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Fernandes LDS, Ogasawara LS, Medina-Alarcón KP, dos Santos KS, de Matos Silva S, de Assis LR, Regasini LO, de Oliveira AG, Mendes Giannini MJS, Scarpa MV, Fusco Almeida AM. Bioprospecting, Synergistic Antifungal and Toxicological Aspects of the Hydroxychalcones and Their Association with Azole Derivates against Candida spp. for Treating Vulvovaginal Candidiasis. Pharmaceutics 2024; 16:843. [PMID: 39065540 PMCID: PMC11279727 DOI: 10.3390/pharmaceutics16070843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 07/28/2024] Open
Abstract
Vulvovaginal candidiasis (VVC) remains a prevalent fungal disease, characterized by challenges, such as increased fungal resistance, side effects of current treatments, and the rising prevalence of non-albicans Candida spp. naturally more resistant. This study aimed to propose a novel therapeutic approach by investigating the antifungal properties and toxicity of 2-hydroxychalcone (2-HC) and 3'-hydroxychalcone (3'-HC), both alone and in combination with fluconazole (FCZ) and clotrimazole (CTZ). A lipid carrier (LC) was also developed to deliver these molecules. The study evaluated in vitro anti-Candida activity against five Candida species and assessed cytotoxicity in the C33-A cell line. The safety and therapeutic efficacy of in vivo were tested using an alternative animal model, Galleria mellonella. The results showed antifungal activity of 2-HC and 3'-HC, ranging from 7.8 to 31.2 as fungistatic and 15.6 to 125.0 mg/L as fungicide effect, with cell viability above 80% from a concentration of 9.3 mg/L (2-HC). Synergistic and partially synergistic interactions of these chalcones with FCZ and CTZ demonstrated significant improvement in antifungal activity, with MIC values ranging from 0.06 to 62.5 mg/L. Some combinations reduced cytotoxicity, achieving 100% cell viability in many interactions. Additionally, two LCs with suitable properties for intravaginal application were developed. These formulations demonstrated promising therapeutic efficacy and low toxicity in Galleria mellonella assays. These results suggest the potential of this approach in developing new therapies for VVC.
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Affiliation(s)
- Lígia de Souza Fernandes
- Laboratory of Clinical Mycology, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Road Araraquara Jaú, Km 01, S/N, Araraquara 14800-903, SP, Brazil; (L.d.S.F.); (L.S.O.); (K.P.M.-A.); (K.S.d.S.); (S.d.M.S.); (M.J.S.M.G.)
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Road Araraquara Jaú, Km 01, S/N, Araraquara 14800-903, SP, Brazil; (A.G.d.O.); (M.V.S.)
| | - Letícia Sayuri Ogasawara
- Laboratory of Clinical Mycology, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Road Araraquara Jaú, Km 01, S/N, Araraquara 14800-903, SP, Brazil; (L.d.S.F.); (L.S.O.); (K.P.M.-A.); (K.S.d.S.); (S.d.M.S.); (M.J.S.M.G.)
| | - Kaila Petronila Medina-Alarcón
- Laboratory of Clinical Mycology, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Road Araraquara Jaú, Km 01, S/N, Araraquara 14800-903, SP, Brazil; (L.d.S.F.); (L.S.O.); (K.P.M.-A.); (K.S.d.S.); (S.d.M.S.); (M.J.S.M.G.)
| | - Kelvin Sousa dos Santos
- Laboratory of Clinical Mycology, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Road Araraquara Jaú, Km 01, S/N, Araraquara 14800-903, SP, Brazil; (L.d.S.F.); (L.S.O.); (K.P.M.-A.); (K.S.d.S.); (S.d.M.S.); (M.J.S.M.G.)
| | - Samanta de Matos Silva
- Laboratory of Clinical Mycology, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Road Araraquara Jaú, Km 01, S/N, Araraquara 14800-903, SP, Brazil; (L.d.S.F.); (L.S.O.); (K.P.M.-A.); (K.S.d.S.); (S.d.M.S.); (M.J.S.M.G.)
