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FSRH Guideline (March 2023) Intrauterine contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:1-142. [PMID: 37188461 DOI: 10.1136/bmjsrh-2023-iuc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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2
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Abstract
The burden of fungal infections has been on the rise globally and remains a significant public health concern in Kenya. We estimated the incidence and prevalence of fungal infections using all mycology publications in Kenya up to January 2023, and from neighbouring countries where data lacked. We used deterministic modelling using populations at risk to calculate the disease burden. The total burden of serious fungal infections is estimated to affect 6,328,294 persons which translates to 11.57% of the Kenyan population. Those suffering from chronic infections such as chronic pulmonary aspergillosis are estimated to be 100,570 people (0.2% of the population) and probably nearly 200,000 with fungal asthma, all treatable with oral antifungal therapy. Serious acute fungal infections secondary to HIV (cryptococcal meningitis, disseminated histoplasmosis, pneumocystis pneumonia, and mucosal candidiasis) affect 196,543 adults and children (0.4% of the total population), while cancer-related invasive fungal infection cases probably exceed 2,299 and those in intensive care about 1,230 incident cases, including Candida auris bloodstream infection. The burden of fungal infections in Kenya is high; however, limited diagnostic test availability, low clinician awareness and inadequate laboratory capacity constrain the country's health system in responding to the syndemic of fungal disease in Kenya.
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Affiliation(s)
- Stanley N. Ratemo
- Research Department, Kisii Teaching and Referral Hospital, Kisii, Kenya
- CONTACT Stanley N. Ratemo
| | - David W Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Global Action for Fungal Infections (GAFFI), Geneva, Switzerland
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3
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Fernandes Â, Azevedo N, Valente A, Dias M, Gomes A, Nogueira-Silva C, Henriques M, Silva S, Gonçalves B. Vulvovaginal candidiasis and asymptomatic vaginal colonization in Portugal: epidemiology, risk factors and antifungal pattern. Med Mycol 2022; 60:6575555. [PMID: 35482711 DOI: 10.1093/mmy/myac029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Vulvovaginal candidiasis (VVC) has been identified as a global issue of concern due to its clinical, social and economic implications. The emerging relevance of VVC makes it crucial to increase the knowledge on its epidemiological and etiological features in order to improve its prevention and treatment. Thus, this study aimed to reveal the incidence, microbiology, antifungal pattern and risk factors of VVC in Portugal. For that, high vaginal samples were collected from 470 symptomatic and asymptomatic participants; Candida spp. were identified with molecular techniques and their antifungal susceptibility was analysed with E-tests. The results revealed an incidence of VVC among women with vulvovaginitis of 74.4%. Furthermore, 63.7% of asymptomatic women were colonized with Candida spp. Importantly, women with history of recurrent vaginal infections, those who use over-the-counter antifungals, oral contraceptive pills and non-cotton underwear were found to be at significantly higher risk of developing VVC. Candida albicans was the most common species (59%), followed by Candida glabrata (27%), in a total of 8 distinct species, with similar distribution among colonized and infected participants. Of note, various isolates, especially of the most common species, showed low susceptibility towards fluconazole. In contrast, only few isolates showed low susceptibility towards caspofungin. Overall, this study suggests that the identification of species causing VVC and their antifungal susceptibility are urgently needed in clinical practice in order to improve the decision for the most adequate treatment. It also suggests that avoiding certain risk behaviours may prevent the development of VVC.
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Affiliation(s)
- Ângela Fernandes
- Family Health Unit (USF) +Carandá, Health Centre Group (ACeS) Cávado I, Braga, Portugal
| | - Nuno Azevedo
- Biofilm Research Laboratory Rosário Oliveira (LIBRO), Centre of Biological Engineering (CEB), University of Minho, 4710-057 Braga, Portugal.,LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
| | - Andreia Valente
- Biofilm Research Laboratory Rosário Oliveira (LIBRO), Centre of Biological Engineering (CEB), University of Minho, 4710-057 Braga, Portugal.,LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
| | - Marisol Dias
- Biofilm Research Laboratory Rosário Oliveira (LIBRO), Centre of Biological Engineering (CEB), University of Minho, 4710-057 Braga, Portugal.,LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
| | - Ana Gomes
- Family Health Unit (USF) +Carandá, Health Centre Group (ACeS) Cávado I, Braga, Portugal
| | - Cristina Nogueira-Silva
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; Life and Health Sciences Research Institute/3B's - PT Government Associate Laboratory, Braga/ Guimarães, Portugal; Department of Obstetrics and Gynaecology, Hospital de Braga, Braga, Portugal
| | - Mariana Henriques
- Biofilm Research Laboratory Rosário Oliveira (LIBRO), Centre of Biological Engineering (CEB), University of Minho, 4710-057 Braga, Portugal.,LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
| | - Sónia Silva
- Biofilm Research Laboratory Rosário Oliveira (LIBRO), Centre of Biological Engineering (CEB), University of Minho, 4710-057 Braga, Portugal.,National Institute for Agrarian and Veterinary Research, Vairão, 4485-655, Vila do Conde, Portugal
| | - Bruna Gonçalves
- Biofilm Research Laboratory Rosário Oliveira (LIBRO), Centre of Biological Engineering (CEB), University of Minho, 4710-057 Braga, Portugal.,LABBELS - Associate Laboratory, Braga, Guimarães, Portugal
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Happel AU, Gasper M, Balle C, Konstantinus I, Gamieldien H, Dabee S, Gill K, Bekker LG, Passmore JAS, Jaspan HB. Persistent, Asymptomatic Colonization with Candida is Associated with Elevated Frequencies of Highly Activated Cervical Th17-Like Cells and Related Cytokines in the Reproductive Tract of South African Adolescents. Microbiol Spectr 2022; 10:e0162621. [PMID: 35348351 PMCID: PMC9045181 DOI: 10.1128/spectrum.01626-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/25/2022] [Indexed: 11/20/2022] Open
Abstract
Cervicovaginal inflammation, nonoptimal microbiota, T-cell activation, and hormonal contraceptives may increase HIV risk, yet associations between these factors and subclinical Candida colonization or hyphae are unknown. We collected cervicovaginal samples from 94 South African adolescents, aged 15 to 19 years, who were randomized to injectable norethisterone enanthate (Net-En), an etonorgesterol/ethinyl estradiol vaginal ring (NuvaRing), or oral contraceptives in the UChoose trial (NCT02404038) at baseline and 16 weeks post-randomization. We assessed cervicovaginal samples for subclinical Candida colonization (by quantitative PCR [qPCR]), hyphae (by Gram stain), microbiota composition (by 16S rRNA gene sequencing), cytokine concentrations (by Luminex), and cervical T-cell phenotypes and activation (by multiparameter flow cytometry). While hormonal contraceptive type did not influence incidence of Candida colonization or hyphae, hyphae presence was associated with significantly elevated concentrations of IL-22, IL-17A and IL-17F, all produced by Th17 cells, but not of other cytokines, such as IL-1β or IL-6, after adjustment for confounders. Subclinical Candida colonization was associated with reduced frequencies of Th17-like cells and elevated frequencies of CCR6-CCR10 T cells. Women with Candida hyphae were less likely to have bacterial vaginosis (BV). Persistent, subclinical colonization with Candida over 16 weeks was associated with significant increases in Th17-related cytokine concentrations and highly activated Th17-like and CCR6-CCR10 T-cell frequencies. These data suggest that vaginal Candida colonization and hyphae increase Th17-related cytokines, but not overall female genital tract inflammation in Sub-Saharan African adolescents. Persistent Candida colonization, even when asymptomatic, may increase Th17 cell frequencies and related cytokines and thereby could subsequently increase HIV risk, although the causal relationship requires confirmation. IMPORTANCE Sub-Saharan African female adolescents are globally at the highest risk of HIV acquisition, and genital inflammation, microbial dysbiosis, and cervical HIV target cell activation are thought to contribute to this risk. Previously, the relationship between these mucosal factors and subclinical vaginal Candida colonization or hyphae has not been described, and the role of HIV-susceptible Th17 cells in mediating anti-Candida immunity in the human female genital tract has not been clearly established. We show that presence of yeast hyphae was associated with increases in Th17 cell-related cytokines and the absence of microbial dysbiosis, and that persistent Candida colonization resulted in significant increases in Th17-related cytokines and highly activated Th17-like cell frequencies. Our results suggest that Th17 cells are important for anti-Candida immunity in the human female genital tract and that prolonged vaginal Candida colonization may contribute to increased HIV risk in Sub-Saharan African adolescents by increasing HIV target cell frequencies and activation.
