; OR 0.30; 95% CI 0.10-0.77, p = 0.006).

CONCLUSIONS

The high prevalence of Candida infection, especially those due to non-albicans Candida species that are resistant to fluconazole, is a great concern in our setting and may lead to poor treatment outcomes. Access to microbiological testing for Candida species in the context of syndromic management is warranted.

First detection of mutated ERG11 gene in vulvovaginal Candida albicans isolates at Ouagadougou/Burkina Faso

Background

Vulvovaginal candidiasis is an important cause of morbidity among women due to Candida species. In the last decades, resistance to azoles, first-line antifungals has increased. One molecular mechanism of azole resistance by Candida involves mutations in the ERG11 gene encoding lanosterol 14-α-demethylase, the target enzyme. This study was conducted to identify the clinical Candida species associated in vulvovaginal candidiasis; to determine the rate of antifungal resistance among Candida albicans isolates and to determine mutated ERG11 gene at Saint Camille Hospital in Ouagadougou, Burkina Faso.

Methods

Antifungals susceptibility were performed using Kirby–Bauer disk diffusion method. ERG11 gene was detected using conventional PCR in C. albicans isolates resistant to at least one azole.

Results

Out of 262 clinical strains isolated, C. albicans accounted for 59.90%, followed by Candida glabrata 27.86%, Candida famata 7.25%, Candida tropicalis 3.05% and Saccharomyces cerevisiae 1.91%. Resistance rate of fluconazole to C. albicans was 59.54%. ERG11 gene was found in 9.79% of 92 C. albicans strains resistant to azoles.

Conclusions

This detection of mutated ERG11 gene in C. albicans is the first in Burkina Faso and may be a cause of azole resistance in recurrent Candida vulvovaginitis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07619-5.

Prevalence and Risk Factors of Vulvovaginal Candidosis during Pregnancy: A Review

Vulvovaginal candidosis (VVC) is a symptomatic vaginal yeast infection, especially caused by Candida spp. Although VVC is common among reproductive-age women, prevalence studies notice the uprise of vaginal Candida colonization to 30% during pregnancy by culture, especially in the last trimester. Recent studies have considered it a severe problem due to the emerging evidence showing the association of VVC with a higher chance of pregnancy-related complexities (e.g., preterm labor, premature rupture of membranes, congenital cutaneous candidosis, and chorioamnionitis). In this review, we have reassessed and summarized the prevalence rate of VVC in expecting mothers and analyzed the association of several factors to the increased risk of VVC during pregnancy in different regions of the world. Altogether, these data collected from various studies showed the highest prevalence of VVC during pregnancy, mostly in Asian and African countries (90.38%, 62.2%, and 61.5% in Kenya, Nigeria, and Yemen, respectively). The prevalence rate of VVC during pregnancy was also found to differ with age, gestation period, parity, educational status, and socioeconomic level. Some pregnancy-related factors (e.g., weakened immunity; elevated level of sex hormones, glycogen deposition; low vaginal pH; decreased cell-mediated immunity) and several clinical and behavioral factors can be suggested as potential risk factors of candidosis during pregnancy.

Abnormal vaginal flora correlates with pregnancy outcomes: A retrospective study from 737 pregnant women

OBJECTIVE

Abnormal vaginal flora (AVF) is a common cause of vulvovaginal symptoms in women. This study aims to investigate the prevalence of AVF in pregnant women and assess associations between diverse AVF subtypes and pregnancy outcomes.

METHODS

This study retrospectively collected clinical data of pregnant women who had vaginal flora tests (VFT) between January 2015 and December 2018 in the First Affiliated Hospital of Xi'an Jiaotong University. AVF were defined into different subtypes according to the results of VFT, including bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), aerobic bacteria (AV), cytolytic vaginosis (CV), and trichomoniasis. Pregnancy outcomes included gestational age at delivery, preterm birth (PTB), premature rupture of membranes (PROM), and infant birth weight. Student's t-test and Fisher's exact test was used for analyses using SPSS 22.0. P < 0.05 was considered as statistical significance.

RESULTS

A total of 737 pregnant women were included in this study. Pregnant women in AVF group suffered more PROM than women in normal vaginal flora (NVF) group (18.8% [33/176] vs 10.6% [32/302], P = 0.012); pregnant women with BV (31.3% [5/16] vs 10.6% [32/302], P = 0.018) and mixed vaginitis (55.6% [5/9] vs 10.6% [32/302], P = 0.001) had higher PROM rates than women in the NVF group. In addition, pregnant women in NVF and AVF groups had similar PTB rates (5.0% [15/302] vs 3.5% [32/302], P = 0.38).