| | - Letícia Ribeiro de Assis
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (UNESP), St. Quirino de Andrade, 215, São José do Rio Preto 01049-010, SP, Brazil; (L.R.d.A.); (L.O.R.)
| | - Luís Octavio Regasini
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (UNESP), St. Quirino de Andrade, 215, São José do Rio Preto 01049-010, SP, Brazil; (L.R.d.A.); (L.O.R.)
| | - Anselmo Gomes de Oliveira
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Road Araraquara Jaú, Km 01, S/N, Araraquara 14800-903, SP, Brazil; (A.G.d.O.); (M.V.S.)
| | - Maria José Soares Mendes Giannini
- Laboratory of Clinical Mycology, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Road Araraquara Jaú, Km 01, S/N, Araraquara 14800-903, SP, Brazil; (L.d.S.F.); (L.S.O.); (K.P.M.-A.); (K.S.d.S.); (S.d.M.S.); (M.J.S.M.G.)
| | - Maria Virginia Scarpa
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Road Araraquara Jaú, Km 01, S/N, Araraquara 14800-903, SP, Brazil; (A.G.d.O.); (M.V.S.)
| | - Ana Marisa Fusco Almeida
- Laboratory of Clinical Mycology, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Road Araraquara Jaú, Km 01, S/N, Araraquara 14800-903, SP, Brazil; (L.d.S.F.); (L.S.O.); (K.P.M.-A.); (K.S.d.S.); (S.d.M.S.); (M.J.S.M.G.)
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Ardizzoni A, Wheeler RT, Pericolini E. It Takes Two to Tango: How a Dysregulation of the Innate Immunity, Coupled With Candida Virulence, Triggers VVC Onset. Front Microbiol 2021; 12:692491. [PMID: 34163460 PMCID: PMC8215348 DOI: 10.3389/fmicb.2021.692491] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022] Open
Abstract
Vulvovaginal candidiasis (VVC) is a symptomatic inflammation of the vagina mainly caused by C. albicans. Other species, such as C. parapsilosis, C. glabrata, C. tropicalis, and C. krusei, are mainly associated to the recurrent form of the disease (RVVC), although with a lower frequency. In its yeast form, C. albicans is tolerated by the vaginal epithelium, but switching to the invasive hyphal form, co-regulated with the expression of genes encoding virulence factors such as secreted aspartyl proteases (Sap) and candidalysin, allows for tissue damage. Vaginal epithelial cells play an important role by impairing C. albicans tissue invasion through several mechanisms such as epithelial shedding, secretion of mucin and strong interepithelial cell connections. However, morphotype switching coupled to increasing of the fungal burden can overcome the tolerance threshold and trigger an intense inflammatory response. Pathological inflammation is believed to be facilitated by an altered vaginal microbiome, i.e., Lactobacillus dysbiosis. Notwithstanding the damage caused by the fungus itself, the host response to the fungus plays an important role in the onset of VVC, exacerbating fungal-mediated damage. This response can be triggered by host PRR-fungal PAMP interaction and other more complex mechanisms (i.e., Sap-mediated NLRP3 activation and candidalysin), ultimately leading to strong neutrophil recruitment. However, recruited neutrophils appear to be ineffective at reducing fungal burden and invasion; therefore, they seem to contribute more to the symptoms associated with vaginitis than to protection against the disease. Recently, two aspects of the vulvovaginal environment have been found to associate with VVC and induce neutrophil anergy in vitro: perinuclear anti-neutrophil cytoplasmic antibodies (pANCA) and heparan sulfate. Interestingly, CAGTA antibodies have also been found with higher frequency in VVC as compared to asymptomatic colonized women. This review highlights and discusses recent advances on understanding the VVC pathogenesis mechanisms as well as the role of host defenses during the disease.