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Affiliation(s)
- Anna-Ursula Happel
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Melanie Gasper
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Christina Balle
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Iyaloo Konstantinus
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Namibia Institute of Pathology, Windhoek, Namibia
| | - Hoyam Gamieldien
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Smritee Dabee
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Katherine Gill
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Jo-Ann S. Passmore
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- DST-NRF CAPRISA Centre of Excellence in HIV Prevention, Cape Town, South Africa
- National Health Laboratory Service, Cape Town, South Africa
| | - Heather B. Jaspan
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Pediatrics and Global Health, University of Washington, Seattle, Washington, USA
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5
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Jansåker F, Frimodt-Møller N, Li X, Sundquist K. Novel risk factors associated with common vaginal infections: a nationwide primary healthcare cohort study. Int J Infect Dis 2022; 116:380-386. [PMID: 35038603 DOI: 10.1016/j.ijid.2022.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To estimate the association between potential risk factors and common vaginal infections, using nationwide primary healthcare and other national register. METHODS An open cohort study consisting of 2 357 711 women aged 15-50 years (2001-2018) was conducted in Sweden. The outcomes were first event of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) in relation to sociodemographic factors. Cox regression models were used. Sensitivity analyses including diabetes mellitus, contraceptive use, and cervical cancer were conducted. RESULTS The incidence rates per 1000 person-years for VVC and BV were 3.3 (95% CI 3.2-3.3) and 3.4 (95% CI 3.4-3.4), respectively. In the fully adjusted model, sociodemographic factors were significantly associated with both outcomes. Compared to Swedish-born women, women from Middle East/North Africa had the highest risk of VVC (HR 2.77, 95% CI, 2.72-2.83), followed by Africa (excluding North Africa) (HR 2.53, 95% CI, 2.45-2.61), and Latin America and the Caribbean (HR 2.18, 95% CI, 2.09-2.27). For BV, women from Latin America and the Caribbean had the highest risk (HR 1.83, 95% CI, 1.75-1.92). CONCLUSION This study presents novel risk factors associated with medically attended vaginal infections. Women from non-western countries seem to suffer disproportionately from these conditions.
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Affiliation(s)
- Filip Jansåker
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden; Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.
| | | | - Xinjun Li
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA; Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Japan
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6
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Heuer C, Bahnemann J, Scheper T, Segal E. Paving the Way to Overcome Antifungal Drug Resistance: Current Practices and Novel Developments for Rapid and Reliable Antifungal Susceptibility Testing. SMALL METHODS 2021; 5:e2100713. [PMID: 34927979 DOI: 10.1002/smtd.202100713] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/05/2021] [Indexed: 06/14/2023]
Abstract
The past year has established the link between the COVID-19 pandemic and the global spread of severe fungal infections; thus, underscoring the critical need for rapid and realizable fungal disease diagnostics. While in recent years, health authorities, such as the Centers for Disease Control and Prevention, have reported the alarming emergence and spread of drug-resistant pathogenic fungi and warned against the devastating consequences, progress in the diagnosis and treatment of fungal infections is limited. Early diagnosis and patient-tailored therapy are established to be key in reducing morbidity and mortality associated with fungal (and cofungal) infections. As such, antifungal susceptibility testing (AFST) is crucial in revealing susceptibility or resistance of these pathogens and initiating correct antifungal therapy. Today, gold standard AFST methods require several days for completion, and thus this much delayed time for answer limits their clinical application. This review focuses on the advancements made in developing novel AFST techniques and discusses their implications in the context of the practiced clinical workflow. The aim of this work is to highlight the advantages and drawbacks of currently available methods and identify the main gaps hindering their progress toward clinical application.
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Affiliation(s)
- Christopher Heuer
- Institute of Technical Chemistry, Leibniz University Hannover, 30167, Hannover, Germany
- Department of Biotechnology and Food Engineering, Technion-Israel Institute of Technology, Haifa, 320003, Israel
| | - Janina Bahnemann
- Institute of Technical Chemistry, Leibniz University Hannover, 30167, Hannover, Germany
| | - Thomas Scheper
- Institute of Technical Chemistry, Leibniz University Hannover, 30167, Hannover, Germany
| | - Ester Segal
- Department of Biotechnology and Food Engineering, Technion-Israel Institute of Technology, Haifa, 320003, Israel
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7
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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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Vaginal candidiasis in Konya area: Etiology, risk factors, virulence patterns, and antifungal susceptibility. REV ROMANA MED LAB 2021. [DOI: 10.2478/rrlm-2021-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Vulvovaginal candidiasis (VVC), a common genital tract infection, is known to affect millions of women worldwide. In this study, it was aimed to determine the prevalence, virulence, possible risk factors and antifungal susceptibility model of Candida species. Vaginal swab samples were taken from patients aged 18 years and older who presented to the gynecology outpatient clinic with signs and symptoms suggestive of vulvovaginitis. Demographic data were recorded using a questionnaire. Standard microbiological methods were used for the identification of the isolates. Broth microdilution method was used to determine the antifungal susceptibility of Candida isolates. Virulence factors of Candida strains were determined by performing proteinase, phospholipase, hemolytic and biofilm activity tests. Sequencing of the isolates identified as Candida were performed using ITS 1-4 primers. Vaginal discharge (OR: 3.365; 95% CI: 1.595-7.101), burning complaint (OR: 9.098; 95% CI: 2.284-36.232) and history of allergy (OR: 3.396; 95% CI: 0.968) were risk factors. The results showed that the most common isolated strain was Candida albicans (57%). It was found that the prevalence of C. glabrata remained at 26%, 44 of the C. albicans isolates presented proteinase, 35 had phospholipase, 47 had biofilm, and 47 had hemolytic activity. In this study, susceptible dose-dependent and resistant rates of all Candida strains were found for fluconazole as 9% and 16%, respectively. Host and organism-related factors should be considered in the clinical treatment of VVC, and continuous monitoring of changes in the prevalence of Candida species and susceptibility rates is required for effective antifungal therapy.
