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Day T, Chapman-Burgess E, Scurry J. Clinicopathologic Overlap of Vulvar Psoriasis and Candidiasis. J Low Genit Tract Dis 2024; 28:175-182. [PMID: 38518215 DOI: 10.1097/lgt.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVES The study's aim is to assess if vulvar psoriasis and candidiasis may be distinguished by clinical presentation and histopathologic appearance. METHODS The pathology database identified biopsies with corneal or subcorneal neutrophils, acanthosis, and dermal lymphocytic infiltrate. Exclusions were age younger than 18 years and unavailable or uninterpretable slides. Clinical data included demographics, comorbid conditions, symptoms, examination, microbiology, treatment, and response. Histopathologic review documented site, thickness, and characteristics of stratum corneum and epidermis, distribution of neutrophils, and infiltrate. Cases were stratified by microbiologic presence or absence of Candida albicans. RESULTS Biopsies from 62 women with median age of 60 years were associated with C. albicans on vulvovaginal culture in 28 (45%), whereas 26 (42%) were negative, and 8 (13%) lacked microbiologic assessment. Swab-positive women were more likely to have diabetes, receive prereferral estrogen, and report vulvar pain. Specialist clinical impression was candidiasis in 33 (53%), psoriasis in 11 (18%), comorbid candidiasis and psoriasis in 7 (11%), dermatitis in 10 (16%), and unknown in 2 (3%). Visible fungal organisms occurred in 16 (26%) cases and were associated with diabetes and satellite lesions. Other than presence of organisms, there were no histopathologic differences stratified by microbiologic result. CONCLUSIONS The histopathologic triad of corneal/subcorneal neutrophils, acanthosis, and dermal lymphocytic infiltrate is common to vulvar psoriasis and candidiasis, and clinical features do not reliably distinguish between them. Microbiologic assessment and single-agent treatment are useful strategies to clarify the diagnosis.
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Affiliation(s)
| | - Erika Chapman-Burgess
- Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia
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Ranđelović M, Dimitrijević M, Otašević S, Stanojević L, Išljamović M, Ignjatović A, Arsić-Arsenijević V, Stojanović-Radić Z. Antifungal Activity and Type of Interaction of Melissa officinalis Essential Oil with Antimycotics against Biofilms of Multidrug-Resistant Candida Isolates from Vulvovaginal Mucosa. J Fungi (Basel) 2023; 9:1080. [PMID: 37998884 PMCID: PMC10672467 DOI: 10.3390/jof9111080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
(1) Background: Vulvovaginal candidosis (VVC) is a major therapy issue due to its high resistance rate and virulence factors such as the ability to form biofilms. The possibility of combining commonly used antifungals with natural products might greatly improve therapeutic success. (2) Methods: A total of 49 vulvovaginal isolates, causative agents of recurrent VVC, were tested for their susceptibility to fluconazole, nystatin, and Melissa officinalis essential oil (MOEO). This examination included testing the antibiofilm potential of antifungals and MOEO and the determination of their types of interaction with mature biofilms. (3) Results: Antimicrobial testing showed that 94.4% of the Candida albicans isolates and all the Candida krusei isolates were resistant to fluconazole, while all strains showed resistance to nystatin. The same strains were susceptible to MOEO in 0.156-2.5 mg/mL concentrations. Additionally, the results revealed very limited action of fluconazole, while nystatin and MOEO reduced the amount of biofilm formed by as much as 17.7% and 4.6%, respectively. Testing of the combined effect showed strain-specific synergistic action. Furthermore, the lower concentrations exhibited antagonistic effects even in cases where synergism was detected. (4) Conclusions: This study showed that MOEO had a very good antibiofilm effect. However, combining MOEO with antimycotics demonstrated that the type of action depended on the choice of antifungal drugs as well as the applied concentration.
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Affiliation(s)
- Marina Ranđelović
- Department of Microbiology and Immunology, Medical Faculty, University of Nis, 18000 Nis, Serbia;
- Centre of Microbiology, Public Health Institute Nis, 18000 Nis, Serbia
| | - Marina Dimitrijević
- Department of Biology, Faculty of Science and Mathematics, University of Nis, 18000 Nis, Serbia; (M.D.); (Z.S.-R.)
| | - Suzana Otašević
- Department of Microbiology and Immunology, Medical Faculty, University of Nis, 18000 Nis, Serbia;
- Centre of Microbiology, Public Health Institute Nis, 18000 Nis, Serbia
| | - Ljiljana Stanojević
- Department of Chemistry and Chemical Technology, Faculty of Technology, University of Nis, 18000 Nis, Serbia;
| | - Milica Išljamović
- Department of Dental Health Care, Health Center Niš, 18000 Nis, Serbia;
| | - Aleksandra Ignjatović
- Department of Medical Statistics and Informatics, Medical Faculty, University of Nis, 18000 Nis, Serbia;
| | | | - Zorica Stojanović-Radić
- Department of Biology, Faculty of Science and Mathematics, University of Nis, 18000 Nis, Serbia; (M.D.); (Z.S.-R.)
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Teixeira ADR, Quaresma ADV, Branquinho RT, Santos SLEN, Magalhães JTD, Silva FHRD, Marques MBDF, Moura SALD, Barboza APM, Araújo MGDF, Silva GRD. Miconazole-loaded nanoparticles coated with hyaluronic acid to treat vulvovaginal candidiasis. Eur J Pharm Sci 2023; 188:106508. [PMID: 37379779 DOI: 10.1016/j.ejps.2023.106508] [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: 04/29/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
Miconazole-loaded nanoparticles coated with hyaluronic acid (miconazole-loaded nanoparticles/HA) were developed to overcome the limitations of the conventional therapy of the vulvovaginal candidiasis (VVC). They were synthesized by emulsification and solvent evaporation techniques, characterized by diameter, polydispersity index, zeta potential, encapsulation efficiency, atomic force microscopy (AFM), evaluated in terms of efficacy against C. albicans in vitro, and tested in a murine VVC model. Nanoparticles showed 211nm of diameter with a 0.32 polydispersity index, -53mV of zeta potential, and 90% miconazole encapsulation efficiency. AFM evidenced nanoparticles with a spherical shape. They inhibited the proliferation of C. albicans in vitro and in vivo after a single administration. Nanoparticles released the miconazole directly in the site of action at low therapeutic doses, which was enough to eliminate the fungal burden in the murine VVC model. These systems were rationally designed since the existence of the HA induces their adhesion on the vaginal mucus and their internalization via CD44 receptors, inhibiting the C. albicans. Therefore, miconazole-loaded nanoparticles/HA represent an innovative non-conventional pharmaceutical dosage form to treat the VVC and recurrent VVC.
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Affiliation(s)
- Aniely Dos Reis Teixeira
- School of Pharmacy, Federal University of Ouro Preto, Ouro Preto, Minas Gerais 35400-000, Brazil
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Satora M, Grunwald A, Zaremba B, Frankowska K, Żak K, Tarkowski R, Kułak K. Treatment of Vulvovaginal Candidiasis-An Overview of Guidelines and the Latest Treatment Methods. J Clin Med 2023; 12:5376. [PMID: 37629418 PMCID: PMC10455317 DOI: 10.3390/jcm12165376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Vulvovaginal candidiasis (VVC) is a common condition associated with discomfort in affected women. Due to the presence of different forms of the disease, diverse treatment regimens are developed; the newest ones include oteseconazole and ibrexafungerp. Here, we focus on the most up-to-date recommendations regarding VVC treatment, as well as novel treatment options. Topical and oral azoles are the drugs of choice in uncomplicated mycosis. The efficacy of probiotics and substances such as TOL-463 and chlorhexidine is indicated as satisfactory; however, there are no relevant guidelines. Although the majority of researchers agree that the treatment of non-albicans VVC should be long-lasting, the recommendations are inconsistent. Another clinical problem is the treatment of VVC with azole intolerance or resistance, for which literature proposes the use of several drugs including oteseconazole, ibrexafungerp, and voriconazole. The treatment schedules for recurrent VVC include mainly fluconazole; however, alternative options such as immunotherapeutic vaccine (NDV-3A) or designed antimicrobial peptides (dAMPs) were also described. We also focused on VVC affecting pregnant women, which is a substantial challenge in clinical practice, also due to the heterogeneous relevant guidelines. Thus far, few precise recommendations are available in the literature. Future studies should focus on atypical VVC forms to elucidate the inconsistent findings.
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Affiliation(s)
- Małgorzata Satora
- Student’s Scientific Association at the I Chair and Department of Gynaecological Oncology and Gynaecology, Medical University of Lublin, Staszica 16 Str., 20-081 Lublin, Poland; (A.G.); (B.Z.); (K.F.); (K.Ż.)
| | - Arkadiusz Grunwald
- Student’s Scientific Association at the I Chair and Department of Gynaecological Oncology and Gynaecology, Medical University of Lublin, Staszica 16 Str., 20-081 Lublin, Poland; (A.G.); (B.Z.); (K.F.); (K.Ż.)
| | - Bartłomiej Zaremba
- Student’s Scientific Association at the I Chair and Department of Gynaecological Oncology and Gynaecology, Medical University of Lublin, Staszica 16 Str., 20-081 Lublin, Poland; (A.G.); (B.Z.); (K.F.); (K.Ż.)
| | - Karolina Frankowska
- Student’s Scientific Association at the I Chair and Department of Gynaecological Oncology and Gynaecology, Medical University of Lublin, Staszica 16 Str., 20-081 Lublin, Poland; (A.G.); (B.Z.); (K.F.); (K.Ż.)
| | - Klaudia Żak
- Student’s Scientific Association at the I Chair and Department of Gynaecological Oncology and Gynaecology, Medical University of Lublin, Staszica 16 Str., 20-081 Lublin, Poland; (A.G.); (B.Z.); (K.F.); (K.Ż.)
| | - Rafał Tarkowski
- I Chair and Department of Gynaecological Oncology and Gynaecology, Medical University of Lublin, Staszica 16 Str., 20-081 Lublin, Poland; (R.T.); (K.K.)
| | - Krzysztof Kułak
- I Chair and Department of Gynaecological Oncology and Gynaecology, Medical University of Lublin, Staszica 16 Str., 20-081 Lublin, Poland; (R.T.); (K.K.)
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Gerges MA, Fahmy YA, Hosny T, Gandor NH, Mohammed SY, Mohamed TMA, Abdelmoteleb NEM, Esmaeel NE. Biofilm Formation and Aspartyl Proteinase Activity and Their Association with Azole Resistance Among Candida albicans Causing Vulvovaginal Candidiasis, Egypt. Infect Drug Resist 2023; 16:5283-5293. [PMID: 37601561 PMCID: PMC10439283 DOI: 10.2147/idr.s420580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023] Open
Abstract
Background Candida albicans (C. albicans) is a major cause of vulvovaginal candidiasis (VVC), a condition that is commonly treated with azole agents. Biofilm formation and aspartyl proteinase production are important virulence factors that could be linked to azole resistance in C. albicans impeding therapy. Aim To find out the association of both factors with azole resistance among C. albicans isolated from VVC cases in Egyptian nonpregnant women of childbearing age. Patients and Methods In a cross-sectional study, C. albicans was isolated from nonpregnant females diagnosed clinically as having VVC during a 1-year study period. Susceptibility to azole agents was tested using the disc diffusion method. Biofilm formation and aspartyl proteinase production were assessed phenotypically. Additionally, two biofilm-related genes (ALS1 and HWP1) and three proteinase genes (SAP2, SAP4, and SAP6) were screened for using polymerase chain reaction (PCR). Results Among 204 C. albicans isolates, azole resistance ratios were as follows: voriconazole (30.4%), itraconazole (17.6%), fluconazole (11.3%) and econazole (6.4%). Biofilm-producing capacity was detected in 63.2% of isolates, and 63.2% were proteinase producers. The frequencies of ALS1 and HWP1 were 69.6% and 74.5%, respectively, while SAP2, SAP4, and SAP6 were 69.2%, 88.7%, and 64.7%, respectively. Biofilm formation was significantly associated with azole resistance (P < 0.001 for each tested azole agent) as was proteinase production (P < 0.001 for fluconazole, voriconazole, and econazole resistance and P = 0.047 for itraconazole). Conclusion Among nonpregnant Egyptian women of childbearing age, azole resistance in C. albicans causing VVC is significantly associated with biofilm formation and proteinase production. The development of new therapeutic agents that can target these factors is warranted.