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Affiliation(s)
- Andrea Ardizzoni
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Robert T Wheeler
- Department of Molecular and Biomedical Sciences, University of Maine, Orono, ME, United States.,Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, United States
| | - Eva Pericolini
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Graduate School of Microbiology and Virology, University of Modena and Reggio Emilia, Modena, Italy
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Waikhom SD, Afeke I, Kwawu GS, Mbroh HK, Osei GY, Louis B, Deku JG, Kasu ES, Mensah P, Agede CY, Dodoo C, Asiamah EA, Tampuori J, Korbuvi J, Opintan JA. Prevalence of vulvovaginal candidiasis among pregnant women in the Ho municipality, Ghana: species identification and antifungal susceptibility of Candida isolates. BMC Pregnancy Childbirth 2020; 20:266. [PMID: 32375724 PMCID: PMC7201979 DOI: 10.1186/s12884-020-02963-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/21/2020] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Sayanika Devi Waikhom
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, PMB 31, Ho, Ghana.
| | - Innocent Afeke
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Grace Sefakor Kwawu
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | | | - George Yiadom Osei
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Bengyella Louis
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | - John Gameli Deku
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Emmanuel Senyo Kasu
- Public Health Department, Ho Teaching Hospital, Ho, Ghana.,Department of Biostatistics and Epidemiology, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Prosper Mensah
- Medical Laboratory Department, Ho Teaching Hospital, Ho, Ghana
| | | | - Cornelius Dodoo
- Department of Pharmaceutical Microbiology, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Emmanuel Akomanin Asiamah
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | | | - John Korbuvi
- Pharmacy Department, Ho Teaching Hospital, Ho, Ghana
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Mbakwem-Aniebo C, Osadebe AU, Athanasonny E, Okonko IO. Prevalence of Candida spp. and age-related disparities amongst women presenting with vaginitis at the Obstetrics and Gynaecology (O&G) Clinic in a Tertiary hospital in Port Harcourt, Nigeria. Afr Health Sci 2020; 20:51-58. [PMID: 33402892 PMCID: PMC7750038 DOI: 10.4314/ahs.v20i1.9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Vaginitis, an infection of the lower genital tract in women, is known to be triggered by the overgrowth of the vagina's naturally occurring microorganisms. Objective This study looked at the prevalence of Candida spp. and age-related disparities amongst women presenting with vaginitis at the Obstetrics and Gynaecology (O&G) clinic in a tertiary hospital in Port Harcourt, Nigeria. Methods One hundred high vaginal swabs were collected from pregnant and non-pregnant women and examined microscopically and microbiologically. Results Age-group 20–29 years had the highest incidence of candidal vaginitis. There was a higher occurrence of yeast cells in pregnant than in non-pregnant participants while the non-pregnant women had a greater level of bacterial cells. Forty (40) of the samples contained yeasts of Candida species representing a 40% prevalence. Three species of Candida were identified with C. albicans dominating. Of the 40 samples positive for Candida spp., 30 (75.0%) were confirmed to be C. albicans. The remaining isolates were C. tropicalis (15.0%) and C. parapsilosis (10.0%). Conclusion The findings in this study would play a role in the future management of Candida-induced vaginitis.
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Affiliation(s)
- Chiaka Mbakwem-Aniebo
- Department of Microbiology, University of Port Harcourt, P.M.B. 5323, Choba, Nigeria
| | - Anwuli Uche Osadebe
- Department of Microbiology, University of Port Harcourt, P.M.B. 5323, Choba, Nigeria
| | - Eunice Athanasonny
- Department of Microbiology, University of Port Harcourt, P.M.B. 5323, Choba, Nigeria
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Willems HME, Ahmed SS, Liu J, Xu Z, Peters BM. Vulvovaginal Candidiasis: A Current Understanding and Burning Questions. J Fungi (Basel) 2020; 6:jof6010027. [PMID: 32106438 PMCID: PMC7151053 DOI: 10.3390/jof6010027] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 12/22/2022] Open
Abstract
Candida albicans, along with other closely related Candida species, are the primary causative agents of vulvovaginal candidiasis (VVC)-a multifactorial infectious disease of the lower female reproductive tract resulting in pathologic inflammation. Unlike other forms of candidiasis, VVC is a disease of immunocompetent and otherwise healthy women, most predominant during their child-bearing years. While VVC is non-lethal, its high global incidence and profound negative impact on quality-of-life necessitates further understanding of the host and fungal factors that drive disease pathogenesis. In this review, we cover the current state of our understanding of the epidemiology, host response, fungal pathogenicity mechanisms, impact of the microbiome, and novel approaches to treatment of this most prevalent human candidal infection. We also offer insight into the latest advancements in the VVC field and identify important questions that still remain.