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Martin-Cruz L, Sevilla-Ortega C, Benito-Villalvilla C, Diez‐Rivero CM, Sanchez-Ramón S, Subiza JL, Palomares O. A Combination of Polybacterial MV140 and Candida albicans V132 as a Potential Novel Trained Immunity-Based Vaccine for Genitourinary Tract Infections. Front Immunol 2021; 11:612269. [PMID: 33552074 PMCID: PMC7858650 DOI: 10.3389/fimmu.2020.612269] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022] Open
Abstract
Recurrent urinary tract infections (RUTIs) and recurrent vulvovaginal candidiasis (RVVCs) represent major healthcare problems with high socio-economic impact worldwide. Antibiotic and antifungal prophylaxis remain the gold standard treatments for RUTIs and RVVCs, contributing to the massive rise of antimicrobial resistance, microbiota alterations and co-infections. Therefore, the development of novel vaccine strategies for these infections are sorely needed. The sublingual heat-inactivated polyvalent bacterial vaccine MV140 shows clinical efficacy for the prevention of RUTIs and promotes Th1/Th17 and IL-10 immune responses. V132 is a sublingual preparation of heat-inactivated Candida albicans developed against RVVCs. A vaccine formulation combining both MV140 and V132 might well represent a suitable approach for concomitant genitourinary tract infections (GUTIs), but detailed mechanistic preclinical studies are still needed. Herein, we showed that the combination of MV140 and V132 imprints human dendritic cells (DCs) with the capacity to polarize potent IFN-γ- and IL-17A-producing T cells and FOXP3+ regulatory T (Treg) cells. MV140/V132 activates mitogen-activated protein kinases (MAPK)-, nuclear factor-κB (NF-κB)- and mammalian target of rapamycin (mTOR)-mediated signaling pathways in human DCs. MV140/V132 also promotes metabolic and epigenetic reprogramming in human DCs, which are key molecular mechanisms involved in the induction of innate trained immunity. Splenocytes from mice sublingually immunized with MV140/V132 display enhanced proliferative responses of CD4+ T cells not only upon in vitro stimulation with the related antigens contained in the vaccine formulation but also upon stimulation with phytohaemagglutinin. Additionally, in vivo sublingual immunization with MV140/V132 induces the generation of IgG and IgA antibodies against all the components contained in the vaccine formulation. We uncover immunological mechanisms underlying the potential mode of action of a combination of MV140 and V132 as a novel promising trained immunity-based vaccine (TIbV) for GUTIs.
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MESH Headings
- Animals
- Antigens, Bacterial/administration & dosage
- Antigens, Bacterial/immunology
- Antigens, Fungal/administration & dosage
- Antigens, Fungal/immunology
- Bacterial Infections/immunology
- Bacterial Infections/metabolism
- Bacterial Infections/microbiology
- Bacterial Infections/prevention & control
- Bacterial Vaccines/administration & dosage
- Bacterial Vaccines/immunology
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- Candidiasis, Vulvovaginal/immunology
- Candidiasis, Vulvovaginal/metabolism
- Candidiasis, Vulvovaginal/microbiology
- Candidiasis, Vulvovaginal/therapy
- Cells, Cultured
- Coculture Techniques
- Cytokines/metabolism
- Dendritic Cells/drug effects
- Dendritic Cells/immunology
- Female
- Fungal Vaccines/administration & dosage
- Fungal Vaccines/immunology
- Humans
- Lymphocyte Activation/drug effects
- Mice, Inbred BALB C
- Phenotype
- Urinary Tract Infections/immunology
- Urinary Tract Infections/metabolism
- Urinary Tract Infections/microbiology
- Urinary Tract Infections/prevention & control
- Vaccination
- Vaccines, Combined/administration & dosage
- Vaccines, Combined/immunology
- Mice
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Affiliation(s)
- Leticia Martin-Cruz
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
| | - Carmen Sevilla-Ortega
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
| | - Cristina Benito-Villalvilla
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
| | | | - Silvia Sanchez-Ramón
- Department of Clinical Immunology and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Department of Immunology, ENT and Ophthalmology, School of Medicine, Complutense University, Madrid, Spain
| | | | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
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10
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Rodríguez-Cerdeira C, Martínez-Herrera E, Carnero-Gregorio M, López-Barcenas A, Fabbrocini G, Fida M, El-Samahy M, González-Cespón JL. Pathogenesis and Clinical Relevance of Candida Biofilms in Vulvovaginal Candidiasis. Front Microbiol 2020; 11:544480. [PMID: 33262741 PMCID: PMC7686049 DOI: 10.3389/fmicb.2020.544480] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/23/2020] [Indexed: 12/30/2022] Open
Abstract
The ability of Candida spp. to form biofilms is crucial for its pathogenicity, and thus, it should be considered an important virulence factor in vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC). Its ability to generate biofilms is multifactorial and is generally believed to depend on the site of infection, species and strain involved, and the microenvironment in which the infection develops. Therefore, both cell surface proteins, such as Hwp1, Als1, and Als2, and the cell wall-related protein, Sun41, play a critical role in the adhesion and virulence of the biofilm. Immunological and pharmacological approaches have identified the NLRP3 inflammasome as a crucial molecular factor contributing to host immunopathology. In this context, we have earlier shown that Candida albicans associated with hyphae-secreted aspartyl proteinases (specifically SAP4-6) contribute to the immunopathology of the disease. Transcriptome profiling has revealed that non-coding transcripts regulate protein synthesis post-transcriptionally, which is important for the growth of Candida spp. Other studies have employed RNA sequencing to identify differences in the 1,245 Candida genes involved in surface and invasive cellular metabolism regulation. In vitro systems allow the simultaneous processing of a large number of samples, making them an ideal screening technique for estimating various physicochemical parameters, testing the activity of antimicrobial agents, and analyzing genes involved in biofilm formation and regulation (in situ) in specific strains. Murine VVC models are used to study C. albicans infection, especially in trials of novel treatments and to understand the cause(s) for resistance to conventional therapeutics. This review on the clinical relevance of Candida biofilms in VVC focuses on important advances in its genomics, transcriptomics, and proteomics. Moreover, recent experiments on the influence of biofilm formation on VVC or RVVC pathogenesis in laboratory animals have been discussed. A clear elucidation of one of the pathogenesis mechanisms employed by Candida biofilms in vulvovaginal candidiasis and its applications in clinical practice represents the most significant contribution of this manuscript.
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Affiliation(s)
- Carmen Rodríguez-Cerdeira
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Health Research Institute, SERGAS-UVIGO, Vigo, Spain.,Department of Dermatology, Hospital do Meixoeiro and University of Vigo, Vigo, Spain.,European Women's Dermatologic and Venereologic Society, Tui, Spain.,Psychodermatology Task Force of the Ibero-Latin American College of Dermatology (CILAD), Buenos Aires, Argentina
| | - Erick Martínez-Herrera
- Psychodermatology Task Force of the Ibero-Latin American College of Dermatology (CILAD), Buenos Aires, Argentina.,Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Mexico
| | - Miguel Carnero-Gregorio
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Health Research Institute, SERGAS-UVIGO, Vigo, Spain.,Department of Molecular Diagnosis (Array & NGS Division), Institute of Cellular and Molecular Studies, Lugo, Spain
| | - Adriana López-Barcenas
- European Women's Dermatologic and Venereologic Society, Tui, Spain.,Psychodermatology Task Force of the Ibero-Latin American College of Dermatology (CILAD), Buenos Aires, Argentina.,Section of Mycology, Department of Dermatology, Manuel Gea González hospital, Mexico City, Mexico
| | - Gabriella Fabbrocini
- European Women's Dermatologic and Venereologic Society, Tui, Spain.,Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Monika Fida
- European Women's Dermatologic and Venereologic Society, Tui, Spain.,Department of Dermatology, University of Medicine, Tirana, Tirana, Albania
| | - May El-Samahy
- European Women's Dermatologic and Venereologic Society, Tui, Spain.,Department of Dermatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - José Luís González-Cespón
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Health Research Institute, SERGAS-UVIGO, Vigo, Spain
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11
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Chee WJY, Chew SY, Than LTL. Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining vaginal health. Microb Cell Fact 2020; 19:203. [PMID: 33160356 PMCID: PMC7648308 DOI: 10.1186/s12934-020-01464-4] [Citation(s) in RCA: 200] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
Human vagina is colonised by a diverse array of microorganisms that make up the normal microbiota and mycobiota. Lactobacillus is the most frequently isolated microorganism from the healthy human vagina, this includes Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, and Lactobacillus jensenii. These vaginal lactobacilli have been touted to prevent invasion of pathogens by keeping their population in check. However, the disruption of vaginal ecosystem contributes to the overgrowth of pathogens which causes complicated vaginal infections such as bacterial vaginosis (BV), sexually transmitted infections (STIs), and vulvovaginal candidiasis (VVC). Predisposing factors such as menses, pregnancy, sexual practice, uncontrolled usage of antibiotics, and vaginal douching can alter the microbial community. Therefore, the composition of vaginal microbiota serves an important role in determining vagina health. Owing to their Generally Recognised as Safe (GRAS) status, lactobacilli have been widely utilised as one of the alternatives besides conventional antimicrobial treatment against vaginal pathogens for the prevention of chronic vaginitis and the restoration of vaginal ecosystem. In addition, the effectiveness of Lactobacillus as prophylaxis has also been well-founded in long-term administration. This review aimed to highlight the beneficial effects of lactobacilli derivatives (i.e. surface-active molecules) with anti-biofilm, antioxidant, pathogen-inhibition, and immunomodulation activities in developing remedies for vaginal infections. We also discuss the current challenges in the implementation of the use of lactobacilli derivatives in promotion of human health. In the current review, we intend to provide insights for the development of lactobacilli derivatives as a complementary or alternative medicine to conventional probiotic therapy in vaginal health.