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Affiliation(s)
- Marian A Gerges
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Yasmin Ahmed Fahmy
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Thoraya Hosny
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nessma H Gandor
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sherif Y Mohammed
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Noura E Esmaeel
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Yang M, Cao Y, Zhang Z, Guo J, Hu C, Wang Z, Du Y. Low intensity ultrasound-mediated drug-loaded nanoparticles intravaginal drug delivery: an effective synergistic therapy scheme for treatment of vulvovaginal candidiasis. J Nanobiotechnology 2023; 21:53. [PMID: 36782198 PMCID: PMC9926847 DOI: 10.1186/s12951-023-01800-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE Vulvovaginal candidiasis (VVC) is a mucosal infection of the female lower genital tract for which treatment using conventional antifungal drugs shows limited effectiveness. Herein, amphotericin B-loaded poly(lactic-co-glycolic acid)-polyethylene glycol (PLGA-PEG) nanoparticles (AmB-NPs) were fabricated and combined with low intensity ultrasound (US) to mediate AmB-NPs intravaginal drug delivery to achieve productive synergistic antifungal activity in a rabbit model of VVC. METHODS Polymeric AmB-NPs were fabricated by a double emulsion method and the physical characteristics and biosafety of nanoparticles were analyzed. The distribution and tissue permeability of nanoparticles after intravaginal ultrasound irradiation (1.0 MHz, 1.0 W/cm2, 5 min, 50% duty ratio) were observed in the vagina. The synergistic therapeutic activity of US-mediated AmB-NPs treatment was evaluated using an experimental rabbit model of VVC. Vaginal C. albicans colony counts, the pathological structure of the vagina epithelium, and Th1/Th2/Th17-type cytokine and oxidative stress levels were analyzed to investigate the therapeutic effect in vivo. RESULTS The prepared AmB-NPs showed an obvious shell and core structure with uniform size and good dispersion and displayed high biosafety and US-sensitive slow drug release. Ultrasound significantly enhanced nanoparticle transport through the mucus and promoted permeability in the vaginal tissue. US-mediated AmB-NPs treatment effectively increased drug sensitivity, even in the presence of the vaginal mucus barrier in vitro. On the seventh day after treatment in vivo, the combination treatment of AmB-NPs and US significantly reduced the fungal load in the vagina, achieving over 95% clearance rates, and also improved the pathological epithelium structural damage and glycogen secretion function. The expression of Th1 (IFN-γ, IL-2) and Th17 (IL-17) cytokines were significantly increased and Th2 (IL-6, IL-10) cytokines significantly decreased in the US + AmB-NP group. Furthermore, US-mediated AmB-NPs treatment effectively increased C. albicans intracellular reactive oxygen species (ROS) levels and promoted vaginal oxidation and antioxidants to normal levels. CONCLUSION US-mediated drug-loaded nanoparticles with intravaginal drug delivery exhibited a productive synergistic antifungal effect, which may provide a new non-invasive, safe, and effective therapy for acute or recurrent fungal vaginitis.
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Affiliation(s)
- Min Yang
- grid.203458.80000 0000 8653 0555State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016 China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016 China
| | - Yuchao Cao
- grid.203458.80000 0000 8653 0555State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016 China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016 China
| | - Zhifei Zhang
- grid.203458.80000 0000 8653 0555State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016 China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016 China
| | - Jiajun Guo
- grid.203458.80000 0000 8653 0555State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016 China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016 China
| | - Can Hu
- grid.203458.80000 0000 8653 0555State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016 China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016 China
| | - Zhibiao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China. .,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China.
| | - Yonghong Du
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China. .,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China.
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Murray MA, Penza KL, Furst JW, Pecina JL. Comparison of Virtual Management of Vulvovaginal Candidiasis to Traditional In-Person Care. Telemed J E Health 2022; 29:738-743. [PMID: 36251960 DOI: 10.1089/tmj.2022.0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Compare demographics, treatment, and follow-up rates for patients with complaints of vulvovaginitis suggestive of candida infection evaluated via e-visit, face-to-face (F2F) visits, or nurse-administered phone protocol. Methods: Manual review of 150 vaginitis visits of each visit type (e-visit, F2F, and phone protocol) completed between May 5, 2018 through January 31, 2020 by Mayo Clinic patients residing in Minnesota. Outcomes: Comparison between the three visit types of patient characteristics, treatment rates, type of treatment, follow-up rates, and types of follow-up. Results: Patients utilizing phone visits were significantly older than those seeking care via e-visit (p < 0.0001) or F2F (p = 0.001) and were more likely to be treated with oral fluconazole than those treated by e-visit (p < 0.0001) or F2F (p < 0.0001) encounters. Patients were significantly less likely to receive fungal directed treatment at a F2F visit than an e-visit (p < 0.0001) or phone encounter (p < 0.0001). There was no significant difference in follow-up rates between the three groups. Conclusion: Virtual visits (non-F2F) for suspected vulvovaginal candidiasis are unlikely to result in more follow-up visits than F2F encounters; however, prescriptions for antifungals are significantly higher with virtual visits.
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Affiliation(s)
- Martha A. Murray
- Mayo Clinic Express Care, Rochester, Minnesota, USA
- Department of Family Medicine, Employee and Community Health, Rochester, Minnesota, USA
| | - Kristine L. Penza
- Mayo Clinic Express Care, Rochester, Minnesota, USA
- Department of Family Medicine, Employee and Community Health, Rochester, Minnesota, USA
| | - Joseph W. Furst
- Department of Family Medicine, Employee and Community Health, Rochester, Minnesota, USA
| | - Jennifer L. Pecina
- Department of Family Medicine, Employee and Community Health, Rochester, Minnesota, USA
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Murina F, Lubrano C, Cappelli E, Campo M, Taraborrelli S. The role of female intimate hygiene practices in the management of vulvovaginal candidiasis: A randomized, controlled open-label trial. Health Care Women Int 2022; 44:689-700. [PMID: 35759680 DOI: 10.1080/07399332.2022.2061972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In this multicenter, observational, controlled open-label trial, researchers randomized 200 women with vulvovaginal candidiasis (VVC) to: Group 1, 6-days clotrimazole 2% vaginal cream once-daily plus 15-days concomitant acid pH thymol and zinc-containing cleansing wash (SaugellaActi3) twice-daily; Group 2, 6-days clotrimazole treatment alone. In both groups, pruritus and burning VAS scores improved from baseline at Days 6, 10 and 15. On Day 10 and Day 15, the pruritus score was significantly lower in Group 1 versus Group 2 (P <0.005 at both timepoints), suggesting acid pH thymol and zinc-containing cleansing wash ameliorates VVC-associated pruritus as part of a female hygiene regimen.
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Affiliation(s)
- Filippo Murina
- Lower Genital Tract Disease Unit, Obstetrics and Gynecology Department, V. Buzzi Hospital-University of the Study of Milan, Milan, Italy
| | - Chiara Lubrano
- Lower Genital Tract Disease Unit, Obstetrics and Gynecology Department, V. Buzzi Hospital-University of the Study of Milan, Milan, Italy
| | | | - Maria Campo
- Gynaecology and Obstetrics Hospital Unit, Giovanni Paolo II Hospital, Ragusa, Italy
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Boahen A, Than LTL, Loke YL, Chew SY. The Antibiofilm Role of Biotics Family in Vaginal Fungal Infections. Front Microbiol 2022; 13:787119. [PMID: 35694318 PMCID: PMC9179178 DOI: 10.3389/fmicb.2022.787119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
“Unity in strength” is a notion that can be exploited to characterize biofilms as they bestow microbes with protection to live freely, escalate their virulence, confer high resistance to therapeutic agents, and provide active grounds for the production of biofilms after dispersal. Naturally, fungal biofilms are inherently resistant to many conventional antifungals, possibly owing to virulence factors as their ammunitions that persistently express amid planktonic transition to matured biofilm state. These ammunitions include the ability to form polymicrobial biofilms, emergence of persister cells post-antifungal treatment and acquisition of resistance genes. One of the major disorders affecting vaginal health is vulvovaginal candidiasis (VVC) and its reoccurrence is termed recurrent VVC (RVVC). It is caused by the Candida species which include Candida albicans and Candida glabrata. The aforementioned Candida species, notably C. albicans is a biofilm producing pathogen and habitually forms part of the vaginal microbiota of healthy women. Latest research has implicated the role of fungal biofilms in VVC, particularly in the setting of treatment failure and RVVC. Consequently, a plethora of studies have advocated the utilization of probiotics in addressing these infections. Specifically, the excreted or released compounds of probiotics which are also known as postbiotics are being actively researched with vast potential to be used as therapeutic options for the treatment and prevention of VVC and RVVC. These potential sources of postbiotics are harnessed due to their proven antifungal and antibiofilm. Hence, this review discusses the role of Candida biofilm formation in VVC and RVVC. In addition, we discuss the application of pro-, pre-, post-, and synbiotics either individually or in combined regimen to counteract the abovementioned problems. A clear understanding of the role of biofilms in VVC and RVVC will provide proper footing for further research in devising novel remedies for prevention and treatment of vaginal fungal infections.
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Design, synthesis and biological studies of some new imidazole-1,2,3-triazole hybrid derivatives. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2022.132516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Hong N, Lei Y, Chen H, Chen X, Tsui KM, Hu D, Liao W, Yan L, Zhang H, Zhao R, Wu G, Yu N, Deng S. Genotyping and Drug Resistance Profile of Clinical Isolates of Candida albicans from Vulvovaginal Candidiasis in the Eastern China. Mycopathologia 2022; 187:217-224. [PMID: 35072854 PMCID: PMC9124162 DOI: 10.1007/s11046-022-00616-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/01/2022] [Indexed: 11/23/2022]
Abstract
A total of 244 Candida albicans isolates recovered from vulvovaginal candidiasis (VVC) patients in Suzhou, Eastern China, were investigated. According to CLSI documents M27-A4 and M59-3ed/M60-2ed, the MIC geometric means of nine antifungals in increasing order were micafungin (0.048 mg/L), anidulafungin (0.132 mg/L), caspofungin (0.19 mg/L), itraconazole (0.23 mg/L), posaconazole (0.25 mg/L), voriconazole (0.28 mg/L), 5-flucytosine (0.44 mg/L), amphotericin B (0.49 mg/L) and fluconazole (2.01 mg/L) respectively. Of note, 6.5% (16/244) C. albicans isolates showed resistance mainly to anidulafungin (mono-echinocandin resistance), while voriconazole had the lowest susceptibility rate of 34.8% (85/244), followed by fluconazole 59.4% (145/244), respectively. All isolates were genotyped by allelic combination of 3 microsatellite markers (CEF3, CAIII and LOC4). A total of 129 different allelic genotypes were identified, in which seven different clades were recognized with a discriminatory power of 0.96. Genotypes A-D were present in 35% of the isolates. In conclusion, decrease in antifungal drug susceptibility to C. albicans isolates from VVC is alarming. Our findings revealed the genetic diversity of C. albicans isolates among VVC patients and provided insights into the molecular epidemiology of Candida infections in China.
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Affiliation(s)
- Nan Hong
- Department of Dermatology, South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China.,Department of Dermatology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yan Lei
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huan Chen
- Department of Dermatology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiaofei Chen
- Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Kin Ming Tsui
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Danyang Hu
- Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Wanqing Liao
- Shanghai Key Laboratory of Medical Molecular Mycology, Department of Dermatology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Liang Yan
- Department of Dermatology, PLA General Hospital of Central Theater Command, Wuhan, China
| | - Hong Zhang
- Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Rongfen Zhao
- Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Gang Wu
- Nanjing Chia Tai Tianqing Pharmaceutical Co., Ltd, Nanjing, China
| | - Nong Yu
- Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Shuwen Deng
- Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China.
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12
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Hady MA, Darwish AB, Abdel-Aziz MS, Sayed OM. Design of transfersomal nanocarriers of nystatin for combating vulvovaginal candidiasis; A different prospective. Colloids Surf B Biointerfaces 2021; 211:112304. [PMID: 34959094 DOI: 10.1016/j.colsurfb.2021.112304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/26/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
The objective of this study was to prepare and evaluate Nystatin (NYS) loaded transfersomes to achieve better treatment of vulvovaginal candidiasis. Nystatin transferosomes were formulated utilizing thin film hydration method. A 32 full factorial design was employed to evaluate the effect of different formulation variables. Two independent variables were chosen; the ratio between lecithin surfactant (X1) was set at three levels (10-40), and the type of surfactants (X2) was set at three levels (Span 60, Span 85 and Pluronic F-127). The dependent responses were; entrapment efficiency (Y1: EE %), vesicles size (Y2: VS) and release rate (Y3: RR). Design Expert® software was utilized to statistically optimize formulation variables. The vesicles revealed high NYS encapsulation efficiency ranging from 97.35 ± 0.03 to 98.01 ± 0.20% whereas vesicle size ranged from 194.8 ± 20.42 to 400.8 ± 42.09 nm. High negative zeta potential values indicated good stability of the prepared formulations. NYS release from transfersomes was biphasic and the release pattern followed Higuchi's model. The optimized formulation (F7) exhibited spherical morphology under transmission electron microscopy (TEM). In-vitro and in-vivo antifungal efficiency studies revealed that the optimized formula F7 exhibited significant eradication of candida infestation in comparison to free NYS. The results revealed that the developed NYS transfersomes could be a promising drug delivery system to enhance antifungal efficacy of NYS.
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Affiliation(s)
- Mayssa Abdel Hady
- Department of Pharmaceutical Technology, National Research Centre, El Bohouth Street, Cairo12622, Egypt
| | - Asmaa B Darwish
- Department of Pharmaceutical Technology, National Research Centre, El Bohouth Street, Cairo12622, Egypt.
| | - Mohamed S Abdel-Aziz
- Microbial Chemistry Department, Genetic Engineering and Biotechnology Division, National Research Centre, El Bohouth Street, Cairo 12622, Egypt
| | - Ossama M Sayed
- Department of Pharmaceutics Industrial Pharmacy, Faculty of Pharmacy, Sinai University - Kantara Branch, Egypt.