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Affiliation(s)
- Hubertine M. E. Willems
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (H.M.E.W.); (J.L.); (Z.X.)
| | - Salman S. Ahmed
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510641, China;
| | - Junyan Liu
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (H.M.E.W.); (J.L.); (Z.X.)
| | - Zhenbo Xu
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (H.M.E.W.); (J.L.); (Z.X.)
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510641, China;
| | - Brian M. Peters
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (H.M.E.W.); (J.L.); (Z.X.)
- Correspondence:
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Vieira de Melo AP, Zuza-Alves DL, da Silva-Rocha WP, Ferreira Canário de Souza LB, Francisco EC, Salles de Azevedo Melo A, Maranhão Chaves G. Virulence factors of Candida spp. obtained from blood cultures of patients with candidemia attended at tertiary hospitals in Northeast Brazil. J Mycol Med 2019; 29:132-139. [PMID: 30876744 DOI: 10.1016/j.mycmed.2019.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/30/2019] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Yeasts of the Candida genus are one of the most common causes of bloodstream infections associated with high rates of morbidity and mortality, mainly affecting immunocompromised patients. We aimed to identify yeasts obtained from blood cultures of patients interned at tertiary hospitals in Brazil. METHODS We evaluated some of the major virulence factors of Candida spp., including the ability to adhere to human buccal epithelial cells, biofilm formation, hemolytic and phospholipase activity. RESULTS We analyzed 70 isolates of Candida spp. obtained from March 2011 and March 2015. Candida spp. showed different peculiarities in terms of expression of virulence factors evaluated in vitro. C. albicans strains were more adherent to HBEC than all the other Candida species. C. tropicalis strains were considered strong biofilm producers. Strains belonging to the C. parapsilosis species complex were able to produce hemolysins, while C. glabrata was also able to lyse erythrocytes and to produce phospholipase. CONCLUSION These results suggest that Non-Candida albicans Candida species are also able to express virulence factors which play an important role in bloodstream infectious caused by these yeasts.
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Affiliation(s)
- A P Vieira de Melo
- Natal City, Rio Grande do Norte, Brazil; Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Brazil
| | - D L Zuza-Alves
- Natal City, Rio Grande do Norte, Brazil; Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Brazil
| | - W P da Silva-Rocha
- Natal City, Rio Grande do Norte, Brazil; Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Brazil
| | - L B Ferreira Canário de Souza
- Natal City, Rio Grande do Norte, Brazil; Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Brazil
| | - E C Francisco
- São Paulo City, Laboratório Especial de Micologia, Federal University of São Paulo, São Paulo, Brazil
| | - A Salles de Azevedo Melo
- São Paulo City, Laboratório Especial de Micologia, Federal University of São Paulo, São Paulo, Brazil
| | - G Maranhão Chaves
- Natal City, Rio Grande do Norte, Brazil; Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Brazil.