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Affiliation(s)
- Wallace Jeng Yang Chee
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Shu Yih Chew
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Leslie Thian Lung Than
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
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12
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Arumugam G, Rajendran R. Callophycin A loaded chitosan and spicules based nanocomposites as an alternative strategy to overcome vaginal candidiasis. Int J Biol Macromol 2020; 161:656-665. [PMID: 32544582 DOI: 10.1016/j.ijbiomac.2020.06.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/23/2020] [Accepted: 06/11/2020] [Indexed: 12/16/2022]
Abstract
The present study aimed to understand the killing effects of seaweed derived metabolite Callophycin A (Cal A). In vitro studies confirmed that the beneficial effects of Cal A on the viability of C. albicans. To enhance the biological activity, we used to demonstrated that chitosan and spicules as a drug carrier. The Callophycin A loading was confirmed by spectral variation of FT-IR and morphological variation by SEM. Moreover, around 65% and 38% of Cal A was successfully loaded in chitosan and spicules respectively. Further, VVC induced animal model experiments confirmed that the candidicidal activity of 1% clotrimazole, Cal A, Cal@Chi and Cal@Spi. After 6 days of treatment Cal@Chi produces a significant reduction in the fungal burden of vaginal lavage. The histo-morphological alterations also evidenced that the protective role of Cal@Chi in VVC model. The present investigations are known to be the first and foremost study to discriminate the potentiality of Cal A composites. Cal A loaded chitosan nanoparticles could be used as an alternative strategy for the development of the novel marine natural product based topical applications.
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Affiliation(s)
- Ganeshkumar Arumugam
- DNA Barcoding and Marine Genomics Laboratory, Department of Marine Science, Bharathidasan University, Tiruchirappalli, Tamilnadu, India
| | - Rajaram Rajendran
- DNA Barcoding and Marine Genomics Laboratory, Department of Marine Science, Bharathidasan University, Tiruchirappalli, Tamilnadu, India.
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13
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Saxon Lead Author GDGC, Edwards A, Rautemaa-Richardson R, Owen C, Nathan B, Palmer B, Wood C, Ahmed H, Ahmad Patient Representatives S, FitzGerald Ceg Editor M. British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis (2019). Int J STD AIDS 2020; 31:1124-1144. [PMID: 32883171 DOI: 10.1177/0956462420943034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Guideline Development Group Cara Saxon Lead Author
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Anne Edwards
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Riina Rautemaa-Richardson
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Caroline Owen
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Bavithra Nathan
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Bret Palmer
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Clare Wood
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Humera Ahmed
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Sameena Ahmad Patient Representatives
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Mark FitzGerald Ceg Editor
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
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14
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Farhan MA, Moharram AM, Salah T, Shaaban OM. Types of yeasts that cause vulvovaginal candidiasis in chronic users of corticosteroids. Med Mycol 2020; 57:681-687. [PMID: 30544194 DOI: 10.1093/mmy/myy117] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/19/2018] [Accepted: 11/05/2018] [Indexed: 12/22/2022] Open
Abstract
The current study aims to compare between the types of yeasts that cause vulvovaginal candidiasis (VVC) in women using corticosteroid medication compared to nonusers and estimate their sensitivity to available commercial antifungal agents. In a descriptive analytical cross-sectional study, we recruited 41 chronic corticosteroid users diagnosed clinically to have VVC from Women's Health Hospital, Assiut University, Egypt. Forty-seven age-matched women with VVC were recruited as a control group. Full history and clinical examination were performed. Vaginal sterile swab obtained from the vagina of each participant was subjected to direct Gram-stained smear examination as well as a culture on Sabouraud's glucose agar and HiCrome Candida agar. Further identification of the isolates was done using traditional methods. Fifty out of 88 samples (56.8%) were positive in culture including 25 samples (61%) from corticosteroid users group and 25 (53.2%) from noncorticosteroid users with no statistically significant difference (P = .302). The chronic corticosteroid users had more incidence of recurrent VVC as compared to nonusers (65.9% vs 40.4%, respectively) (P = .015). There was a significantly higher rate of non-Candida albicans (NCA) infections in corticosteroid users compared with nonusers (48% vs 20%, respectively) (P = .036). A higher significant difference in resistance of the isolates against clotrimazole (P = .003) and ketoconazole (P = .017) was demonstrated in corticosteroid users compared to nonusers. Thus, chronic corticosteroid use causes frequent attacks of VVC and increases the frequency of infection by NCA strains. Also, it increases resistance to common antifungal agents especially azole group.
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Affiliation(s)
- Mohammed A Farhan
- Department of Medical Microbiology, Faculty of Science, Ibb University, Ibb, Yemen.,Assiut University Mycological Centre (AUMC), Assiut University, Assiut, Egypt
| | - Ahmed M Moharram
- Assiut University Mycological Centre (AUMC), Assiut University, Assiut, Egypt.,Department of Botany and Microbiology, Faculty of Science, Assiut University, Assiut, Egypt
| | - Tareq Salah
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Omar M Shaaban
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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15
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Scharmann U, Kirchhoff L, Chapot VLS, Dziobaka J, Verhasselt HL, Stauf R, Buer J, Steinmann J, Rath PM. Comparison of four commercially available chromogenic media to identify Candida albicans and other medically relevant Candida species. Mycoses 2020; 63:823-831. [PMID: 32449997 DOI: 10.1111/myc.13119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The number of invasive Candida infections has significantly increased in recent decades. For the successful treatment of fungal infections, rapid identification at the species level, particularly in polyfungal infections, is a key factor. In this study, four commercially available chromogenic media, CandiSelect™ 4 (CS4), chromID™ Candida Agar (CCA), BBL™ CHROMagar™ Candida Medium (BBL) and Brilliance™ Candida Agar (BCA) were evaluated for Candida identification. MATERIAL/METHODS Overall, 181 bronchial secretion samples from intensive care patients were analysed prospectively. In addition, 18 primarily sterile materials, previously tested positive for Candida, were investigated retrospectively. All samples were cultured as recommended by the manufacturer and visually inspected after 24 and 48 hours by three independent investigators. As a control, colonies were identified by MALDI-TOF MS. Specificity and sensitivity were determined for C albicans identification prospectively. RESULTS CS4 and BCA showed the best overall consensus with the identification results reached by MALDI-TOF MS for Candida albicans and species. A clear differentiation between the species could be ascertained via easily identifiable, species-specific coloration in contrast to BBL and CCA. Sensitivity for C albicans (n = 73) identification varied between 32% (BCA) and 69% (CS4 and CCA) after 24 hours and 68% (BBL) and 82% (BCA) after 48 hours incubation, while specificity ranged between 62% (BBL) and 81% (CCA) after 24 hours and 82% (BBL) and 85% (CS4) after 48 hours. CONCLUSION CS4 and BCA are recommended for routine identification of Candida species in human samples.