CONCLUSIONS

AVF, including BV and Mixed vaginitis, augments PROM risk in pregnant women, demonstrating the need for vaginal flora examination during pregnancy.

Vaginal Exposure to Candida albicans During Early Gestation Results in Adverse Pregnancy Outcomes via Inhibiting Placental Development

Vulvovaginal candidiasis (VVC) is considered the second most common cause of vaginitis after bacterial vaginosis and the most common lower genital tract infection during pregnancy. Candida albicans (C. albicans), an opportunistic pathogen, is the major species causing VVC. Recently, increasing researches have shown that lower reproductive tract infection during pregnancy can lead to various adverse pregnancy outcomes. However, the underlying mechanisms are not fully understood. Hence, we successfully established a mouse model of vaginal C. albicans infection and characterized the adverse pregnancy outcomes. C. albicans infection strikingly increased abortion rate and decreased litter size. Further analysis of placental development demonstrated that placental structure was abnormal, including that the area of spongiotrophoblast (Spo) and labyrinth (Lab) was reduced, and the formation of placental vessel was decreased in Lab zone. Accordingly, the expression of marker genes during placental development was downregulated. Collectively, the above findings revealed that vaginal C. albicans infection during pregnancy can inhibit placental development and ultimately lead to adverse pregnancy outcomes. This study enhances our comprehension of the effect of VVC on pregnancy, and placental dysplasia as a feasible orientation to explore VVC during pregnancy.

Prevalence of vulvovaginal candidiasis in Brazil: a systematic review

Vulvovaginal candidiasis (CVV) is a condition whose signs and symptoms are related to inflammation caused by Candida spp infection. It is the second leading cause of vaginitis in the world, representing a public health problem. The present systematic review comes with the proposal of analyze and identify the available evidence on CVV prevalence in Brazil, pointing out its variability by regions. For this, a systematic literature review was carried out with meta-analysis of cross-sectional and cohort studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guide recommendations, and was registered in the International Prospective Register of Systematic Reviews (PROSPERO 2020 CRD42020181695). The databases used for survey were LILACS, Scielo, Scopus, PUBMED, Web of Science and CINAHL. Fifteen studies were selected to estimate CVV prevalence in the Brazilian territory. South and Southeast regions have higher prevalences than the North and Northeast regions, no data were found for the Midwest region. The estimated prevalence for Brazil is 18%, however, it is suggested that this number is higher due to underreporting and the presence of asymptomatic cases. Therefore, new epidemiological studies are recommended throughout Brazil, to elucidate the profile of this disease in the country, in addition to assisting in the elaboration of an appropriate prevention plan by state.

LAY ABSTRACT

Data found in the literature regarding the epidemiological profile of VVC in Brazil are obsolete and incomplete, so the present systematic review has the proposal to analyze and identify the evidence on VVC prevalence in Brazil. The estimated prevalence is 18%, however, this number can be higher.

Molecular Investigation of Etiologic Agents Causing Vulvovaginal Candidiasis

Background: Vulvovaginal candidiasis (VVC) is an ordinary infection caused by Candida species. Meanwhile, a shift towards non-albicans Candida (NAC) species has been detected in VVC patients. Objectives: This study aimed at molecular identification of Candida isolates, causing VVC. Methods: Vaginal secretion samples of 320 non-pregnant vaginitis patients at Shahid Akbar-Abadi Obstetrics and Gynecology Hospital in Tehran (Iran) were collected. Samples were evaluated using mycological and molecular approaches. Vaginitis isolates were analyzed with the PCR using NL1 and NL4 primers, and the D1/D2 region of the large-subunit rRNA gene was amplified and sequenced. Results: In total, 100 Candida isolates were identified from VVC and recurrent vulvovaginal candidiasis (RVVC). Candida albicans was the most frequent (51%), followed by C. glabrata (36%), C. krusei (Pichia kudriavzevii) (8%), and C. kefyr (Kluyveromyces marxianus) (5%). 51 and 49% of isolates had C. albicans and NAC, respectively. Conclusions: Candida albicans and C. glabrata were the most common agents of vulvovaginal candidiasis. NAC spp. (49%) was found as an important agent associated with VVC.

Prevalence of vulvovaginal candidiasis among pregnant women in the Ho municipality, Ghana: species identification and antifungal susceptibility of Candida isolates

Background

Candida is the leading cause of vaginitis, and 75% of women have at least one episode of infection in their lives, with pregnancy being a predisposing factor. If left untreated, vulvovaginal candidiasis (VVC) can lead to chorioamnionitis with subsequent abortion, prematurity and congenital infection of the neonate. We aimed to determine the prevalence of VVC, identify the recent and most frequently occurring species of Candida in pregnant women, and determine the most effective antifungal drug of choice for treatment.