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13
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De Seta F, Larsen B. Antimicrobial Activity of a Vaginal Gel Formulation: Considerations Related to Vaginal Infection and Dysbiosis. Pathogens 2021; 10:pathogens10121576. [PMID: 34959532 PMCID: PMC8706553 DOI: 10.3390/pathogens10121576] [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: 10/18/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Many non-prescription preparations intended to treat or alleviate symptoms of vaginal infection are available in American and European markets, but many have scant preclinical or clinical research underpinning. Respecta®Balance Gel (RBG) is marketed as an adjunct to probiotic treatment and its relevant antimicrobial properties were studied. Key findings with the manufacturer-supplied gel showed reduced turbidity in broth-dilution tests by 50% against Candida albicans and Candida glabrata at RBG concentrations 0.2-0.4% of neat product, respectively. A 50% reduction in turbidity of Escherichia coli, Streptococcus agalactiae, Enterococcus faecalis ranged from 1.6-2.2% and Gardnerella vaginalis was shown by flow cytometry counts to undergo a 50% reduction at 0.3% RBG. Propidium iodide staining indicated a rapid reduction of cell integrity of G. vaginalis almost immediately while after 4 h 45% of E. coli cells were stained. The lactic acid in BHI inhibited bacteria and yeast at concentrations ranging from 0.2-1.8% but inhibition was not solely due to pH since a 1:4 dilution of RBG resulted in a pH near neutral (6.75). Other findings showed biofilm accumulation assessed after 10-days exposure of Candida spp. to RBG and was reduced by an average of one-third (community strains) to one-half (drug-resistant strains). One excipient of the RBG, disodium EDTA, inhibited the growth of bacteria and yeast at concentrations below those present in RBG and may accentuate the activity of the host defense factor, lactoferrin. We conclude that RBG is a potent inhibitor of vaginal microorganisms relevant to vaginitis or intrapartum infections and contains excipients that may contribute to its antimicrobial activity.
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Affiliation(s)
- Francesco De Seta
- Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy;
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Bryan Larsen
- College of Osteopathic Medicine, Marian University, 3200 Cold Spring Road, Indianapolis, IN 46222, USA
- Correspondence:
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14
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Sobel R, Nyirjesy P, Ghannoum MA, Delchev DA, Azie NE, Angulo D, Harriott IA, Borroto-Esoda K, Sobel JD. Efficacy and safety of oral ibrexafungerp for the treatment of acute vulvovaginal candidiasis: a global phase 3, randomised, placebo-controlled superiority study (VANISH 306). BJOG 2021; 129:412-420. [PMID: 34676663 PMCID: PMC9299454 DOI: 10.1111/1471-0528.16972] [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: 06/03/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 01/25/2023]
Abstract
Objective To evaluate the efficacy and safety of ibrexafungerp versus placebo for acute vulvovaginal candidiasis (VVC) treatment. Design Global phase 3, randomised, placebo‐controlled superiority study. Setting Study sites in the USA (n = 19) and Bulgaria (n = 18). Population Female patients aged ≥12 years with acute VVC and a vulvovaginal signs and symptoms (VSS) score ≥4 at baseline. Methods Patients were randomly assigned 2:1 to ibrexafungerp (300 mg twice for 1 day) or placebo. Main outcome measures The primary endpoint was the percentage of patients with a clinical cure (VSS = 0) at the test‐of‐cure visit (day 11 ± 3). Secondary endpoints included percentages of patients with mycological eradication, clinical cure and mycological eradication (overall success), clinical improvement (VSS ≤1) at test‐of‐cure visit, and complete resolution of symptoms at follow‐up visit (day 25 ± 4). Results At the test‐of‐cure visit, patients receiving ibrexafungerp had significantly higher rates of clinical cure (63.3% [119/188] versus 44.0% [37/84]; P = 0.007), mycological eradication (58.5% [110/188] versus 29.8% [25/84]; P < 0.001), overall success (46.1% [82/188] versus 28.4% [23/84]; P = 0.022) and clinical improvement (72.3% [136/188] versus 54.8% [46/84]; P = 0.01) versus those receiving placebo. Symptom resolution was sustained and further increased with ibrexafungerp (73.9%) versus placebo (52.4%) at follow‐up (P = 0.001). Ibrexafungerp was generally well tolerated. Adverse events were primarily gastrointestinal and were mild to moderate in severity. Conclusions Ibrexafungerp demonstrated statistical superiority over placebo for the primary and secondary endpoints. Ibrexafungerp is a promising novel, well‐tolerated and effective oral 1‐day treatment for acute VVC. Tweetable abstract Ibrexafungerp is statistically superior to placebo for the treatment of vulvovaginal candidiasis. Ibrexafungerp is statistically superior to placebo for the treatment of vulvovaginal candidiasis. Linked article This article is commented on by KSJ Olah, p. 421–422 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17000.
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Affiliation(s)
- R Sobel
- Department of Obstetrics and Gynecology, Jefferson Vulvovaginal Health Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - P Nyirjesy
- Department of Obstetrics and Gynecology, Jefferson Vulvovaginal Health Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M A Ghannoum
- Department of Dermatology, Center for Medical Mycology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - D A Delchev
- Department of Gynaecology, MHAT Dr. Bratan Shukerov AD, Smolyan, Bulgaria
| | - N E Azie
- Departments of Clinical Development and Medical Affairs, SCYNEXIS, Inc., Jersey City, NJ, USA
| | - D Angulo
- Department of Clinical Research, SCYNEXIS, Inc., Jersey City, NJ, USA
| | - I A Harriott
- Department of Medical Affairs, SCYNEXIS, Inc., Jersey City, NJ, USA
| | | | - J D Sobel
- Infectious Diseases, Department of Internal Medicine, Wayne State University, Detroit, MI, USA
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15
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Nyirjesy P, Schwebke JR, Angulo DA, Harriott IA, Azie NE, Sobel JD. Phase 2 randomized study of oral ibrexafungerp vs fluconazole in vulvovaginal candidiasis. Clin Infect Dis 2021; 74:2129-2135. [PMID: 34555149 PMCID: PMC9258939 DOI: 10.1093/cid/ciab841] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Vulvovaginal candidiasis affects approximately 75% of women in their lifetime. Approved treatment options are limited to oral or topical azoles. Ibrexafungerp, a novel, first-in-class oral triterpenoid glucan synthase inhibitor, has demonstrated broad fungicidal Candida activity and a favorable tolerability profile. The primary objective of this dose-finding study was to identify the optimal dose of oral ibrexafungerp in patients with acute vulvovaginal candidiasis. Methods Patients with vulvovaginal signs and symptoms score ≥7 were randomized equally to 6 treatments groups: 5 treatment doses of oral ibrexafungerp or oral fluconazole 150 mg. The primary endpoint was the percentage of patients with a clinical cure (complete resolution of vulvovaginal signs and symptoms) at the test-of-cure visit (day 10). Results Overall, 186 patients were randomized into the 6 treatment groups. Results, using the modified intent-to-treat population (baseline positive culture), are reported for ibrexafungerp 300 mg twice daily (BID) for 1 day (n = 27), which was the dose selected for phase 3 studies, and fluconazole 150 mg for 1 day (n = 24). At day 10, the clinical cure rates for ibrexafungerp and fluconazole were 51.9% and 58.3%, respectively; at day 25, patients with no signs or symptoms were 70.4% and 50.0%, respectively. During the study ibrexafungerp patients required less antifungal rescue medications compared with fluconazole (3.7% vs 29.2%, respectively). Ibrexafungerp was well tolerated, with the most common treatment-related adverse events being mild gastrointestinal events. Conclusions Ibrexafungerp is a well-tolerated novel antifungal with comparable efficacy to fluconazole in the treatment of acute vulvovaginal candidiasis. Clinical Trials Registration NCT03253094
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Affiliation(s)
- Paul Nyirjesy
- Jefferson Vulvovaginal Health Center, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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Schwebke JR, Sobel R, Gersten JK, Sussman SA, Lederman SN, Jacobs MA, Chappell BT, Weinstein DL, Moffett AH, Azie NE, Angulo DA, Harriott IA, Borroto-Esoda K, Ghannoum MA, Nyirjesy P, Sobel JD. Ibrexafungerp versus placebo for vulvovaginal candidiasis treatment: a phase 3, randomized, controlled superiority trial (VANISH 303). Clin Infect Dis 2021; 74:1979-1985. [PMID: 34467969 PMCID: PMC9187327 DOI: 10.1093/cid/ciab750] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 01/20/2023] Open
Abstract
Background Current treatment of vulvovaginal candidiasis (VVC) is largely limited to azole therapy. Ibrexafungerp is a first-in-class triterpenoid antifungal with broad-spectrum anti-Candida fungicidal activity. The objective of this study was to evaluate the efficacy and safety of ibrexafungerp compared with placebo in patients with acute VVC. Methods Patients were randomly assigned 2:1 to receive ibrexafungerp (300 mg twice for 1 day) or placebo. The primary endpoint was the percentage of patients with a clinical cure (complete resolution of vulvovaginal signs and symptoms [VSS] = 0) at test-of-cure (day 11 ± 3). Secondary endpoints included the percentage of patients with mycological eradication, overall success (clinical cure and mycological eradication), clinical improvement (VSS ≤ 1) at test-of-cure, and symptom resolution at follow-up (day 25 ± 4). Results Patients receiving ibrexafungerp had significantly higher rates of clinical cure (50.5% [95/188] vs 28.6% [28/98]; P = .001), mycological eradication (49.5% [93/188] vs 19.4% [19/98]; P < .001), and overall success (36.0% [64/178] vs 12.6% [12/95]; P < .001) compared with placebo. Symptom resolution was sustained and further increased with ibrexafungerp compared with placebo (59.6% [112/188] vs 44.9% [44/98]; P = .009) at follow-up. Post hoc analysis showed similar rates of clinical cure and clinical improvement at test-of-cure for Black patients (54.8% [40/73] and 63.4% [47/73], respectively) and patients with a body mass index >35 (54.5% [24/44] and 68.2% [30/44], respectively) compared with overall rates. Ibrexafungerp was well tolerated. Adverse events were primarily gastrointestinal and mild in severity. Conclusions Ibrexafungerp provides a promising safe and efficacious oral treatment that mechanistically differs from current azole treatment options for acute VVC.
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Affiliation(s)
| | - Ryan Sobel
- Jefferson Vulvovaginal Health Center, Department of Obstetrics and Gynecology Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | - B Todd Chappell
- WR-Medical Research Center of Memphis, LLC, Memphis, TN, USA
| | | | | | | | | | | | | | - Mahmoud A Ghannoum
- Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Paul Nyirjesy
- Jefferson Vulvovaginal Health Center, Department of Obstetrics and Gynecology Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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17
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Zhao Y, Yu Z, Yue X. Evaluating the accuracy and diagnostic value of CFW and a new fluorescent reagents, fluorescent brightener 85, for the diagnosis of vulvovaginal candidiasis. J Clin Lab Anal 2021; 35:e23891. [PMID: 34251053 PMCID: PMC8373344 DOI: 10.1002/jcla.23891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/07/2021] [Accepted: 06/20/2021] [Indexed: 01/17/2023] Open
Abstract
Background Vulvovaginal candidiasis (VVC) is a common vaginitis in females. The commonly used diagnostic method, 10% potassium hydroxide (KOH) smear microscopy, makes it not very easy to recognize fungi. Methods Vaginal secretions were collected from clinically suspected VVC patients and divided into four groups and examined using KOH, CFW (Calcofluor White), FB 85(fluorescent brightener 85), and culture. The data were statistically analyzed. Results In total, 110 patients with suspected VVC were recruited. The positive rates of KOH, CFW, FB 85, and the culture method were 68.2%, 64.5%, 61.8%, and 77%, respectively. According to the McNemar test, there was no statistically significant difference between the KOH, CFW, and the FB 85 methods (p > 0.05). However, CFW had a shorter diagnosis time than the KOH method and had a statistically significant difference (p < 0.001). Moreover, CFW has the highest sensitivity, specificity, and accuracy. In morphological recognition, it was easier to recognize fungal structures with CFW and FB 85 than with the KOH. Conclusions The fluorescent method is a good method for the diagnosis of VVC. And the fungi can be found more quickly. Similar to CFW, FB 85 is also a potential good fluorescent reagent for the diagnosis of VVC and has potential value for application in clinical fungal infection diseases.