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Affiliation(s)
- Ulrike Scharmann
- Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
| | - Lisa Kirchhoff
- Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
| | | | - Jan Dziobaka
- Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
| | | | - Raphael Stauf
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Nuremberg, Germany
| | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University Hospital Essen, Essen, Germany.,Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Nuremberg, Germany
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
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16
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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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Bignoumba M, Onanga R, Bivigou Mboumba B, Gafou A, Mouanga Ndzime Y, Lendamba RW, Mbombe Moghoa K, Kassa Kassa RF. Vulvovaginal candidiasis among symptomatic women of childbearing age attended at a Medical Analysis Laboratory in Franceville, Gabon. J Mycol Med 2019; 29:317-319. [PMID: 31481349 DOI: 10.1016/j.mycmed.2019.100895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vulvovaginal candidiasis (VVC) is one of the most common lower genital tract infections in women; this unpleasant and extremely embarrassing pathology is one of the main reasons for gynaecological consultation. In Gabon, the prevalence of VVC remains poorly described even though VVC is known to be the leading gynaecological condition in several countries. This retrospective cross-sectional study sought to assess the prevalence of VVC among symptomatic women in southeastern Gabon. METHODS Clinical samples were collected from patients suspected to have VVC during a 2-year period (from January 2016 to December 2017). Gram staining of vaginal smears provided indications of vaginal flora and confirmed the presence of yeast. Sabouraud-chloramphenicol and chromID Candida media were used to isolate yeast, and species identification was performed using morphological tests and the Vitek 2 Compact automated system. RESULTS For the 873 patients included in this study, the prevalence of VVC was 28.52%. Eleven Candida species were identified, with greater representation of Candidaalbicans (82.73%) than of Non C. albicanscandida (NCAC) (17.27%), which were distributed as follows: Candidafamata (4.02%), Candida spp. (3.61%), Candidarugosa (3.21%), Candidalipolytica (1.61%), Candidaparapsilosis (1.61%), Candidaglabrata (1.21%), Candidatropicalis (0.80%), Candidakrusei (0.40%), Candidadubliniensis (0.40%), and Candidasphaerica (0.40%). CONCLUSION This study offers the first estimation of VVC among Gabonese women in childbearing age with the symptoms. It showed that VVC is very common in Gabon. C. albicans as the most commonly represented species.
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Affiliation(s)
- M Bignoumba
- Centre International de Recherches Médicales de Franceville, BP 769, Franceville, Gabon.
| | - R Onanga
- Centre International de Recherches Médicales de Franceville, BP 769, Franceville, Gabon
| | - B Bivigou Mboumba
- Centre International de Recherches Médicales de Franceville, BP 769, Franceville, Gabon
| | - A Gafou
- Centre International de Recherches Médicales de Franceville, BP 769, Franceville, Gabon
| | - Y Mouanga Ndzime
- Centre International de Recherches Médicales de Franceville, BP 769, Franceville, Gabon
| | - R W Lendamba
- Centre International de Recherches Médicales de Franceville, BP 769, Franceville, Gabon
| | - K Mbombe Moghoa
- Université des sciences et techniques et Masuku, BP 943,Franceville, Gabon
| | - R F Kassa Kassa
- Centre International de Recherches Médicales de Franceville, BP 769, Franceville, Gabon
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ElFeky DS, Gohar NM, El-Seidi EA, Ezzat MM, AboElew SH. Species identification and antifungal susceptibility pattern ofCandidaisolates in cases of vulvovaginal candidiasis. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2015.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Dalia Saad ElFeky
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University, Egypt
| | - Noha Mahmoud Gohar
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University, Egypt
| | - Eman Ahmad El-Seidi
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University, Egypt
| | - Mona Mahmoud Ezzat
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University, Egypt
| | - Somaia Hassan AboElew
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt
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19
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Lv C, Ming D, Lei TT. A performance evaluation of an immuno-latex chromatography card for the rapid detection of Candida spp. J Microbiol Methods 2018; 157:4-8. [PMID: 30543825 DOI: 10.1016/j.mimet.2018.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 11/19/2022]
Abstract
This report evaluates the performance and species specificity of an immuno-latex chromatography card (ICC) for rapid detection of Candida spp. Double-manipulator single-blind Gram staining smear examination (GSSE) and ICC were used to analyze 354 vaginal discharge specimens (VDS) (including 98 tested as positive by GSSE) from women with suspected candidal vaginitis, simulated specimens with a concentration gradient, and vaginitis causing organism suspensions (0.9% NaCl) of 22 species from nine genera. Limit of detection, semi-quantitative detection performance, total detection performance and species specificity were determined for ICC, and the results were compared with those of the GSSE method. The limits of detection of ICC for Candida spp. in organism suspensions with 0.9% NaCl and simulated specimens were 7 × 106 cells/L and 7 × 108 cells/L respectively. For species specificity, the results were positive for six Candida spp. (C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, C. krusei and C. guilliermondii) and negative for the remaining 16 species (C. lusitaniae, Saccharomyces cerevisiae; three Gram-positive coccus species, four Gram-negative bacillus species, three Gram-negative coccus species and four common microbes causing vaginal infection) from eight genera. The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ICC for VDS were 93.81%, 99.10%, 97.31, 98.14% and 96.90%, respectively. The above indicators in the 98 VDS evaluated as positive were 84.39%, 92.86%, 86.74%, 96.72% and 70.27%, respectively. In summary, ICC offered better specificity, sensitivity, positive predictive value and negative predictive value for the detection of Candida spp. in VDS.
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Affiliation(s)
- Changhong Lv
- Department of Clinical Laboratory, the First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China
| | - Desong Ming
- Department of Clinical Laboratory, the First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China.
| | - Ting-Ting Lei
- Department of Clinical Laboratory, the First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China
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20
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Moradi R, Shariat M, Moghaddam-Banaem L. Effect of intrauterine device insertion on Candida species in cervicovaginal specimen identified by polymerase chain reaction technic: A longitudinal study on Iranian women. J Obstet Gynaecol Res 2018; 45:438-442. [PMID: 30426620 DOI: 10.1111/jog.13844] [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: 03/19/2018] [Accepted: 09/23/2018] [Indexed: 11/28/2022]
Abstract
AIM To assess the effects of copper T-380-A intrauterine device (IUD) insertion on Candida species in cervicovaginal specimen by a molecular method, polymerase chain reaction. METHODS This is a longitudinal prospective study performed on 95 women attending Health Centers of Tehran, Iran in 2012, who selected copper T-380-A IUD for contraception and had no history of local or systemic antibiotics or antifungals use during the previous 2 weeks. Cervicovaginal specimens were twice collected and cultured on Sabouraud dextrose agar and CHROMagar Candida, before and 3 months after IUD insertion. Finally, a molecular method, PCR-RFLP was performed for identification of Candida species. P-values <0.05 were considered significant. RESULTS The mean age of participants was 28 ± 7.44 years. Positive Candida cultures were significantly increased 3 months after IUD insertion (25.3% vs 11.6%, P = 0.007). The most common identified species before and after IUD insertion, were Albicans, Glabrata and then both 'Albicans & Glabrata', respectively. The prevalence of Albicans and Glabrata decreased, while both 'Albicans & Glabrata' increased insignificantly. CONCLUSION There was more than about fourfold increase in positive Candida cultures after IUD insertion. As the prevalence of simultaneous infection with both 'Albicans & Glabrata' species which are resistant to usual treatment, increased, it seems necessary to provide more intensive follow-up care for IUD users.