Method

A prospective cross-sectional study in which 176 high vaginal swab samples of consented pregnant women visiting the antenatal clinic from February 2018 to April 2018 were subjected to direct gram smear and culture for Candida isolation. Candida isolates were identified using a germ tube test and HiCrome Candida differential agar. Candida isolates were then subjected to a disk diffusion method using fluconazole (25 μg), nystatin (100 units), and voriconazole (1 μg) on Mueller-Hinton agar supplemented with 2% (w/v) glucose and 0.5 μg/ml methylene blue dye to determine the susceptibility pattern as per the guidelines of the Clinical Laboratory Standard Institute (CLSI). Chi-square analysis was used to ascertain the significant association of participants’ sociodemographics and clinical presentations to VVC. A univariate logistic regression model was used to identify potential risk factors of VVC.

Results

The prevalence of VVC among our study participants was 30.7%. Non-albicans Candida (NAC) and Candida albicans had a prevalence of 74.1 and 25.9%, respectively. Candida glabrata was the most common species, followed by Candida albicans, Candida krusei, and Candida parapsilosis. 50.0, 18.5 and 3.7% of Candida species were susceptible to voriconazole, fluconazole and nystatin, respectively, whereas 37.0, 48.1 and 9.3% of Candida species were resistant to voriconazole, fluconazole and nystatin, respectively. The majority of isolates were susceptible dose dependent to all three antifungal agents, with voriconazole being the most efficacious antifungal agent. There was no significant association between participants’ socio-demographic information and clinical presentations to VVC.

Conclusion

The prevalence of VVC was high in the study area. C. glabrata was found to be the most common cause of VVC among the pregnant women attending antenatal clinics, in the Ho Municipality region of Ghana. The majority of the Candida isolates were susceptible and resistant to voriconazole and fluconazole, respectively.

Prevalence and antifungal susceptibility of Candida albicans causing vaginal discharge among pregnant women in Lebanon

Background

Vaginal candidiasis is frequent in pregnant women and is associated with sepsis and adverse neonatal outcomes. This study determined the prevalence of candida species in symptomatic pregnant women and evaluated the antifungal susceptibility profile of the isolated Candida strains. It also aimed to explore whether Candida species predicts gestational complications and adverse neonatal outcomes.

Methods

A total of 258 pregnant women with vaginal discharge at 35 to 37 week of gestation participated in this study. Vaginal swabs from these patients were collected at various obstetrics and gynecology clinics in Lebanon for a period of 14 months. Candida isolates were identified at species level and antifungal susceptibility of Candida albicans to fluconazole (FCZ), amphotericin B (AMB), itraconazole (ICZ) and voriconazole (VCZ) was determined by the agar-based E-test method.

Results

Among 258 women tested, 100 (39%) were positive for Candida species. C. albicans, C. glabrata and C. krusei were isolated from 42, 41 and 17% of the women, respectively. C. albicans was significantly associated only with gestational diabetes while C. krusei or C. glabrata had significant positive associations with other gestational complications. The antifungal susceptibility tests of C. albicans isolates revealed 97.5, 90, 87.5 and 97.5% susceptibility to AMB, FCZ, ICZ and VCZ, respectively.

Conclusion

The current study revealed high incidence of both C. albicans and non-C. albicans Candida strains causing vulvovaginitis among pregnant women in Beirut, Lebanon. Candida screening as antenatal follow up is advised to minimize the risk of adverse neonatal outcome or gestational complications.

Prevalence of vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis in pregnant women attending antenatal clinic in the middle belt of Ghana

Background

Vaginal infections usually caused by Candida sp, organisms responsible for bacterial vaginosis and Trichomonas vaginalis are associated with considerable discomfort and adverse outcomes during pregnancy and child birth. The study determined the prevalence of vulvovaginal candidiasis (VVC), bacterial vaginosis (BV) and trichomoniasis (TV) in pregnant women attending antenatal clinic at the Kintampo Municipal Hospital.

Methods

A study adopted a cross sectional design and recruited 589 pregnant women after seeking their informed consent from September, 2014 to March, 2015. Semi-structured questionnaire were administered to participants and vaginal swabs were collected. The samples were analysed using wet mount method and Gram stain (Nugent criteria) for vaginal infection. Univariate and multivariate analysis were used to investigate association of risk factors to vaginal infections.