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Comparative Analysis of the Capacity of the Candida Species To Elicit Vaginal Immunopathology. Infect Immun 2018; 86:IAI.00527-18. [PMID: 30249743 DOI: 10.1128/iai.00527-18] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/12/2018] [Indexed: 01/01/2023] Open
Abstract
The human fungal pathogen Candida albicans is the major etiological agent of vulvovaginal candidiasis (VVC). Despite this fact, other non-albicans Candida (NAC) species have frequently been reported, as well. Despite their presence in the vaginal environment, little is known about their capacities to elicit immune responses classically associated with C. albicans-mediated immunopathology, including neutrophil recruitment and proinflammatory cytokine signaling. Therefore, using a combination of in vitro and in vivo approaches, we undertook a comparative analysis to determine whether a representative panel of NAC species could colonize, induce immunopathological markers, or cause damage at the vaginal mucosa. Using a murine model of VVC, C. albicans was found to induce robust immunopathology (neutrophils and interleukin 1β [IL-1β]) and elicit mucosal damage. However, all the NAC species tested (including C. dubliniensis, C. tropicalis, C. parapsilosis, C. krusei, C. glabrata, and C. auris) induced significantly less damage and neutrophil recruitment than C. albicans, despite achieving similar early colonization levels. These results largely correlated with a notable lack of ability by the NAC species (including C. dubliniensis and C. tropicalis) to form hyphae both in vitro and in vivo Furthermore, both C. dubliniensis and C. tropicalis induced significantly less expression of the ECE1 gene encoding candidalysin, a key fungal virulence determinant driving VVC immunopathology. In order to determine the relative capacities of these species to elicit inflammasome-dependent IL-1β release, both wild-type and NLRP3-/- THP-1 cells were challenged in vitro While most species tested elicited only modest amounts of IL-1β, challenge with C. albicans led to significantly elevated levels that were largely NLRP3 dependent. Collectively, our findings demonstrate that although NAC species are increasingly reported as causative agents of VVC, C. albicans appears to be exceedingly vaginopathogenic, exhibiting robust immunopathology, hypha formation, and candidalysin expression. Thus, this study provides mechanistic insight into why C. albicans is overwhelmingly the major pathogen reported during VVC.
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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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Alizadeh M, Kolecka A, Boekhout T, Zarrinfar H, Ghanbari Nahzag MA, Badiee P, Rezaei-Matehkolaei A, Fata A, Dolatabadi S, Najafzadeh MJ. Identification of Candida species isolated from vulvovaginitis using matrix assisted laser desorption ionization-time of flight mass spectrometry. Curr Med Mycol 2017; 3:21-25. [PMID: 29707675 PMCID: PMC5917097 DOI: 10.29252/cmm.3.4.21] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background and Purpose: Vulvovaginal candidiasis (VVC) is a common problem in women. The purpose of this study was to identify Candida isolates by matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) from women with vulvovaginitis that were referred to Ghaem Hospital, Mashhad, Iran. Materials and Methods: This study was conducted on 65 clinical samples isolated from women that were referred to Ghaem Hospital. All specimens were identified using phenotyping techniques, such as microscopy and culture on Sabouraud dextrose agar and corn meal agar. In addition, all isolates were processed for MALDI-TOF MS identification. Results: Out of the 65 analyzed isolates, 61 (94%) samples were recognized by MALDI-TOF MS. However, the remaining four isolates (6%) had no reliable identification. According to the results, C. albicans (58.5%) was the most frequently isolated species, followed by C. tropicalis (16.9%), C. glabrata (7.7%), C. parapsilosis (7.7%), and guilliermondii (3.1%). Conclusion: As the findings indicated, MALDI TOF MS was successful in the identification of clinical Candida species. C. albicans was identified as the most common Candida species isolated from the women with VVC. Moreover, C. tropicalis was the most common species among the non-albicans Candida species.