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Affiliation(s)
- Raheleh Moradi
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mamak Shariat
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Lida Moghaddam-Banaem
- Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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21
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Vidal F, Paret L, Linet T, Tanguy le Gac Y, Guerby P. [Intrauterine contraception: CNGOF Contraception Guidelines]. ACTA ACUST UNITED AC 2018; 46:806-822. [PMID: 30429071 DOI: 10.1016/j.gofs.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide national clinical guidelines focusing on intrauterine contraception. METHODS A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian guidelines were considered as well. RESULTS Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B). CONCLUSION Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.
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Affiliation(s)
- F Vidal
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France.
| | - L Paret
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France
| | - T Linet
- Service de gynécologie-obstétrique, centre hospitalier Loire-Vendée-Océan, 85300 Challans, France
| | - Y Tanguy le Gac
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - P Guerby
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France
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22
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Cai YM, Chen XS. Concerns regarding bias in estimates of recurrent vulvovaginal candidiasis. THE LANCET. INFECTIOUS DISEASES 2018; 18:1180. [DOI: 10.1016/s1473-3099(18)30565-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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Qin F, Wang Q, Zhang C, Fang C, Zhang L, Chen H, Zhang M, Cheng F. Efficacy of antifungal drugs in the treatment of vulvovaginal candidiasis: a Bayesian network meta-analysis. Infect Drug Resist 2018; 11:1893-1901. [PMID: 30425538 PMCID: PMC6203166 DOI: 10.2147/idr.s175588] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Antifungal drugs are used frequently in the treatment of vulvovaginal candidiasis (VVC), but have shown controversial results. In this study, we aimed to evaluate the effectiveness of different antifungal drugs in the treatment of VVC and to provide an evidence-based reference for clinical use. METHODS The published studies on the effectiveness of antifungal drugs in the treatment of VVC (up to April 2018) were retrieved from PubMed, Embase, the Cochrane Library, and Clini-calTrials.gov. We sifted through the literature according to Patients, Interventions, Comparisons and Outcomes principle, extracted data on the basic characteristics of the study, and evaluated the quality of included studies. We used R software for statistical analysis. RESULTS In total, 41 randomized controlled trials were included in this meta-analysis. The relative risk of VVC associated with ten drugs, including placebo, fluconazole, clotrimazole, miconazole, itraconazole, ketoconazole, econazole, butoconazole, terbinafine, and terconazole, was analyzed. The following drugs appeared to show more efficacy than placebo in the treated patients: fluconazole (OR =6.45, 95% CrI 4.42-9.41), clotrimazole (OR =2.99, 95% CrI 1.61-5.55), miconazole (OR =5.96, 95% CrI 3.17-11.2), itraconazole (OR =2.29, 95% CrI 1.21-4.33), ketoconazole (OR =2.40, 95% CrI 1.55-3.71), butoconazole (OR =1.18, 95% CrI 1.06-1.31), and terconazole (OR =5.60, 95% CrI 2.78-11.3). The value of surface under the cumulative ranking curve of each drug was as follows: placebo (0.5%), fluconazole (91.5%), clotrimazole (61.8%), miconazole (33.8%), itraconazole (50.5%), ketoconazole (42.8%), econazole (46.8%), butoconazole (82.2%), terbinafine (20.9%), and terconazole (65.0%). CONCLUSION Antifungal drugs are effective in the treatment of VVC. Fluconazole appeared to be the best drug for the treatment of VVC according to our analysis.
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Affiliation(s)
- Fen Qin
- Department of Obstetrics and Gynecology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Quan Wang
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Chunlian Zhang
- Department of Obstetrics and Gynecology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Caiyun Fang
- Department of Obstetrics and Gynecology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Liping Zhang
- Department of Obstetrics and Gynecology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Hailin Chen
- Department of Obstetrics and Gynecology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Mi Zhang
- Department of Cardiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China,
| | - Fei Cheng
- Department of Cardiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China,
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Naeimi B, Mirhendi H, Khamisipour G, Sadeghzadeh F, Ahmadi B. Candida africana in recurrent vulvovaginal candidiasis (RVVC) patients: frequency and phenotypic and genotypic characteristics. J Med Microbiol 2018; 67:1601-1607. [PMID: 30248002 DOI: 10.1099/jmm.0.000834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Up to 75 % of all women develop vulvovaginal candidiasis (VVC), with symptoms such as vulvar erythema, pruritus and abnormal vaginal discharge. Despite the global distribution of Candida africana, its role in recurrent vulvovaginal candidiasis (RVVC) is still unclear and requires further investigation. Here, we report on the frequency of C. africana among clinical isolates from patients with RVVC in Bushehr in southern Iran. METHODOLOGY Isolated Candida strains were identified by ITS-PCR-RFLP. Hyphal wall protein 1 (HWP1) was amplified to differentiate C. africana and the resulting sequences were subjected to phylogenetic analyses with a view to identifying similarities and differences in nucleotides. RESULTS Ten out of 119 strains originally identified as C. albicans turned out to be C. africana. Pairwise nucleotide alignment of HWP1 DNA sequences showed 100 % similarity between C. africana strains. Inter-species variation between Iranian C. africana HWP1 sequences and the only three available C. africana type sequences in GenBank revealed 99.7-100 % nucleotide similarity. Phylogenetic analysis of the HWP1 DNA sequences of 10 Iranian C. africana isolates, the 3 C. africana sequences available in GenBank and 2 representative Iranian C. albicans sequences revealed that all 11 Iranian C. africana strains formed a well-supported cluster separated from the remaining C. africana. CONCLUSION In our sample, C. africana was only isolated from 7.8 % of the patients with RVVC. While size polymorphisms in HPW1 genes allowed us to differentiate C. africana from C. albicans, no evidence of sequence variation within the Iranian C. africana isolates was observed.