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Affiliation(s)
- Yunzhuan Zhao
- Department of Clinical LaboratoryBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Zixuan Yu
- Department of Clinical LaboratoryBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xueping Yue
- Department of DermatologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
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18
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Chandrashekar M, Philip S, Nesbitt A, Joshi A, Perera M. Sodium glucose-linked transport protein 2 inhibitors: An overview of genitourinary and perioperative implications. Int J Urol 2021; 28:984-990. [PMID: 34155680 DOI: 10.1111/iju.14624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/16/2021] [Indexed: 01/04/2023]
Abstract
Sodium glucose-linked transport protein 2 inhibitors are relatively novel drugs, used for the treatment of type 2 diabetes mellitus. Their use since Pharmaceutical Benefits Scheme approval in Australia has increased drastically, possibly due to the low risk of hypoglycemic events and their advertised cardiovascular mortality benefits. However, as with any novel drug, adverse effects regarding their use require medical practitioner awareness for optimal patient outcomes. This paper aims to cover the major urological implications, including those pertinent perioperatively, that concern this class of drugs. There is a clear risk of developing genital mycotic infections with the use of sodium glucose-linked transport protein 2 inhibitors, including serious infections such as Fournier's gangrene. Evidence for developing urinary tract infections has been mixed. Sodium glucose-linked transport protein 2 inhibitor-induced lower urinary tract symptoms may have impacts on quality of life via pollakiuria and nocturia, of which there are increased reports. Perioperative use increases the risk of euglycemic diabetic ketoacidosis. It is recommended that sodium glucose-linked transport protein 2 inhibitors be ceased perioperatively.
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Affiliation(s)
- Mohit Chandrashekar
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Stuart Philip
- Department of Urology, Mater Hospital, Brisbane, Queensland, Australia
| | - Alexander Nesbitt
- Department of Urology, Mater Hospital, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Andre Joshi
- Department of Urology, Mater Hospital, Brisbane, Queensland, Australia
| | - Marlon Perera
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Mater Hospital, Brisbane, Queensland, Australia.,Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria.,Department of Urology, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
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19
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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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20
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Bender RA, Çalışkan Ş, Önal B, Aslancan R, Çalışkan E. Treatment methods for vulvovaginal candidiasis in pregnancy. J Mycol Med 2021; 31:101138. [PMID: 33971365 DOI: 10.1016/j.mycmed.2021.101138] [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] [Received: 05/10/2020] [Revised: 02/21/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Vulvovaginal candidiasis (VVC) is one of the three most common vaginal infections of women. Our goal is to check which treatment method (vaginal or vaginal combined with oral) is more effective for each trimester to treat VVC. MATERIALS AND METHOD A retrospective analysis was performed and vaginal culture results after treatment of 61 pregnant women who were treated with vaginal or vaginal plus oral antifungals, were collected. Women were grouped according to the method were treated and the trimester they were in. Patients who had used vaginal 750 mg metronidazole + 200 mg miconazole nitrate were determined as the vaginal treatment group. Patients who had used vaginal 750 mg metronidazole + 200 mg miconazole nitrate and oral 150 mg fluconazole were determined as the vaginal plus oral treatment group. RESULTS When the patients were grouped according to treatment method, there were no significant differences in demographic characteristics except previous antibiotic use. Previous antibiotic use was significantly higher in the vaginal treatment group (p<0.05). There were no statistically significant differences between the recurrence of VVC in the vaginal and vaginal plus oral treatment group in the first, second, and third trimesters. DISCUSSION The results of the study showed that the efficiency of the vaginal treatment was the same as the vaginal plus oral treatment in all three trimesters in the aspect of VVC recurrence. Local treatment of VVC has several advantageous features when compared with oral therapy including a low rate of adverse events, safe utilization during pregnancy, and breastfeeding.
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Affiliation(s)
- Rukiye Ada Bender
- Department of Obstetrics and Gynecology, Biruni University School of Medicine, Istanbul, Turkey; Department of Obstetrics and Gynecology, Medicana International Istanbul Hospital, Istanbul, Turkey.
| | - Şeyda Çalışkan
- Department of Microbiology, Golcuk Necati Celik Public Hospital, Kocaeli, Turkey
| | - Burak Önal
- Department Medical Pharmacology, Biruni University School of Medicine, Istanbul, Turkey
| | - Reyhan Aslancan
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Eray Çalışkan
- Department of Obstetrics and Gynecology, Okan University School of Medicine, Istanbul, Turkey
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Abstract
OBJECTIVE The aim of the study was to describe the clinical and histopathologic features required for a clinicopathologic diagnosis of vulvar lichen planus (LP), which is divided into 3 types: erosive, classic, and hypertrophic. MATERIALS AND METHODS The International Society of the Study of Vulvovaginal Diseases tasked the Difficult Pathologic Diagnoses committee with development of a consensus document for the clinicopathologic diagnosis of vulvar LP, lichen sclerosus, and differentiated vulvar intraepithelial neoplasia. The LP subgroup reviewed the literature and formulated diagnostic criteria, then approved by the International Society of the Study of Vulvovaginal Diseases membership. RESULTS The clinicopathologic diagnosis of erosive LP incorporates 5 criteria: (a) a well-demarcated, glazed red macule or patch at labia minora, vestibule, and/or vagina, (b) disease affects hairless skin, mucocutaneous junction, and/or nonkeratinized squamous epithelium, (c) evidence of basal layer damage, categorized as degenerative or regenerative, (d) a closely applied band-like lymphocytic infiltrate, and (e) absent subepithelial sclerosis. The clinicopathologic diagnoses of classic and hypertrophic LP each require a characteristic clinical appearance accompanied by hyperkeratosis, hypergranulosis, acanthosis, basal layer degeneration, a closely applied lymphocytic infiltrate, and absent dermal sclerosis, with hypertrophic LP showing marked epithelial abnormality compared with classic LP. CONCLUSIONS Clinicopathological correlation yields the most reliable diagnosis of vulvar LP. Disease appearance overlaps with other physiologic, dermatologic, infectious, and neoplastic entities; a low threshold for biopsy at all morphologically distinct areas is recommended. Use of the histopathologic criteria described in this document may reduce the nondiagnostic biopsy rate for clinically diagnosed LP.
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Farr A, Effendy I, Frey Tirri B, Hof H, Mayser P, Petricevic L, Ruhnke M, Schaller M, Schaefer APA, Sustr V, Willinger B, Mendling W. Guideline: Vulvovaginal candidosis (AWMF 015/072, level S2k). Mycoses 2021; 64:583-602. [PMID: 33529414 PMCID: PMC8248160 DOI: 10.1111/myc.13248] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
Approximately 70-75% of women will have vulvovaginal candidosis (VVC) at least once in their lifetime. In premenopausal, pregnant, asymptomatic and healthy women and women with acute VVC, Candida albicans is the predominant species. The diagnosis of VVC should be based on clinical symptoms and microscopic detection of pseudohyphae. Symptoms alone do not allow reliable differentiation of the causes of vaginitis. In recurrent or complicated cases, diagnostics should involve fungal culture with species identification. Serological determination of antibody titres has no role in VVC. Before the induction of therapy, VVC should always be medically confirmed. Acute VVC can be treated with local imidazoles, polyenes or ciclopirox olamine, using vaginal tablets, ovules or creams. Triazoles can also be prescribed orally, together with antifungal creams, for the treatment of the vulva. Commonly available antimycotics are generally well tolerated, and the different regimens show similarly good results. Antiseptics are potentially effective but act against the physiological vaginal flora. Neither a woman with asymptomatic colonisation nor an asymptomatic sexual partner should be treated. Women with chronic recurrent Candida albicans vulvovaginitis should undergo dose-reducing maintenance therapy with oral triazoles. Unnecessary antimycotic therapies should always be avoided, and non-albicans vaginitis should be treated with alternative antifungal agents. In the last 6 weeks of pregnancy, women should receive antifungal treatment to reduce the risk of vertical transmission, oral thrush and diaper dermatitis of the newborn. Local treatment is preferred during pregnancy.
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Affiliation(s)
- Alex Farr
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Isaak Effendy
- Klinikum Bielefeld Rosenhohe, Department of Dermatology and Allergology, Bielefeld, Germany
| | | | - Herbert Hof
- Labor Dr. Limbach und Kollegen, Heidelberg, Germany
| | - Peter Mayser
- Facharzt für Dermatologie und Allergologie, Biebertal, Germany
| | - Ljubomir Petricevic
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Markus Ruhnke
- Department of Hematology, Oncology and Palliative Medicine, Helios Hospital Aue, Aue, Germany
| | - Martin Schaller
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Valentina Sustr
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Birgit Willinger
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Werner Mendling
- Deutsches Zentrum fuer Infektionen in Gynaekologie und Geburtshilfe, Wuppertal, Germany
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Chindamo G, Sapino S, Peira E, Chirio D, Gallarate M. Recent Advances in Nanosystems and Strategies for Vaginal Delivery of Antimicrobials. NANOMATERIALS 2021; 11:nano11020311. [PMID: 33530510 PMCID: PMC7912580 DOI: 10.3390/nano11020311] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 02/08/2023]
Abstract
Vaginal infections such as bacterial vaginosis (BV), chlamydia, gonorrhea, genital herpes, candidiasis, and trichomoniasis affect millions of women each year. They are caused by an overgrowth of microorganisms, generally sexually transmitted, which in turn can be favored by alterations in the vaginal flora. Conventional treatments of these infections consist in systemic or local antimicrobial therapies. However, in the attempt to reduce adverse effects and to contrast microbial resistance and infection recurrences, many efforts have been devoted to the development of vaginal systems for the local delivery of antimicrobials. Several topical dosage forms such as aerosols, lotions, suppositories, tablets, gels, and creams have been proposed, although they are sometimes ineffective due to their poor penetration and rapid removal from the vaginal canal. For these reasons, the development of innovative drug delivery systems, able to remain in situ and release active agents for a prolonged period, is becoming more and more important. Among all, nanosystems such as liposomes, nanoparticles (NPs), and micelles with tunable surface properties, but also thermogelling nanocomposites, could be exploited to improve local drug delivery, biodistribution, retention, and uptake in vulvovaginal tissues. The aim of this review is to provide a survey of the variety of nanoplatforms developed for the vaginal delivery of antimicrobial agents. A concise summary of the most common vaginal infections and of the conventional therapies is also provided.
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24
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Rodríguez-Cerdeira C, González-Cespón JL, Martínez-Herrera E, Carnero-Gregorio M, López-Barcenas A, Sergeev A, Saunte DM. Candida infections in patients with psoriasis and psoriatic arthritis treated with interleukin-17 inhibitors and their practical management. Ital J Dermatol Venerol 2020; 156:545-557. [PMID: 33026212 DOI: 10.23736/s2784-8671.20.06580-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Interleukin 17A (IL-17A) is a pro-inflammatory cytokine produced by helper T cells (Th17) and other cells of the immune system and exerts pleiotropic effects on multiple cell lines. The role of IL-17 in the pathogenesis of numerous inflammatory disorders is well-documented. IL-17 activates signaling through the IL-17 receptor, which induces other proinflammatory cytokines, antimicrobial peptides, and neutrophil chemokines that are important for antifungal activity. EVIDENCE ACQUISITION Healthy levels of IL-17 can protect the host against extracellular bacterial and fungal infections in mucous membranes and epithelia. IL-17 deficiency reduces control of certain infections, while excessive IL-17 can produce unwanted inflammatory effects. EVIDENCE SYNTHESIS Although the efficacy of the therapeutic blockade of this cytokine has been proven in several autoimmune diseases such as psoriasis and psoriatic arthritis, this strategy could also exacerbate fungal infections in such patients. Therefore, a better understanding of IL-17-mediated immunity to Candida is necessary for the development of autoimmune therapeutics that maintain antifungal immunity. CONCLUSIONS In this review, we include a study of the new anti-IL-17 biological agents (secukinumab, ixekizumab, and bromalizumab) used for moderate-to-severe psoriasis and psoriatic arthritis treatment in clinical practice, as well as pivotal trials with bimekizumab. We study the relationship of these biological agents and the appearance of candidiasis in its various clinical forms.
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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, University of Vigo, Vigo, Spain - .,Psychodermatology Task Force of the Ibero-Latin American College of Dermatology (CILAD), Buenos Aires, Argentina - .,European Academy of Dermatology and Venereology (EADV), Lugan, Switzerland -
| | - José L González-Cespón
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Health Research Institute SERGAS-UVIGO, Vigo, Spain
| | - Erick Martínez-Herrera
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Health Research Institute SERGAS-UVIGO, Vigo, Spain.,Psychodermatology Task Force of the Ibero-Latin American College of Dermatology (CILAD), Buenos Aires, Argentina
| | - 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 and NGS Division), Institute of Cellular and Molecular Studies - ICM, Lugo, Spain
| | | | - Alexey Sergeev
- European Academy of Dermatology and Venereology (EADV), Lugan, Switzerland.,Central Research Dermatology Clinic Dmitrovskoe, Moscow, Russia
| | - Ditte M Saunte
- European Academy of Dermatology and Venereology (EADV), Lugan, Switzerland.,Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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25
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Mendling W, Atef El Shazly M, Zhang L. Clotrimazole for Vulvovaginal Candidosis: More Than 45 Years of Clinical Experience. Pharmaceuticals (Basel) 2020; 13:E274. [PMID: 32992877 PMCID: PMC7600851 DOI: 10.3390/ph13100274] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
Vulvovaginal candidosis is a common disease, and various treatment strategies have emerged over the last few decades. Clotrimazole belongs to the drugs of choice for the treatment of vulvovaginal candidosis. Although available for almost 50 years, systematic reviews on the usefulness of topical clotrimazole across disease severity and populations affected are scarce. Thus, we conducted a systematic literature search in the PubMed and Embase databases to summarize the effectiveness and safety of topical clotrimazole in the treatment of uncomplicated (acute) and complicated vulvovaginal candidosis. In total, 37 randomized controlled studies in women suffering from vaginal yeast infections qualified for inclusion in our review. In women with uncomplicated vulvovaginal candidosis, single intravaginal doses of clotrimazole 500 mg vaginal tablets provided high cure rates and were as effective as oral azoles. A single dose of clotrimazole 500 mg was equipotent to multiple doses of lower dose strengths. Prolonged treatment regimens proved to be effective in severe and recurrent cases as well as in symptomatic pregnant women. It is therefore expected that in the general population, clotrimazole will continue to be widely used in the field of vaginal health in the upcoming years; more so as clotrimazole resistance in vaginal candidosis is rare.