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Affiliation(s)
- Majid Alizadeh
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Anna Kolecka
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - Teun Boekhout
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.,Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands
| | - Hossein Zarrinfar
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohamad A Ghanbari Nahzag
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parisa Badiee
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Rezaei-Matehkolaei
- Department of Medical Mycology, School of Medicine, Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abdolmajid Fata
- Department of Parasitology and Mycology, Research Center for Cutaneous Leishmaniasis, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Somayeh Dolatabadi
- Faculty of Engineering, Sabzevar University of New Technologies, Sabzevar, Iran
| | - Mohammad J Najafzadeh
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Vijayalakshmi P, Thenmozhi S, Rajeswari P. The Evaluation of the virulence factors of clinical Candida isolates and the anti-biofilm activity of Elettaria cardamomum against multi-drug resistant Candida albicans. Curr Med Mycol 2017; 2:8-15. [PMID: 28681014 PMCID: PMC5490299 DOI: 10.18869/acadpub.cmm.2.2.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background and Purpose: Today, treatment of life-threatening fungal infections, caused by Candida species, has become a major problem. In the present study, we aimed to evaluate the antifungal susceptibility patterns of different clinical Candida isolates, determine the virulence factors in multi-drug resistant (MDR) Candida species, and assess the anti-biofilm activity of Elettaria cardamomum against MDR Candida species. Materials and Methods: A total of 202 isolates from different Candida species were obtained from three governmental hospitals in Senthamangalam, Tiruchengode, and Namakkal, Tamil Nadu, India. The isolates were identified, using conventional methods. Candida species were tested for virulence factors such as biofilm, protease, and phospholipase activity. The minimum inhibitory concentration (MIC) of Elettaria cardamomum against MDR biofilm-forming C. albicans was determined, using plate and tube methods. Results: The identified Candida isolates (n=202) were C. albicans (74/202), C. glabrata (53/202), C. parapsilosis (44/202), C. tropicalis (15/202), and C. dubliniensis (16/202). The isolates were subjected to antifungal susceptibility testing and the virulence factors were determined. In terms of biofilm production, non-C. albicans species such as C. dubliniensis showed 75% activity. Also, regarding protease activity, C. parapsilosis (75%) showed the highest percentage of protease production. In addition, Candida species showed strong positivity for phospholipase activity (62.87%). In the MIC method, the acetonic extract completely inhibited biofilm production at a concentration of 125 µl (56.25 µg). In comparison with the ethanolic extract, the acetonic extract showed major activity against biofilm production. Conclusion: Based on the findings, pathogenic C. albicans species were inhibited by the ethanolic and acetonic extracts of E. cardamomum. In recent years, MDR and biofilm-forming pathogenic Candida species have been increasingly detected in clinical settings. Therefore, herbal derivatives might contribute to the treatment of infections without causing any side-effects and prevent the associated mortality.
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Affiliation(s)
- P Vijayalakshmi
- Vivekanandha College of Arts and Sciences for Women (Autonomous), Tamil Nadu, India.,Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Hawassa University, Ethiopia
| | - S Thenmozhi
- Vivekanandha College of Arts and Sciences for Women (Autonomous), Tamil Nadu, India
| | - P Rajeswari
- Vivekanandha College of Arts and Sciences for Women (Autonomous), Tamil Nadu, India
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11
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Cymerman RM, Kaplan Hoffmann R, Rouhani Schaffer P, Pomeranz MK. Vulvar infections: beyond sexually transmitted infections. Int J Dermatol 2017; 56:361-369. [DOI: 10.1111/ijd.13464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 06/24/2016] [Accepted: 08/22/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Rachel M. Cymerman
- The Ronald O. Perelman Department of Dermatology; NYU School of Medicine; New York NY USA
| | - Rachel Kaplan Hoffmann
- The Ronald O. Perelman Department of Dermatology; NYU School of Medicine; New York NY USA
| | - Panta Rouhani Schaffer
- The Ronald O. Perelman Department of Dermatology; NYU School of Medicine; New York NY USA
| | - Miriam Keltz Pomeranz
- The Ronald O. Perelman Department of Dermatology; NYU School of Medicine; New York NY USA
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12