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Affiliation(s)
- Behrouz Naeimi
- 1The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Hossein Mirhendi
- 2Departments of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Khamisipour
- 3Department of Hematology, Faculty of Allied Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Farzaneh Sadeghzadeh
- 4Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bahram Ahmadi
- 4Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
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Ameen F, Moslem M, Al Tami M, Al-Ajlan H, Al-Qahtani N. Identification of Candida species in vaginal flora using conventional and molecular methods. J Mycol Med 2017; 27:364-368. [DOI: 10.1016/j.mycmed.2017.04.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/23/2017] [Accepted: 04/30/2017] [Indexed: 01/26/2023]
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Döğen A, Metin B, Ilkit M, de Hoog GS, Heitman J. MTL genotypes, phenotypic switching, and susceptibility profiles of Candida parapsilosis species group compared to Lodderomyces elongisporus. PLoS One 2017; 12:e0182653. [PMID: 28771588 PMCID: PMC5542550 DOI: 10.1371/journal.pone.0182653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 07/21/2017] [Indexed: 01/08/2023] Open
Abstract
Reference isolates of Candida parapsilosis (n = 8), Candida metapsilosis (n = 6), Candida orthopsilosis (n = 7), and Lodderomyces elongisporus (n = 11) were analyzed to gain insight into their pathobiology and virulence mechanisms. Initial evaluation using BBL Chromagar Candida medium misidentified L. elongisporus isolates as C. albicans. Polymerase chain reaction analysis of isolate MTL idiomorphs revealed that all C. parapsilosis isolates were MTLa homozygous and no MTL α1, α2, a1, or a2 gene was detected in L. elongisporus isolates. For C. orthopsilosis, two isolates were MTLa homozygous and five were MTL-heterozygous. Similarly, one C. metapsilosis isolate was MTLα homozygous whereas five were MTL-heterozygous. Isolate phenotypic switching analysis revealed potential phenotypic switching in the MTLα homozygous C. metapsilosis isolate, resulting in concomitant elongated cell formation. Minimum inhibitory concentrations of fluconazole (FLC) and FK506, alone or in combination, were determined by checkerboard assay, with data analyzed using the fractional inhibitory concentration index model. Synergistic or additive effects of these compounds were commonly observed in C. parapsilosis and L. elongisporus isolates. No killer activity was observed in the studied isolates, as determined phenotypically. No significant difference in virulence was seen for the four species in a Galleria mellonella model (P > 0.05). In conclusion, our results demonstrated phenotypic switching of C. metapsilosis CBS 2315 and that FLC and FK506 represent a promising drug combination against C. parapsilosis and L. elongisporus. The findings of the present study contribute to our understanding of the biology, diagnosis, and new possible treatments of the C. parapsilosis species group and L. elongisporus.
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Affiliation(s)
- Aylin Döğen
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Mersin, Mersin, Turkey
| | - Banu Metin
- Department of Food Engineering, Faculty of Engineering and Natural Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine University of Çukurova, Adana, Turkey
- * E-mail:
| | - G. Sybren de Hoog
- Westerdijk Fungal Biodiversity Centre, Utrecht, the Netherlands
- Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, the Netherlands
| | - Joseph Heitman
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, North Carolina, United States of America
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Cauchie M, Desmet S, Lagrou K. Candida and its dual lifestyle as a commensal and a pathogen. Res Microbiol 2017; 168:802-810. [PMID: 28263903 DOI: 10.1016/j.resmic.2017.02.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/19/2022]
Abstract
Candida spp. are part of the normal vaginal microflora in 20-30% of healthy women. However, if the balance between these yeasts and the host is disturbed, Candida spp. can cause vulvovaginal candidiasis (VVC), with Candida albicans being the major causative agent. Different studies have been performed in order to better understand Candida's dual lifestyle in the vagina. The potential of C. albicans to switch from the yeast cell morphology to its hyphal form is considered a key element in VVC pathogenesis. Candida spp. also express other virulence factors, such as hydrolytic extracellular enzymes and heat shock proteins and can form biofilms.
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Affiliation(s)
- Mathieu Cauchie
- Department of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Stefanie Desmet
- Department of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven - University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Katrien Lagrou
- Department of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven - University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Fornari G, Vicente VA, Gomes RR, Muro MD, Pinheiro RL, Ferrari C, Herkert PF, Takimura M, Carvalho NSD, Queiroz-Telles F. Susceptibility and molecular characterization of Candida species from patients with vulvovaginitis. Braz J Microbiol 2016; 47:373-80. [PMID: 26991298 PMCID: PMC4874609 DOI: 10.1016/j.bjm.2016.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 03/05/2015] [Indexed: 11/28/2022] Open
Abstract
Vulvovaginal candidiasis affects women of reproductive age, which represents approximately 15–25% of vaginitis cases. The present study aimed to isolate and characterize yeast from the patients irrespective of the presentation of clinical symptoms. The isolates were subjected to in vitro susceptibility profile and characterization by molecular markers, which intended to assess the distribution of species. A total of 40 isolates were obtained and identified through the CHROMagar, API20aux and by ITS and D1/D2 regions sequencing of DNAr gene. Candida albicans strains were genotyped by the ABC system and the isolates were divided into two genotypic groups. The identity of the C. albicans, C. glabrata, C. guilliermondii, C. kefyr and Saccharomyces cerevisiae isolates was confirmed by the multilocus analysis. The strains of Candida, isolated from patients with complications, were found to be resistant to nystatin but sensitive to fluconazole, amphotericin B and ketoconazole, as observed by in vitro sensitivity profile. The isolates from asymptomatic patients, i.e., the colonized group, showed a dose-dependent sensitivity to the anti-fungal agents, fluconazole and amphotericin B. However, the isolates of C. albicans that belong to distinct genotypic groups showed the same in vitro susceptibility profile.
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Affiliation(s)
- Gheniffer Fornari
- Graduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Laboratory of Microbiology and Molecular Biology-LabMicro, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Vania Aparecida Vicente
- Graduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Laboratory of Microbiology and Molecular Biology-LabMicro, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Renata Rodrigues Gomes
- Graduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Laboratory of Microbiology and Molecular Biology-LabMicro, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | | | | - Patricia Fernanda Herkert
- Graduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Laboratory of Microbiology and Molecular Biology-LabMicro, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | | - Flavio Queiroz-Telles
- Graduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Laboratory of Microbiology and Molecular Biology-LabMicro, Federal University of Paraná, Curitiba, Paraná, Brazil; Support and Diagnosis Unit, Mycology Laboratory, Federal University of Paraná, Brazil.
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Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Crit Rev Microbiol 2015; 42:905-27. [PMID: 26690853 DOI: 10.3109/1040841x.2015.1091805] [Citation(s) in RCA: 324] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Vulvovaginal candidiasis (VVC) is an infection caused by Candida species that affects millions of women every year. Although Candida albicans is the main cause of VVC, the identification of non-Candida albicans Candida (NCAC) species, especially Candida glabrata, as the cause of this infection, appears to be increasing. The development of VVC is usually attributed to the disturbance of the balance between Candida vaginal colonization and host environment by physiological or nonphysiological changes. Several host-related and behavioral risk factors have been proposed as predisposing factors for VVC. Host-related factors include pregnancy, hormone replacement, uncontrolled diabetes, immunosuppression, antibiotics, glucocorticoids use and genetic predispositions. Behavioral risk factors include use of oral contraceptives, intrauterine device, spermicides and condoms and some habits of hygiene, clothing and sexual practices. Despite a growing list of recognized risk factors, much remains to be elucidated as the role of host versus microorganisms, in inducing VVC and its recurrence. Thus, this review provides information about the current state of knowledge on the risk factors that predispose to VVC, also including a revision of the epidemiology and microbiology of VVC, as well as of Candida virulence factors associated with vaginal pathogenicity.
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Affiliation(s)
- Bruna Gonçalves
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Carina Ferreira
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Carlos Tiago Alves
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Mariana Henriques
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Joana Azeredo
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Sónia Silva
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
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He Y, Geng W, Wang P, Xi L, Wang Z, Wu G, Wang C. Simultaneous detection of four common oral Candida species from blood samples by the fluorescence polarization assay. Cell Biochem Biophys 2015; 71:919-24. [PMID: 25308858 DOI: 10.1007/s12013-014-0284-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The genus Candida is both the commensal microbe and the opportunistic pathogen, containing approximately 200 species inhabiting in oral cavity of 53 % of the general population. Candida species can cause the diseases from local mucosal infections to systemic mycoses, even life-threatening infections in immunocompromised individuals. The timely differentiation of Candida species is important for the guidance of clinical medication. Four common Candida species in Chinese population (Candida albicans, Candida tropicalis, Candida glabrata, Candida krusei) were chosen as the targets to develop the rapid screening method in this work. Combined with amplification by asymmetric PCR, this parallel fluorescence polarization (FP) immunoassay is carried out in homogeneous solution phase. The limit of detection of the assay was shown to be 50 copies/mL in blood samples. The evaluation in multicenter manner showed excellent reproducibility and stability. The comparison between DNA sequencing and the FP immunoassay indicated that there was no significant difference between these methods. This molecular strategy-based method is simple, rapid, and feasible for identifying common Candida species and thereby holding great potential in the application of clinical laboratories.