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Affiliation(s)
- Werner Mendling
- German Center for Infections in Obstetrics and Gynaecology, Heusnerstrasse 40, D-42283 Wuppertal, Germany;
| | | | - Lei Zhang
- Bayer Consumer Care AG, Peter Merian-Strasse 84, CH-4002 Basel, Switzerland;
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26
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Mochizuki T, Tsuboi R, Iozumi K, Ishizaki S, Ushigami T, Ogawa Y, Kaneko T, Kawai M, Kitami Y, Kusuhara M, Kono T, Sato T, Sato T, Shimoyama H, Takenaka M, Tanabe H, Tsuji G, Tsunemi Y, Hata Y, Harada K, Fukuda T, Matsuda T, Maruyama R. Guidelines for the management of dermatomycosis (2019). J Dermatol 2020; 47:1343-1373. [DOI: 10.1111/1346-8138.15618] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 01/19/2023]
Affiliation(s)
| | - Ryoji Tsuboi
- Department of Dermatology Tokyo Medical University TokyoJapan
| | - Ken Iozumi
- Department of Dermatology Tokyo Metropolitan Police Hospital TokyoJapan
| | - Sumiko Ishizaki
- Department of Dermatology Tokyo Women’s Medical University Medical Center East TokyoJapan
| | | | - Yumi Ogawa
- Department of Dermatology Juntendo University TokyoJapan
| | - Takehiko Kaneko
- Graduate School of Human Ecology Wayo Women’s University IchikawaJapan
| | - Masaaki Kawai
- Department of Dermatology Juntendo University Koshigaya Hospital KoshigayaJapan
| | - Yuki Kitami
- Department of Dermatology Showa University TokyoJapan
| | | | - Takeshi Kono
- Department of Dermatology Nippon Medical School Chibahokusoh Hospital InzaiJapan
| | | | - Tomotaka Sato
- Department of Dermatology Teikyo University Medical Center IchiharaJapan
| | - Harunari Shimoyama
- Department of Dermatology Teikyo University Mizonokuchi Hospital KawasakiJapan
| | - Motoi Takenaka
- Department of Dermatology Nagasaki University NagasakiJapan
| | | | - Gaku Tsuji
- Department of Dermatology Kyushu UniversityGraduate School of Medical Sciences FukuokaJapan
| | - Yuichiro Tsunemi
- Department of Dermatology Saitama Medical University MoroyamaJapan
| | - Yasuki Hata
- Kanagawa Hata Dermatology Clinic YokohamaJapan
| | | | - Tomoo Fukuda
- Department of Dermatology Saitama Medical Center KawagoeJapan
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27
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Campos LM, de Oliveira Lemos AS, da Cruz LF, de Freitas Araújo MG, de Mello Botti GCR, Júnior JLR, Rocha VN, Denadai ÂML, da Silva TP, Tavares GD, Scio E, Fabri RL, Pinto PF. Development and in vivo evaluation of chitosan-gel containing Mitracarpus frigidus methanolic extract for vulvovaginal candidiasis treatment. Biomed Pharmacother 2020; 130:110609. [PMID: 34321177 DOI: 10.1016/j.biopha.2020.110609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/22/2020] [Accepted: 08/02/2020] [Indexed: 02/08/2023] Open
Abstract
Vulvovaginal candidiasis (VVC) is characterized by inflammatory changes in the vaginal mucosa caused by abnormal colonization of Candida species. Traditional topical therapies using reference antifungal drugs usually present several issues and limitations for VVC treatment. Thus, the interest in new vaginal formulations, mainly those based on compounds from natural origin, has been growing over the last years. Methanolic extract from the plant species Mitracarpus frigidus (Willd. Ex Reem Schult.) K. Schum (MFM) has presented potential antifungal activity against C. albicans vaginal infection. Here, we aimed to develop and characterize a gynecological gel formulation based on chitosan containing MFM and to evaluate its anti-C. albicans effectiveness in the treatment of VVC. First, MFM was incorporated into a gel formulation based on chitosan in three final concentrations: 2.5 %, 5.0 %, and 10.0 %. Next, these gel formulations were subjected to stationary and oscillatory rheological tests. Finally, the gel was tested in an experimental VVC model. The rheological tests indicated pseudoplastic fluids, becoming more viscous and elastic with the increase of the extract concentration, indicating intermolecular interactions. Our in vivo analyses demonstrated a great reduction of vulvovaginal fungal burden and infection accompanied with the reduction of mucosal inflammation after MFM chitosan-gel treatment. The present findings open perspectives for the further use of the MFM-chitosan-gel formulation as a therapeutic alternative for VVC treatment.
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Affiliation(s)
- Lara Melo Campos
- Bioactive Natural Products Laboratory and Protein Structure and Function Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Ari Sérgio de Oliveira Lemos
- Bioactive Natural Products Laboratory and Protein Structure and Function Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Luisa Ferreira da Cruz
- Laboratory of Pharmacology, Federal University of São João Del-Rei, Campus Centro Oeste Dona Lindu, Divinópolis, MG, Brazil
| | | | | | - Janildo Ludolf Reis Júnior
- Department of Veterinary Medicine, Faculty of Medicine, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Vinícius Novaes Rocha
- Department of Veterinary Medicine, Faculty of Medicine, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Ângelo Márcio Leite Denadai
- Department of Pharmacy, Institute of Life Sciences, Federal University of Juiz de Fora, Campus Governador Valadares, Governor Valadares, MG, Brazil
| | - Thiago Pereira da Silva
- Laboratory of Cellular Biology, Department of Biology, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Guilherme Diniz Tavares
- Laboratory of Nanostructured Systems Development, Department of Pharmaceutical Science, Faculty of Pharmacy, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Elita Scio
- Bioactive Natural Products Laboratory and Protein Structure and Function Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
| | - Rodrigo Luiz Fabri
- Bioactive Natural Products Laboratory and Protein Structure and Function Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil.
| | - Priscila Faria Pinto
- Bioactive Natural Products Laboratory and Protein Structure and Function Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Campus, Juiz de Fora, MG, Brazil
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28
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Xu L, Hu Z, Yu F, Tang Y. Analysis of characteristics of vulvo-vaginal infections in 14- to 18-year-old girls in late puberty. J Int Med Res 2020; 48:300060520946506. [PMID: 32790515 PMCID: PMC7543224 DOI: 10.1177/0300060520946506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective This study aimed to determine the characteristics of vulvo-vaginal infections in 14- to 18-year-old girls in late puberty. Methods From July 2016 to June 2019, 487 14- to 18-year-old girls with vulvo-vaginal infection in late puberty in West China Second University Hospital were retrospectively studied. The incidence of bacterial vaginosis (BV), the intermediate type of BV, vulvo-vaginal candidiasis (VVC), Trichomonas vaginalis (TV), and differences among the incidence of these infections for patients with different ages were analyzed. Results The incidence of BV, the intermediate type of BV, TV, VVC, and unknown pathogenic vaginitis was 25.67%, 19.30%, 2.46%, 29.37%, and 23.20%, respectively. The incidence of BV and VVC was significantly higher than that of TV. The incidence of BV in the 17-year-old group was significantly higher than that in other age groups. The incidence of VVC and non-albicans Candida infection in the 17- and 18-year-old groups was significantly higher than that in the 14-year-old group. Conclusion Girls in late puberty are more susceptible to suffer from BV and VVC than TV infections. Therefore, more attention should be paid to the effects of menstrual hygiene, female estrogen levels, the vaginal internal environment, and hygiene in vulvo-vaginal infection at this stage.
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Affiliation(s)
- Ling Xu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Zhengqiang Hu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Fan Yu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yuanting Tang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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29
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Ignjatović A, Arsić-Arsenijević V, Golubović M, Đenić S, Momčilović S, Trajković A, Ranđelović M, Ćirić V, Otašević S. Recurrent Vulvovaginal Candidosis and Cluster Analysis of Clinical Signs and Symptoms: A Laboratory-Based Investigation. J Fungi (Basel) 2020; 6:jof6030113. [PMID: 32707751 PMCID: PMC7559823 DOI: 10.3390/jof6030113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 12/18/2022] Open
Abstract
Recurrent vulvovaginal candidosis (RVVC) represents a major health problem that significantly affects a patient’s quality of life (QoL). This infection presents with a plethora of clinical manifestation, and this is the first study that carries out a cluster analysis of these signs and symptoms (SS). The goals are to evaluate the distribution of species causing RVVC, their in-vitro susceptibility to antifungals, and the patient’s QoL. Additionally, the clinical characteristics are analyzed using cluster analysis. Prospective analysis of data was performed for women diagnosed with RVVC in the period from January 2016 to December 2019 based on the analysis of data from a single-center’s records. The standard mycological methods and antifungal susceptibility testing were done. Clinical characteristics and QoL were examined by appropriate questions. The cluster analysis was used to identify clusters of SS. A total of 320 women were diagnosed. The dominant species was Candida (C.) albicans. Non-albicans Candida (NAC) yeast was found in 24.4%, and the most common was C. glabrata. Interestingly, Saccharomyces (S.) cerevisiae was detected in 2%. All of the isolated species, except C. parapsilosis and C. kefyr, demonstrated reduced susceptibility to antifungals. We confirmed the emergence of the NAC species and S. cerevisiae with reduced susceptibility to antifungals. Cluster analysis represented by a dendrogram revealed three SS clusters: irritation, uncommon, and discharge, but further studies are needed to examine the relationship between clusters, Candida strains, and outcomes.
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Affiliation(s)
- Aleksandra Ignjatović
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Niš, 18000 Niš, Serbia;
- Public Health Institute Niš, 18000 Niš, Serbia; (M.R.); (S.O.)
| | - Valentina Arsić-Arsenijević
- Department of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-63327564
| | - Milan Golubović
- Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (M.G.); (S.Đ.); (S.M.)
- Clinic of Pediatrics, Clinical Center Niš, 18000 Niš, Serbia
| | - Saša Đenić
- Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (M.G.); (S.Đ.); (S.M.)
- Center for Radiology, Clinical Center Nis, 18000 Niš, Serbia
| | - Stefan Momčilović
- Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (M.G.); (S.Đ.); (S.M.)
- Plastic and Reconstructive Surgery Clinic, Clinical Center Niš, 18000 Niš, Serbia
| | | | - Marina Ranđelović
- Public Health Institute Niš, 18000 Niš, Serbia; (M.R.); (S.O.)
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
| | - Vojislav Ćirić
- Department of Internal Medicine, Faculty of Medicine, University of Niš, 18000 Niš, Serbia;
| | - Suzana Otašević
- Public Health Institute Niš, 18000 Niš, Serbia; (M.R.); (S.O.)
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
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30
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Gómez-Gaviria M, Mora-Montes HM. Current Aspects in the Biology, Pathogeny, and Treatment of Candida krusei, a Neglected Fungal Pathogen. Infect Drug Resist 2020; 13:1673-1689. [PMID: 32606818 PMCID: PMC7293913 DOI: 10.2147/idr.s247944] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 05/28/2020] [Indexed: 12/22/2022] Open
Abstract
Fungal infections represent a constant and growing menace to human health, because of the emergence of new species as causative agents of diseases and the increment of antifungal drug resistance. Candidiasis is one of the most common fungal infections in humans and is associated with a high mortality rate when the fungi infect deep-seated organs. Candida krusei belongs to the group of candidiasis etiological agents, and although it is not isolated as frequently as other Candida species, the infections caused by this organism are of special relevance in the clinical setting because of its intrinsic resistance to fluconazole. Here, we offer a thorough revision of the current literature dealing with this organism and the caused disease, focusing on its biological aspects, the host-fungus interaction, the diagnosis, and the infection treatment. Of particular relevance, we provide the most recent genomic information, including the gene prediction of some putative virulence factors, like proteases, adhesins, regulators of biofilm formation and dimorphism. Moreover, C. krusei veterinary aspects and the exploration of natural products with anti-C. krusei activity are also included.