Results

The overall prevalence of at least one vaginal infection was 56.4%. The prevalence of vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis were 36.5, 30.9 and 1.4% respectively. Women with more than four previous pregnancies (OR: 0.27, 95% CI: 0.13–0.58) and those in the third trimester of pregnancy (OR: 0.54, CI: 0.30–0.96) were associated with a lower risk of bacterial vaginosis. Douching and antibiotic use were neither associated with VVC or BV.

Conclusion

The prevalence of vaginal infections was high among pregnant women in the Kintampo area. There is the need for interventions such as adequate investigations and early treatment of vaginal infections to reduce the disease burden to avoid associated complications.

An Update on the Roles of Non-albicans Candida Species in Vulvovaginitis

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.

Detection of Candida species in pregnant Chinese women with a molecular beacon method

Purpose

Candida pathogens are commonly found in women and can cause vulvovaginal candidiasis (VVC), whose infection rate is further increased during pregnancy. We aimed to study the Candida prevalence and strain distribution in pregnant Chinese women with a molecular beacon assay.

Methodology

From March 2016 to February 2017, a total of 993 pregnant women attending routine antenatal visits at the Beijing Obstetrics and Gynecology Hospital were enrolled. For Candida detection and identification, a unique molecular beacon assay was presented and compared with a traditional phenotypic method. Antifungal susceptibility was tested with the following agents: 5-flucytosine, amphotericin B, fluconazole, itraconazole and voriconazole.

Results

The prevalence of Candida was found to be 21.8 % when using the molecular method and 15.0 % when using the phenotypic method. The distribution of the Candida spp. was listed in order of decreasing prevalence: Candida albicans (79.8 %), Candida glabrata (13.5 %), Candida parapsilosis (3.7 %), Candida krusei (2.2 %) and Candida tropicalis (1.1 %). We found that 90.7 % of the Candida detection results were consistent between the molecular and the phenotypic methods. In the cases where the sequencing analyses for the Candida isolates resulted in inconsistent identification, the molecular method showed higher sensitivity than the phenotypic method (96.0 vs 64.6 %). C. albicans, C. glabrata and C. parapsilosis were essentially susceptible to all five antifungal agents tested, whereas C. tropicalis and C. krusei were susceptible to voriconazole and amphotericin B.

Conclusion

By exhibiting good sensitivity and specificity, the molecular assay may offer a fast and accurate Candida screening platform for pregnant women.

Burden of Severe Fungal Infections in Burkina Faso

Because of the limited access to more powerful diagnostic tools, there is a paucity of data regarding the burden of fungal infections in Burkina Faso. The aim of this study was to estimate the incidence and prevalence of serious fungal infections in this sub-Saharan country. We primarily used the national demographic data and performed a PubMed search to retrieve all published papers on fungal infections from Burkina Faso and its surrounding West African countries. Considering the prevalence of HIV infection (0.8% of the population) and a 3.4% incidence of cryptococcosis in hospitals, it is estimated that 459 patients per year develop cryptococcosis. For pneumocystosis, it is suggested that 1013 new cases occur every year. Taking into account the local TB frequency (population prevalence at 0.052%), we estimate the prevalence of chronic pulmonary aspergillosis at 1120 cases. Severe forms of asthma with fungal sensitization and allergic bronchopulmonary aspergillosis are estimated to affect 7429 and 5628 cases, respectively. Vulvovaginal candidiasis may affect 179,000 women, and almost 1,000,000 children may suffer from tinea capitis. Globally, we estimate that roughly 1.4 million people in Burkina Faso (7.51% of the population) suffer from a serious fungal infection. These data should be used to drive future epidemiological studies, diagnostic approaches, and therapeutic strategies.

NLRP3 inflammasome is a key player in human vulvovaginal disease caused by Candida albicans

The expression of host inflammatory and Candida albicans putative virulence factors was studied in women with vulvovaginal candidiasis (VVC; twenty) or colonized by the fungus but asymptomatic (carriers; fifteen) or non-colonized asymptomatic (ten subjects). Overexpression of genes encoding NLRP3 and caspase-1 inflammasome components sharply differentiated VVC patients from asymptomatic colonized or non-colonized women. Inflammasome expression was coupled with neutrophils recruitment in the vagina of VVC women and IL-1β and IL-8 production. Both cytokines were present, though to a lower concentration, also in the vaginal fluid of colonized and non-colonized women. Secretory aspartyl proteinases (SAPs) and hyphae associated genes HWP1 and ECE1 were upregulated in VVC but with some differences among infected women. The most overexpressed SAP gene was SAP2, that correlated with neutrophils accumulation. Our data provide clinical evidence that the intracytoplasmic activation of NLRP3 inflammasome complex plays a critical, pathogenesis-relevant role in human VVC.