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Prevalence of Candidial Infections with their Antifungal Susceptibility Pattern in a Tertiary Care Hospital. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2016. [DOI: 10.22207/jpam.10.4.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Tamsikar J, Singh S, Naidu J. Prevalence of non- albicans Candida vaginitis in patients on hormonal treatment in Jabalpur, Central India. J Mycol Med 2011. [DOI: 10.1016/j.mycmed.2011.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Erdem H, Cetin M, Timuroglu T, Cetin A, Yanar O, Pahsa A. Identification of yeasts in public hospital primary care patients with or without clinical vaginitis. Aust N Z J Obstet Gynaecol 2003; 43:312-6. [PMID: 14714718 DOI: 10.1046/j.0004-8666.2003.00089.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Vaginal yeast infections are one of the most common female genital tract infections. Candida albicans is the most common infectious cause. Candida species other than C. albicans are being diagnosed with increasing frequency. The aim of the present study was to determine species of yeasts obtained from the vaginal fluid among public hospital primary care patients with or without clinical vaginitis and to evaluate the correlation of vaginal yeast colonisation with epidemiological and clinical features of applicants. METHODS Vaginal swabs from 622 women who underwent vaginal examination in a women's hospital were obtained. After isolation, identification tests were carried out on 106 yeast species. Epidemiological and clinical features of women with respect to these species were evaluated. RESULTS Of 106 yeasts isolated, 67 C. albicans, 10 C. glabrata, seven C. kefyr (pseudotropicalis), six C. tropicalis, five C. parapsilosis, five C. krusei, three Saccharomyces boulardii, one C. guillermondii, one S. cerevisiae and one Trichosporon species were identified as yeast subtypes. Of the women with C. albicans, C. glabrata, C. kefyr, C. tropicalis, C. krusei, 60, three, one, one, and one, respectively, had symptoms of vaginitis. Of women with C. albicans, C. glabrata, C. kefyr, C. tropicalis, C. parapsilosis, C. krusei, and the other species, 27, four, three, two, one, one, and one, respectively, had clinical findings of vaginitis. CONCLUSION Despite the heterogeneity of the present study group, the results support the use of vaginal culture as the most sensitive test for final diagnosis. However, a positive culture does not mean that the C. albicans is pathogenic, as it may be the normal commensal pathogen. Correlation of clinical and laboratory findings is important as it enables the administration of appropriate treatment without delay.
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Affiliation(s)
- Hakan Erdem
- Department of Infectious Diseases and Clinical Microbiology, Sivas, Turkey.
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Dostál J, Hamal P, Pavlícková L, Soucek M, Ruml T, Pichová I, Hrusková-Heidingsfeldová O. Simple method for screening Candida species isolates for the presence of secreted proteinases: a tool for the prediction of successful inhibitory treatment. J Clin Microbiol 2003; 41:712-6. [PMID: 12574271 PMCID: PMC149682 DOI: 10.1128/jcm.41.2.712-716.2003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The yeasts of the genus Candida are opportunistic pathogens associated with the rising incidence of life-threatening infections in immunocompromised individuals. Secretion of aspartic proteinases has been determined to be one of the virulence factors of the pathogenic Candida species. To analyze the extracellular proteolytic activities of a large number of Candida clinical isolates, we developed a screening system based on a solid medium containing hemoglobin as the sole nitrogen source. The cleavage of hemoglobin by the secreted proteinases results in formation of clearance zones. The visibility of such zones was enhanced by addition of an acid-base indicator. Using this system, we assessed 245 clinical isolates of Candida from patients in the hospital of the Faculty of Medicine, Palacky University, Olomouc, Czech Republic, for the presence of secreted aspartic proteases (Saps). We also used the test plates for rapid semiquantitative testing of Sap inhibitors. Most of the pepstatin analogs affected the formation of the zones of clearance as well as the growth of Candida albicans, C. tropicalis, and C. parapsilosis colonies. By contrast, the human immunodeficiency virus proteinase inhibitors saquinavir, ritonavir, nelfinavir, and indinavir had no effect on the Candida strains tested. These results are in agreement with the inhibition constants obtained for the individual inhibitors with purified Saps. Thus, the plates containing hemoglobin proved to be an appropriate tool for the rapid and reliable assessment of Sap production and inhibition.
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Affiliation(s)
- Jií Dostál
- Institute of Organic Chemistry and Biochemistry, Academy of Sciences of the Czech Republic
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