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Affiliation(s)
- Manuela Gómez-Gaviria
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, Gto, México
| | - Héctor M Mora-Montes
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, Gto, México
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31
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Donders G, Bellen G, Oerlemans E, Claes I, Ruban K, Henkens T, Kiekens F, Lebeer S. The use of 3 selected lactobacillary strains in vaginal probiotic gel for the treatment of acute Candida vaginitis: a proof-of-concept study. Eur J Clin Microbiol Infect Dis 2020; 39:1551-1558. [PMID: 32356027 DOI: 10.1007/s10096-020-03868-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
In vitro studies suggest that certain probiotic bacterial strains have potential activity against opportunistic infections such as Candida. There are few in vivo trials using probiotics as a single treatment for acute Candida vulvovaginitis (CV). In this open-label, proof-of-concept study, selected Lactobacillus strains were tested in women with acute Candida vaginitis. Twenty women diagnosed with proven, symptomatic CV were instructed to administer a vaginal probiotic gel with L. plantarum YUN-V2.0, L. pentosus YUN-V1.0 and L. rhamnosus YUN-S1.0 for 10 consecutive days. Vaginal rinsing fluid, vaginal culture swab and vaginal smear for fresh wet-mount microscopy were collected before and 7, 14 and 28 days after start of treatment. On average, participating women were 39 years old and had an history of 5 vaginal infections of which 95% was CV. Nine women (45%) completed the study without the need of rescue medication. Women who needed rescue treatment experienced twice as much Candida infections in the past. A negative correlation was found between the clinical composite score and the time to use rescue medication (R2 = 0.127). Seventy-four per cent of participants found the study gel comfortable to use, and 42% of all women would use the tested gel again for this indication. Forty-five per cent of women were treated successfully for acute CV with a novel vaginal gel containing 3 selected Lactobacillus strains. Patients needing rescue treatment were suffering from more severe and long-standing disease. These results warrant for further testing of this new product, especially of its potential in cases with mild to moderate severity, as an adjuvant to antimycotics or as a preventive measure in women with recurrent vulvovaginal candidosis.
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Affiliation(s)
- Gilbert Donders
- Femicare, Clinical Research for Women, Gasthuismolenstraat 31, 3300, Tienen, Belgium. .,Department of Gynaecology and Obstetrics, University Hospital of Antwerp, Antwerp, Belgium.
| | - Gert Bellen
- Femicare, Clinical Research for Women, Gasthuismolenstraat 31, 3300, Tienen, Belgium
| | - Eline Oerlemans
- Department of Bioscience Engineering, Research group Environmental Ecology and Microbiology, University of Antwerp, Antwerp, Belgium
| | - Ingmar Claes
- Department of Bioscience Engineering, Research group Environmental Ecology and Microbiology, University of Antwerp, Antwerp, Belgium.,YUN NV, Aartselaar, Belgium
| | - Kateryna Ruban
- Femicare, Clinical Research for Women, Gasthuismolenstraat 31, 3300, Tienen, Belgium
| | - Tim Henkens
- Department of Pharmaceutical, Biomedical and Veterinary Sciences, Laboratory of Pharmaceutical Technology and Biopharmacy, University of Antwerp, Antwerp, Belgium
| | - Filip Kiekens
- Department of Pharmaceutical, Biomedical and Veterinary Sciences, Laboratory of Pharmaceutical Technology and Biopharmacy, University of Antwerp, Antwerp, Belgium
| | - Sarah Lebeer
- Department of Bioscience Engineering, Research group Environmental Ecology and Microbiology, University of Antwerp, Antwerp, Belgium
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Woelber L, Prieske K, Mendling W, Schmalfeldt B, Tietz HJ, Jaeger A. Vulvar pruritus-Causes, Diagnosis and Therapeutic Approach. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:126-133. [PMID: 32181734 DOI: 10.3238/arztebl.2020.0126] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 05/16/2019] [Accepted: 11/27/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND In Germany, 17-23% of the population suffers from chronic itching of the skin; in 5-10% of cases, the female genitalia are affected, specifically, the vulva. Vulvar pruritus is thus a common symptom that often markedly impairs the affected women's quality of life. METHODS This review is based on pertinent publications that were retrieved by a selective search in MEDLINE/PubMed for articles on the pathogenesis, diagnosis, and treatment of vul- var pruritus. The search terms were (in German and English) "vulvärer Juckreiz," "pruritus vulvae," and "genital itch," alone and in combination with "Behandlung," "Therapie," or "treat- ment." RESULTS The most common cause of vulvar pruritus is vulvo- vaginal candidiasis followed by chronic dermatoses, such as lichen sclerosus and vulvar eczema. Especially in refractory cases, an invasive or preinvasive lesion such as squamous epithelial dysplasia (VIN, vulvar intraepithelial neoplasia) should be borne in mind in the differential diagnosis. Rarer causes include infection, atrophy, and vulvodynia. The essen- tial elements of treatment are topical/oral antimycotic drugs and high-potency glucocorticoids, along with consistently ap- plied, basic moisturizing care and the avoidance of potential triggering factors. CONCLUSION As vulvar pruritus has multiple causes, standard- ization of its diagnostic evaluation and treatment would be l efficacy and to meet the diverse needs of women who suffer from this condition.
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Affiliation(s)
- Linn Woelber
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infections in Gynecology and Obstetrics, Wuppertal, Germany; Institute of Fungal Disease and Internal Medicine, Mycoclinic Berlin, Berlin, Germany
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Rodrigues Costa A, Bezerra JWA, Pereira da Cruz R, de Freitas MA, da Silva VB, Neto JC, dos Santos ATL, Bezerra Morais Braga MF, da Silva LA, Ivaneide Rocha M, Kamdem JP, Iriti M, Vitalini S, Duarte AE, Barros LM. In vitro Antibiotic and Modulatory Activity of Mesosphaerum suaveolens (L.) Kuntze against Candida strains. Antibiotics (Basel) 2020; 9:E46. [PMID: 32012710 PMCID: PMC7168177 DOI: 10.3390/antibiotics9020046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 11/24/2022] Open
Abstract
The emergence of fungal resistance to commercial drugs has been a major problem for the WHO. In this context, research with natural products is promising in the discovery of new active substances. Thus, this work evaluated the antifungal effect of a medicinal plant (i.e., Mesosphaerum suaveolens) against strains of the genus Candida, tested the combined effect with the drug fluconazole, and, finally, determined the phenolic constituents present in the species. Initially, aqueous extracts of leaves (AELMs) and aerial parts (AEAPMs) of the species were prepared. For microbiological assays, the minimum fungicidal concentration was determined by broth microdilution, and the combined effect of fluconazole extracts were verified by sub-inhibitory microdilution concentrations (CFM/8) followed by spectrophotometric readings which were used to determine the IC50. HPLC detected the presence of flavonoids and phenolic acids, detecting eight compounds present in the samples of which caffeic acid and quercetin were major components. The AELMs modulated fluconazole activity since it decreased fluconazole's IC50 from 7.8 µg/mL to an IC50 of 4.7 µg/mL (CA LM 77) and from 28.8 µg/mL to 18.26 µg/mL (CA INCQS 40006) for the C. albicans strains. The AEAPMs were able to potentiate the effect of fluconazole more effectively than the AELMs. Such an effect was significant for the 16 µg/mL concentration for CA LM 77 and 32 µg/mL for CA INCQS 40006. The AEAPMs as well as the AELMs presented clinically relevant activities for C. tropicalis strains. For the C. tropicalis LM 23 strain, the AEPMs obtained an IC50 of 25 µg/mL and the AELMs an IC50 of 359.9 µg/mL.
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Affiliation(s)
- Adrielle Rodrigues Costa
- Postgraduate Program in Molecular Bioprospecting, Regional University of Cariri (URCA), Crato 63122-290, CE, Brazil; (A.R.C.); (V.B.d.S.)
| | | | - Rafael Pereira da Cruz
- Laboratory of Applied Mycology of Cariri, Regional University of Cariri (URCA), Crato 63122-290, CE, Brazil; (R.P.d.C.); (M.A.d.F.); (A.T.L.d.S.)
| | - Maria Audilene de Freitas
- Laboratory of Applied Mycology of Cariri, Regional University of Cariri (URCA), Crato 63122-290, CE, Brazil; (R.P.d.C.); (M.A.d.F.); (A.T.L.d.S.)
| | - Viviane Bezerra da Silva
- Postgraduate Program in Molecular Bioprospecting, Regional University of Cariri (URCA), Crato 63122-290, CE, Brazil; (A.R.C.); (V.B.d.S.)
| | - João Cruz Neto
- Nursing Course at the Regional University of Cariri (URCA), Crato-CE-Brazil;
| | - Antonia Thassya Lucas dos Santos
- Laboratory of Applied Mycology of Cariri, Regional University of Cariri (URCA), Crato 63122-290, CE, Brazil; (R.P.d.C.); (M.A.d.F.); (A.T.L.d.S.)
| | - Maria Flaviana Bezerra Morais Braga
- Laboratory of Applied Mycology of Cariri, Regional University of Cariri (URCA), Crato 63122-290, CE, Brazil; (R.P.d.C.); (M.A.d.F.); (A.T.L.d.S.)
| | - Leomara Andrade da Silva
- Postgraduate Program in Botany – National Amazon Research Institute (INPA), Manaus 69067-375, AM, Brazil;
| | - Maria Ivaneide Rocha
- Biology and Toxicology Laboratory, University of Regional Cariri (URCA), Crato 63122-290, CE, Brazil (J.P.K.); (A.E.D.)
| | - Jean Paul Kamdem
- Biology and Toxicology Laboratory, University of Regional Cariri (URCA), Crato 63122-290, CE, Brazil (J.P.K.); (A.E.D.)
| | - Marcello Iriti
- Department of Agricultural and Environmental Sciences, Milan State University, 20133 Milan, Italy;
| | - Sara Vitalini
- Department of Agricultural and Environmental Sciences, Milan State University, 20133 Milan, Italy;
| | - Antonia Eliene Duarte
- Biology and Toxicology Laboratory, University of Regional Cariri (URCA), Crato 63122-290, CE, Brazil (J.P.K.); (A.E.D.)
| | - Luiz Marivando Barros
- Vegetable Ecophysiology Laboratory, Regional University of Cariri, Crato 63122-290, CE, Brazil;
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Hizkiyahu R, Baumfeld Y, Paz Levy D, Lanxner Battat T, Imterat M, Weintraub AY. Antepartum vaginal Candida colonization and the risk for obstetrical tears. J Matern Fetal Neonatal Med 2020; 35:75-79. [PMID: 31937157 DOI: 10.1080/14767058.2020.1712701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Vaginal Candida colonization is very common during pregnancy. An association between Candida colonization and obstetrical tears has not yet been investigated. We investigated whether vaginal Candida colonization during pregnancy is associated with an increased risk for obstetrical tears.Study design: A prospective cohort study was undertaken between the years 2014-2016, comparing pregnancy and delivery characteristics of women with and without Candida colonization during pregnancy. Clinical characteristics of Candida positive women and those with normal vaginal flora were collected. To test the statistical significance of the categorical variables, the chi-square test or Fisher's exact test were used, where appropriate. For continuous variables, the Student's t-test was used.Results: During the study period, 102 women with vaginal Candida during pregnancy (of whom 70% had Candida albicans species) and 102 controls with normal vaginal flora were included in the analysis. No significant differences were observed between Candida positive women and those with normal vaginal flora. Pregnancy and delivery outcomes were comparable and no increased risk of obstetrical tears was found in the Candida group.Conclusions: Vaginal colonization with Candida species during pregnancy was not found to be associated with an increased risk of obstetrical tears.
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Affiliation(s)
- Ranit Hizkiyahu
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Dorit Paz Levy
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Talya Lanxner Battat
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Majdi Imterat
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Ghaddar N, Anastasiadis E, Halimeh R, Ghaddar A, Dhar R, AlFouzan W, Yusef H, El Chaar M. Prevalence and antifungal susceptibility of Candida albicans causing vaginal discharge among pregnant women in Lebanon. BMC Infect Dis 2020; 20:32. [PMID: 31931738 PMCID: PMC6958632 DOI: 10.1186/s12879-019-4736-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/24/2019] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Nahed Ghaddar
- Faculty of Science, Biological Sciences Department, Beirut Arab University, Beirut, Lebanon
| | - Elie Anastasiadis
- Department of Obstetrics and Gynecology, Saint George Hospital, Beirut, Lebanon.,Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Rawad Halimeh
- Department of Obstetrics and Gynecology, Saint George Hospital, Beirut, Lebanon
| | - Ali Ghaddar
- Department of Biomedical Sciences, Lebanese International University, Beirut, Lebanon
| | - Rita Dhar
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon
| | - Wadha AlFouzan
- Microbiology Unit, Department of Laboratories, Farwania Hospital, Sabah Al Nasser, Kuwait.,Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon
| | - Hoda Yusef
- Faculty of Science, Biological Sciences Department, Beirut Arab University, Beirut, Lebanon
| | - Mira El Chaar
- Department of Microbiology, Health Sciences Center, Kuwait University, Jabriya, Kuwait.
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Abouali N, Moghimipour E, Mahmoudabadi AZ, Namjouyan F, Abbaspoor Z. The effect of curcumin-based and clotrimazole vaginal cream in the treatment of vulvovaginal candidiasis. J Family Med Prim Care 2019; 8:3920-3924. [PMID: 31879636 PMCID: PMC6924253 DOI: 10.4103/jfmpc.jfmpc_584_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/21/2019] [Accepted: 10/02/2019] [Indexed: 12/03/2022] Open
Abstract
Background: Vulvovaginal candidiasis (VVC) is the second most common infection of the lower female genital among women passing through their productive age. Furthermore, Candida albicans is the most common VVC agents followed by, non-albicans Candida species. Nowadays, extensive studies are being conducted on alternative therapies and the use of herbal medicines. Objectives: The present study was conducted to compare the effect of curcumin and clotrimazole vaginal cream in the treatment of VVC. Methods: The present randomized controlled trial study was performed on 94 women passing through their productive age after their being diagnosed with VVC. The subjects were randomly divided into two groups, with one receiving curcumin-based vaginal 10% cream and the other receiving clotrimazole vaginal 1% cream. The treatment period was 1 week and a full 5 g applicator was used every night. Required follow-up was implemented 4–7 days after the end of treatment. Results: The results showed no significant differences between the two groups in terms of vaginal discharge, itching, vulvovaginal irritation, and vulvovaginal erythema (P > 0.05); however, the number of negative cultures in the group receiving curcumin was significantly lower in comparison with the other group, which received clotrimazole (P = 0.002). Conclusion: It seems that although curcumin could be effective in the treatment of clinical symptoms of VVC, it, quite similar to clotrimazole vaginal cream, did not affect vaginal culture.
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Affiliation(s)
- Nilufar Abouali
- Department of Midwifery, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Eskandar Moghimipour
- Medicinal Plants Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Zarei Mahmoudabadi
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Foroogh Namjouyan
- Pharmacognosy, Marine Pharmaceutical Research Center, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Abbaspoor
- Department of Midwifery, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Wu X, Zhang S, Xu X, Shen L, Xu B, Qu W, Zhuang W, Locock K, Deighton M, Qu Y. RAFT-Derived Polymethacrylates as a Superior Treatment for Recurrent Vulvovaginal Candidiasis by Targeting Biotic Biofilms and Persister Cells. Front Microbiol 2019; 10:2592. [PMID: 31787962 PMCID: PMC6853869 DOI: 10.3389/fmicb.2019.02592] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022] Open
Abstract
Background Vulvovaginal candidiasis (VVC) is a common infection in need of more effective treatment. Formation of epithelium-associated Candida biofilms and the presence of persister cells are among the major contributing factors to the recurrence of this condition. We have previously developed RAFT-derived polymethacrylates that are effective in killing C. albicans biofilms in vitro. This study aimed to examine the clinical potential of polymethacrylates as antifungals for treatment of recurrent VVC (RVVC). Methods A mouse model of VVC was used to establish vaginal epithelium-associated biofilms, using C. albicans isolates from VVC/RVVC patients. A comparison was made of the efficacies of polymethacrylates and conventional antifungals, clotrimazole and nystatin, in killing Candida in epithelium-associated biofilms in vivo. Ex vivo biofilms were used for Candida population profiling and to quantify persister cells in vaginal epithelia. The potency of polymethacrylates and conventional antifungals against persister cells, either as sole agents or in combination, was assessed. Results Polymethacrylates showed negligible local toxicity, resistance to vaginal acidity, and outstanding in vivo activity against vaginal epithelium-associated C. albicans biofilms. In vivo tests polymethacrylates outperformed the conventional antifungals, nystatin and clotrimazole at concentrations 50 times below the over-the-counter concentrations. Using polymethacrylates was associated with fewer persister cells, and better eradication of persister cells pre-selected by conventional antifungals. Conclusion This study systematically assessed the clinical potential of RAFT-derived polymethacrylates as an effective treatment for VVC/RVVC in a mouse model. Polymethacrylates effectively killed vaginal epithelium-related C. albicans in vivo by specially targeting biotic biofilms and persister cells. Treatment presented negligible local toxicity.
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Affiliation(s)
- Xueqing Wu
- The Division of Gynecology, Shenzhen University General Hospital, Shenzhen, China.,Department of Obstetrics and Gynecology, Wenzhou Medical University, Wenzhou, China
| | - Sisi Zhang
- Department of Obstetrics and Gynecology, Wenzhou Medical University, Wenzhou, China
| | - Xinxin Xu
- Department of Obstetrics and Gynecology, Wenzhou Medical University, Wenzhou, China
| | - Laien Shen
- Department of Obstetrics and Gynecology, Wenzhou Medical University, Wenzhou, China
| | - Boyun Xu
- Department of Obstetrics and Gynecology, Wenzhou Medical University, Wenzhou, China
| | - Wenzhen Qu
- Department of Obstetrics and Gynecology, Wenzhou Medical University, Wenzhou, China
| | - Wenyi Zhuang
- The Division of Gynecology, Shenzhen University General Hospital, Shenzhen, China
| | - Katherine Locock
- CSIRO Manufacturing Flagship, Clayton, VIC, Australia.,School of Chemical and Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Margaret Deighton
- School of Applied Sciences, RMIT University, Bundoora, VIC, Australia
| | - Yue Qu
- Neonatal Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Microbiology, Monash University, Clayton, VIC, Australia
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Majdabadi N, Falahati M, Heidarie-Kohan F, Farahyar S, Rahimi-Moghaddam P, Ashrafi-Khozani M, Razavi T, Mohammadnejad S. Effect of 2-Phenylethanol as Antifungal Agent and Common Antifungals (Amphotericin B, Fluconazole, and Itraconazole) on Candida Species Isolated from Chronic and Recurrent Cases of Candidal Vulvovaginitis. Assay Drug Dev Technol 2019; 16:141-149. [PMID: 29658789 DOI: 10.1089/adt.2017.837] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The antifungal effects of 2-phenylethanol are clearly visible through its intervention in Candida morphogenesis. Chronic and recurrent vulvovaginitis, however, does not respond to this standard experimental therapy; therefore, the study presented in this article investigated the effect of common antifungal drugs (amphotericin B [AMB], fluconazole [FLU], and itraconazole [ITC]), in combination with 2-phenylethanol, on the Candida species isolated from cases of chronic and recurrent vulvovaginitis, thereby allowing the recommendation of a more appropriate treatment option. Forty isolates from patients with chronic and recurrent vaginal candidiasis were investigated in this experimental study. The specimens were examined by direct microscopy, culturing, and PCR to identify the species. The antifungal effects of 2-phenylethanol and conventional drugs, both alone and in combination, were determined in duplicate. Finally, the findings were analyzed. In this study, 40 strains of Candida species were identified, whose agents were Candida albicans (95%) and Candida africana (5%). After 48 h, the minimum inhibitory concentration (MIC) range of the 2-phenylethanol was 800-3,200 μg/mL. Also, in the final study on the MIC levels of common antifungal drugs, AMB (0.42 μg/mL) had the lowest MIC, FLU (40.51 μg/mL) had the highest MIC, and the combination of ITC and 2-phenylethanol had the lowest fractional inhibitory concentration index (FICI) of any of the combinations (FICI range, 0.26-1.03). Combining FLU and ITC with 2-phenylethanol can effectively increase their antifungal effect.
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Affiliation(s)
- Niloufar Majdabadi
- 1 Department of Medical Parasitology and Mycology, International Campus, School of Medicine, Iran University of Medical Sciences , Tehran, Iran
| | - Mehraban Falahati
- 2 Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences , Tehran, Iran
| | | | - Shirin Farahyar
- 2 Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences , Tehran, Iran
| | - Parvaneh Rahimi-Moghaddam
- 4 Department of Pharmacology, School of Medicine, Iran University of Medical Sciences , Tehran, Iran
| | - Mahtab Ashrafi-Khozani
- 2 Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences , Tehran, Iran
| | - Tandis Razavi
- 2 Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences , Tehran, Iran
| | - Sina Mohammadnejad
- 2 Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences , Tehran, Iran
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Russo R, Superti F, Karadja E, De Seta F. Randomised clinical trial in women with Recurrent Vulvovaginal Candidiasis: Efficacy of probiotics and lactoferrin as maintenance treatment. Mycoses 2019; 62:328-335. [PMID: 30565745 DOI: 10.1111/myc.12883] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/27/2018] [Accepted: 12/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Vulvovaginal candidiasis (VVC) is a recurrent vaginal condition in childbearing women. OBJECTIVES The aim of this study was to assess the efficacy of an oral formulation containing Lactobacillus acidophilus GLA-14, Lactobacillus rhamnosus HN001 and bovine lactoferrin on symptoms and recurrence of VVC as adjuvant therapy to topical clotrimazole. PATIENTS/METHODS Forty-eight women positive for C. albicans, symptoms of VVC and documented history of recurrences were randomised into 2 groups receiving verum or placebo (2 capsules/day for 5 days followed by 1 capsule/day for additional 10 days) as adjuvant treatment to clotrimazole (induction phase) followed by a maintenance cycle of 6 months (1 capsule/day verum or placebo for 10 consecutive days each month). Symptoms, overall cure rate and recurrence rate were assessed. RESULTS After clotrimazole therapy, a significant improvement of symptoms was shown in both groups. However, only women treated with probiotics and lactoferrin showed a significant improvement of itching and discharge at 3 and 6 months. During the six-month follow-up, recurrences were significantly less in the intervention group vs placebo (33.3% vs 91.7% after 3 months and 29.2% vs 100% after 6 months). CONCLUSIONS The results show that the investigated lactobacilli mixture in combination with lactoferrin represents a safe and effective adjuvant approach for reducing symptoms and recurrences of RVVC.
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Affiliation(s)
| | - Fabiana Superti
- National Centre for Innovative Technologies in Public Health, National Institute of Health, Rome, Italy
| | - Eugen Karadja
- Emergency Clinical County Hospital "Pius Branzeu", Timisoara, Romania
| | - Francesco De Seta
- Department of Medical Science, University of Trieste, Trieste, Italy
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Prevalence of Vulvovaginal Candidiasis in Ahvaz, Southwest Iran: A Semi-Large Scale Study. Jundishapur J Microbiol 2019. [DOI: 10.5812/jjm.89815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Buggio L, Somigliana E, Borghi A, Vercellini P. Probiotics and vaginal microecology: fact or fancy? BMC Womens Health 2019; 19:25. [PMID: 30704451 PMCID: PMC6357464 DOI: 10.1186/s12905-019-0723-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 01/23/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Probiotics are live microorganisms that, when administered in adequate amounts, should confer a health benefit to the host. Media sources tend to present probiotics as an appealing health promotion method able to prevent or treat a wide variety of clinical conditions. In obstetrics and gynaecology, Lactobacilli species are mainly used to restore the physiologic vaginal microbiota in order to treat bacterial vaginosis and vulvovaginal candidiasis (VVC) and prevent preterm birth. DISCUSSION Several RCTs investigated the potential benefits of probiotics in gynaecological and obstetrics conditions. For all potential indications, recent specific meta-analyses have been published. Considering vulvovaginal candidiasis in non-pregnant women, probiotics slightly improved the short-term clinical and mycological cure, and reduced the 1-month relapse. However, no important impact of probiotic use was observed on long-term clinical or mycological cure. Similarly, the addition of probiotics to metronidazole for the treatment of bacterial vaginosis was not shown to provide any additional benefit. In obstetrics, using probiotics during pregnancy neither decreased nor increased the risk of preterm birth before 34 weeks or before 37 weeks. Similarly, no benefits emerged for gestational diabetes, preterm premature rupture of membrane, and small and large for gestational age infants. CONCLUSION Despite increasing marketing of probiotics for the treatment of vulvovaginal candidiasis and prevention of preterm birth robust evidence demonstrating a beneficial effect is scarce. Moreover, there was considerable heterogeneity among the different studies in terms of route of administration, strain/s of probiotic adopted, and length of probiotic use. Before recommending the systematic use of probiotics to treat bacterial vaginosis and VVC and prevent preterm birth, high-quality research is needed. Professional medical associations should issue recommendations defining if, when, and how probiotics should be used for gynaecological disorders.
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Affiliation(s)
- Laura Buggio
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda, 12 - 20122 Milan, Italy
| | - Edgardo Somigliana
- Deparment of Clinical Sciences and Community Health, Università degli Studi, Milan, Italy
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Borghi
- Deparment of Clinical Sciences and Community Health, Università degli Studi, Milan, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda, 12 - 20122 Milan, Italy
- Deparment of Clinical Sciences and Community Health, Università degli Studi, Milan, Italy
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Zhang X, Li T, Chen X, Wang S, Liu Z. Nystatin enhances the immune response against Candida albicans and protects the ultrastructure of the vaginal epithelium in a rat model of vulvovaginal candidiasis. BMC Microbiol 2018; 18:166. [PMID: 30359236 PMCID: PMC6202846 DOI: 10.1186/s12866-018-1316-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 10/15/2018] [Indexed: 02/06/2023] Open
Abstract
Background Vulvovaginal candidiasis (VVC) is a common infectious disease of the lower genital tract. Nystatin, a polyene fungicidal antibiotic, is used as a topical antifungal agent for VVC treatment. The aim of the current study was to investigate the possible immunomodulatory effects of nystatin on the vaginal mucosal immune response during Candida albicans infection and examine its role in protection of vaginal epithelial cell (VEC) ultrastructure. Results Following infection with C. albicans, IFN-γ and IL-17 levels in VECs were significantly elevated, while the presence of IgG was markedly decreased as compared to uninfected controls (P < 0.05). No significant differences in IL4 expression were observed. After treatment with nystatin, the level of IFN-γ, IL-17 and IgG was dramatically increased in comparison to the untreated group (P < 0.05). Transmission electron microscopy revealed that C. albicans invades the vaginal epithelium by both induced endocytosis and active penetration. Nystatin treatment protects the ultrastructure of the vaginal epithelium. Compared with the untreated C. albicans-infected group, Flameng scores which measure mitochondrial damage of VECs were markedly decreased (P < 0.001) and the number of adhesive and invasive C. albicans was significantly reduced (P < 0.01) after treatment with nystatin. Conclusions Nystatin plays a protective role in the host defense against C. albicans by up-regulating the IFN-γ-related cellular response, the IL-17 signaling pathway and possibly through enhancing VEC-derived IgG-mediated immunity. Furthermore, nystatin notably improves the ultramorphology of the vaginal mucosa, partially through the protection of mitochondria ultrastructure in VECs and inhibition of adhesion and invasion by C. albicans. Together, these effects enhance the immune response of the vaginal mucosa against C. albicans and protect the ultrastructure of vaginal epithelium in VVC rats.
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Affiliation(s)
- Xu Zhang
- Laboratory of Electron Microscopy, Ultrastructural Pathology Center, Peking University First Hospital, Beijing, 100034, China
| | - Ting Li
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Xi Chen
- Department of Gynecology Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Suxia Wang
- Laboratory of Electron Microscopy, Ultrastructural Pathology Center, Peking University First Hospital, Beijing, 100034, China
| | - Zhaohui Liu
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China.
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Souza RO, Henrique de Lima T, Oréfice RL, de Freitas Araújo MG, de Lima Moura SA, Magalhães JT, da Silva GR. Amphotericin B-Loaded Poly(lactic-co-glycolic acid) Nanofibers: An Alternative Therapy Scheme for Local Treatment of Vulvovaginal Candidiasis. J Pharm Sci 2018; 107:2674-2685. [DOI: 10.1016/j.xphs.2018.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 12/25/2022]
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Sherrard J, Wilson J, Donders G, Mendling W, Jensen JS. 2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge. Int J STD AIDS 2018; 29:1258-1272. [PMID: 30049258 DOI: 10.1177/0956462418785451] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Four common pathological conditions are associated with vaginal discharge: bacterial vaginosis, aerobic vaginitis, candidosis, and the sexually transmitted infection, trichomoniasis. Chlamydial or gonococcal cervical infection may result in vaginal discharge. Vaginal discharge may be caused by a range of other physiological and pathological conditions including atrophic vaginitis, desquamative inflammatory vaginitis, cervicitis, and mucoid ectopy. Psychosexual problems may present with recurrent episodes of vaginal discharge and vulval burning. These need to be considered if tests for specific infections are negative. Many of the symptoms and signs are non-specific and a number of women may have other conditions such as vulval dermatoses or allergic and irritant reactions.
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Affiliation(s)
- Jackie Sherrard
- 1 Department of Genitourinary Medicine, Sexual Health Department, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Janet Wilson
- 2 Department of Genitourinary Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gilbert Donders
- 3 Department of Obstetrics and Gynecology, Regional Hospital H Hart Tienen, University Hospital Antwerp
| | - Werner Mendling
- 4 Infektionen in Gynäkologie und Geburtshilfe, Wuppertal, Germany
| | - Jørgen S Jensen
- 5 Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark
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Brandão L, Boniek D, Resende Stoianoff M, da Mata F, de Azevedo P, Fernandes J, Andrade V. Prevalence and antifungal susceptibility of Candida
species among pregnant women attending a school maternity at Natal, Brazil. Lett Appl Microbiol 2018; 67:285-291. [DOI: 10.1111/lam.13034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 01/26/2023]
Affiliation(s)
- L.D.S. Brandão
- Departamento de Microbiologia e Parasitologia, Centro de Biociências; Universidade Federal do Rio Grande do Norte, UFRN; Natal Rio Grande do Norte Brazil
| | - D. Boniek
- Departamento de Microbiologia; Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, UFMG; Belo Horizonte Minas Gerais Brazil
| | - M.A. Resende Stoianoff
- Departamento de Microbiologia; Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, UFMG; Belo Horizonte Minas Gerais Brazil
| | - F.M.R. da Mata
- Departamento de Microbiologia; Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, UFMG; Belo Horizonte Minas Gerais Brazil
| | - P.R.M. de Azevedo
- Departamento de Estatística, Centro de Ciências Exatas da Terra; Universidade Federal do Rio Grande do Norte, UFRN; Natal Rio Grande do Norte Brazil
| | - J.V. Fernandes
- Departamento de Microbiologia e Parasitologia, Centro de Biociências; Universidade Federal do Rio Grande do Norte, UFRN; Natal Rio Grande do Norte Brazil
| | - V.S. Andrade
- Departamento de Microbiologia e Parasitologia, Centro de Biociências; Universidade Federal do Rio Grande do Norte, UFRN; Natal Rio Grande do Norte Brazil
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de Jesús Valle MJ, Coutinho P, Ribeiro MP, Sánchez Navarro A. Lyophilized tablets for focal delivery of fluconazole and itraconazole through vaginal mucosa, rational design and in vitro evaluation. Eur J Pharm Sci 2018; 122:144-151. [PMID: 29969668 DOI: 10.1016/j.ejps.2018.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 12/15/2022]
Abstract
The present work deals with the rational design and in vitro evaluation of vaginal tablets for focal delivery of fluconazole (FLZ) and itraconazol (ITZ). Drug loaded liposomes with and without d-alpha-tocopheryl polyethylene glycol 1000 succinate (vit E TPGS) were prepared by direct sonication of the components and mixed with albumin to obtain albusomes. Tablets were obtained by direct compression of the lyophilized cake. The influence of vit E TPGS on size, zeta potential and entrapment efficiency (EE%) of liposomes and albusomes was evaluated. Tablet swelling and drug release were studied by in vitro assays. Vit E TPGS neither affected the zeta potential nor the EE% of liposomes and albusomes, but affected the liposomes size and the tablet disintegration time. A rapid erosion was observed for the tablets with the highest content of vitamin, while a slow swelling for those lacking the vitamin (swelling index = 57.76 ± 13.51%). A faster drug release profile was obtained for the former compared to the latter. The in vitro assay showed that FLZ diffused and solved in the vaginal fluid simulant while ITZ remained into the albusomes, which slowly released ITZ-albumin complex and ITZ-loaded liposomes, both suitable carriers for drug transport to deeper vaginal endothelium.
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Affiliation(s)
- Maria José de Jesús Valle
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain; Institute of Biopharmaceutical Sciences of University of Salamanca (IBSAL), Salamanca, Spain.
| | - Paula Coutinho
- CPIRN-IPG - Center of Potential and Innovation of Natural Resources, Polytechnic Institute of Guarda, Guarda, Portugal; CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
| | - Maximiano Prata Ribeiro
- CPIRN-IPG - Center of Potential and Innovation of Natural Resources, Polytechnic Institute of Guarda, Guarda, Portugal; CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
| | - Amparo Sánchez Navarro
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain; Institute of Biopharmaceutical Sciences of University of Salamanca (IBSAL), Salamanca, Spain.
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Antimicrobial photodynamic therapy as a new approach for the treatment of vulvovaginal candidiasis: preliminary results. Lasers Med Sci 2018; 33:1925-1931. [PMID: 29931589 DOI: 10.1007/s10103-018-2557-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 06/06/2018] [Indexed: 12/26/2022]
Abstract
In this work, we present the efficacy of photodynamic therapy against yeast cells in an animal model. We tested two photosensitizers, methylene blue and protoporphyrin IX. Thirty-seven female BALB-c mice with a body mass of 20-25 g were used. To achieve persistent vaginitis, estrus was induced by subcutaneous injection of 0.1 mg/mL estradiol valerate applied weekly. Three days after pseudo-estrus, intravaginal inoculation with Candida albicans was performed. Mice were anesthetized with ketamine (80 mg/kg) and xylazine (10 mg/kg) by intraperitoneal injection before inoculation, and antimicrobial photodynamic therapy (aPDT) was performed 5 days after fungal inoculation. Two photosensitizers were tested, methylene blue (MB; 100 μM) and protoporphyrin IX (PpNetNI; 10 μM). Two custom-made LEDs emitting light at 660 and 630 nm at approximately 800 mW each were used for irradiation. The aPDT treatment reduced the fungal colony-forming units (CFUs) by one order of magnitude for the MB (p = 0.020) and PpNetNI (p = 0.018) photosensitizers. Seven days after the treatment, there were significantly fewer CFUs compared to the control group (p = 0.041 and p = 0.035 for MB and PpNetNI, respectively), but this was not increased compared to the initial number immediately after aPDT. Using aPDT as a therapeutic option to decrease fungal infection in a vaginal candidiasis model resulted in a significant reduction in the C. albicans population. Both photosensitizers were effective for preventing reinfection within 7 days. The aPDT also had no effect on the vaginal mucosa at the ultrastructural level. In addition to the fungicide effect, we observed reduced swelling and lack of the formation of abscesses, microabscesses coating the cornified epithelial layer, and the accumulation of neutrophils in the submucosa.
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Rapala-Kozik M, Bochenska O, Zajac D, Karkowska-Kuleta J, Gogol M, Zawrotniak M, Kozik A. Extracellular proteinases of Candida species pathogenic yeasts. Mol Oral Microbiol 2018; 33:113-124. [PMID: 29139623 DOI: 10.1111/omi.12206] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 02/06/2023]
Abstract
The increased incidence of severe disseminated infections caused by the opportunistic yeast-like fungi Candida spp. highlights the urgent need for research into the major virulence factors of these pathogens-extracellular aspartic proteinases of the candidapepsin and yapsin families. Classically, these enzymes were considered to be generally destructive factors that damage host tissues and provide nutrients for pathogen propagation. However, in recent decades, novel and more specific functions have been suggested for extracellular candidal proteinases. These include contributions to cell wall maintenance and remodeling, the formation of polymicrobial biofilms, adhesion to external protective barriers of the host, the deregulation of host proteolytic cascades (such as the complement system, blood coagulation and the kallikrein-kinin system), a dysregulated host proteinase-inhibitor balance, the inactivation of host antimicrobial peptides, evasion of immune responses and the induction of inflammatory mediator release from host cells. Only a few of these activities recognized in Candida albicans candidapepsins have been also confirmed in other Candida species, and characterization of Candida glabrata yapsins remains limited.
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Affiliation(s)
- M Rapala-Kozik
- Department of Comparative Biochemistry and Bioanalytics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - O Bochenska
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - D Zajac
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - J Karkowska-Kuleta
- Department of Comparative Biochemistry and Bioanalytics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - M Gogol
- Department of Comparative Biochemistry and Bioanalytics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland.,Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - M Zawrotniak
- Department of Comparative Biochemistry and Bioanalytics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - A Kozik
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
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Thorley N, Ross J. Intravaginal boric acid: is it an alternative therapeutic option for vaginal trichomoniasis? Sex Transm Infect 2017; 94:574-577. [DOI: 10.1136/sextrans-2017-053343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/12/2017] [Accepted: 11/25/2017] [Indexed: 01/07/2023] Open
Abstract
ObjectivesTrichomoniasis, caused by Trichomonas vaginalis (TV), is the most common curable sexually transmitted infection worldwide. Current guidance in the UK is to treat TV with a nitroimidazole antibiotic. The high prevalence of TV, high rate of antibiotic resistance and limited tolerability to nitroimidazoles suggest that alternative treatment regimens are needed. Intravaginal boric acid (BA) has been used safely for the treatment of candida vulvovaginitis and bacterial vaginosis, and in vitro studies suggest BA is active against TV. We review the evidence for the efficacy of BA in patients with TV.MethodsMEDLINE, EMBASE, CINAHL, AMED, HMIC and BNI and Grey literature databases, The Cochrane Library, Trial Registers, conference abstracts and proceedings were searched. Inclusion criteria were women aged 16 years or over with microbiological confirmation of TV infection and using BA as treatment. There were no restrictions on language, publication date or study design. The in vitro evidence for BA activity against TV was also reviewed.ResultsNo randomised controlled trials or case series were found. Four case reports demonstrated TV clearance with BA using a variety of dose regimens (dose 600 mg alternate nights to 600 mg two times per day; duration 1–5 months). In vitro studies suggest that BA has activity against TV which is independent of its effect on pH.DiscussionFurther evaluation of BA for the treatment of uncomplicated TV is required, but it may be useful when therapeutic options are limited. If shown to be safe and effective, intravaginal BA might provide a well-tolerated alternative anti-infective treatment which reduces community exposure to systemic antibiotics.
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Vaginitis por Candida glabrata: ¿la gran olvidada? Rev Iberoam Micol 2017; 34:246. [DOI: 10.1016/j.riam.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/28/2016] [Accepted: 01/23/2017] [Indexed: 11/23/2022] Open
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