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Affiliation(s)
- Yuhong He
- Department of Orthodontics, College of Stomatology, Shandong University, Jinan, 250012, China
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31
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Clinical and Laboratory Features of Six Cases of Candida and Dermatophyte Folliculitis and a Review of Published Studies. Mycopathologia 2015; 181:97-105. [DOI: 10.1007/s11046-015-9939-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
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32
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Sobel JD, Akins RA. The Role of PCR in the Diagnosis of Candida Vulvovaginitis-a New Gold Standard? Curr Infect Dis Rep 2015; 17:488. [PMID: 26003471 DOI: 10.1007/s11908-015-0488-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PCR is recognized as a reliable technique for detection of all types of microorganisms. Being highly objective and reproducible also sensitive and specific, PCR is now widely used for sexually transmitted infection (STI) diagnosis. Potential, however, exists for detecting non-pathogens, and not identifying a pathogenic state decreases specificity or clinical significance. PCR Candida tests of vaginal specimens are now widely available and frequently used offering a modest to moderate increase in sensitivity and are likely to replace traditional culture and DNA homology testing. Nevertheless, there remain considerable gaps in our knowledge regarding the usefulness and applications of these expensive tests.
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Affiliation(s)
- J D Sobel
- Division of Infectious Diseases, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA,
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Zhang JY, Liu JH, Liu FD, Xia YH, Wang J, Liu X, Zhang ZQ, Zhu N, Ying Y, Huang XT. Vulvovaginal candidiasis: species distribution, fluconazole resistance and drug efflux pump gene overexpression. Mycoses 2015; 57:584-91. [PMID: 24962255 DOI: 10.1111/myc.12204] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/02/2014] [Accepted: 04/14/2014] [Indexed: 11/28/2022]
Abstract
The increasing incidence of vulvovaginal candidiasis (VVC) and the emergence of fluconazole resistance are an indisputable fact. However, little information is available regarding the correlation between fluconazole resistance in vaginal Candida albicans and the expression of drug efflux pump genes. In this study, we investigated the species distribution, fluconazole susceptibility profiles and the mechanisms of fluconazole resistance in Candida strains. In total, 785 clinical Candida isolates were collected from patients with VVC. C. albicans was the most frequently isolated species(n = 529) followed by C. glabrata (n = 164) and C. krusei (n = 57). Of all Candida isolates, 4.7% were resistant to fluconazole. We randomly selected 18 fluconazole resistant isolates of C. albicans to evaluate the expression of CDR1, CDR2, MDR1 and FLU1 genes. Compared with fluconazole-susceptible C. albicans isolates, CDR1 gene expression displayed 3.16-fold relative increase, which was statistically significant. CDR2, MDR1 and FLU1 overexpression was observed in several fluconazole-resistant C. albicans isolates, but statistical significance was not achieved. These results demonstrate a high frequency of non-albicans species (32.6%); however, C. albicans is the most common Candida species implicated in vaginitis, and this strain displays considerable fluconazole resistance. Meanwhile, our study further indicates that fluconazole resistance in C. albicans may correlate with CDR1 gene overexpression.
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Kalantari N, Ghaffari S, Bayani M. Trichomonas, Candida, and gardnerella in cervical smears of Iranian women for cancer screening. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:25-9. [PMID: 24678473 PMCID: PMC3938869 DOI: 10.4103/1947-2714.125861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Trichomonas vaginalis, Gardrenella vaginalis, and Candida sp are responsible for 90% of vaginitis which has been reported as important risk factors for cervical cancer. Aim: This study aimed to find the prevalence of T. vaginalis, Candida sp, and G. vaginalis in women attended the cancer clinic charity, Babol, Iran and to identify the associated risk factors. Materials and Methods: This retrospective study carried out from 1996 to July 2012 on women who attended to a cancer screening program at the cancer clinics charity, Babol, Iran. Papanicolaou test and clinical examinations were performed for each woman. In addition to Papanicolaou test results, demographic data were collected. The data were analyzed with X2 test using SPSS software, version 18. Results: In total, 2511 out of 33600 (7.5%) cases had vaginal infections. A total of 71 (0.2%), 2248 (6.7%), and 192 (0.6%) of subjects were infected by T. vaginalis, Candida sp, and Gardnerella, respectively. The highest rate of infection was seen in 20-30 and 30-40 years age group. The frequency of vaginal ulcers was higher in trichomoniasis (14.1%). Conclusion: This study demonstrated that the prevalence of T. vaginalis, Candida sp, and Gardnerella was low among the studied population. Moreover, malignant cytological alternations were not seen in any infected women.
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Affiliation(s)
- Narges Kalantari
- Cellular and Molecular Biology Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Salman Ghaffari
- Department of Parasitology Mycology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Masomeh Bayani
- Department of Infectious Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran
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Clinical characteristics of Turkish women with Candida krusei vaginitis and antifungal susceptibility of the C. krusei isolates. Infect Dis Obstet Gynecol 2013; 2013:698736. [PMID: 24396265 PMCID: PMC3874352 DOI: 10.1155/2013/698736] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 11/04/2013] [Indexed: 11/18/2022] Open
Abstract
Objective. Candida krusei causes approximately 1% of vulvovaginal candidiasis (VVC) cases and is naturally resistant to fluconazole. Antifungal testing may be required if C. krusei vaginitis fails to respond to non-fluconazole therapy, particularly in patients with recurrent infections. Design. We investigated the clinical characteristics and antifungal susceptibility profile of vaginal C. krusei isolates. Between 2009 and 2012, we identified 560 unrelated Candida spp.-positive vaginal cultures, of which 28 (5.0%) were C. krusei. These isolates were analyzed according to host factors and the clinical forms of VVC, and their in vitro susceptibility to 10 antifungal agents was tested using a reference microdilution method. Results. We observed that perineal laceration and increased age (>50 years) were significant predictors of C. krusei in vaginal samples (P < 0.05). All isolates were susceptible to amphotericin B, caspofungin, ketoconazole, and miconazole. Additionally, susceptible dose-dependent and resistant rates were found for fluconazole as 42.9% and 57.1%, respectively. Remarkably, only 42.9% and 67.9% of the isolates were susceptible to itraconazole and voriconazole, respectively. Conclusions. Understanding local susceptibility patterns, especially those of non-C. albicans Candida species, can significantly aid in the selection of an effective antifungal agent. The in vivo response of C. krusei vaginitis to various antifungal therapeutics remains unknown and requires further research.
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Güzel AB, Küçükgöz-Güleç Ü, Aydin M, Gümral R, Kalkanci A, Ilkit M. Candidavaginitis during contraceptive use: The influence of methods, antifungal susceptibility and virulence patterns. J OBSTET GYNAECOL 2013; 33:850-6. [DOI: 10.3109/01443615.2013.834306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hormonal contraception decreases bacterial vaginosis but oral contraception may increase candidiasis: implications for HIV transmission. AIDS 2013; 27:2141-53. [PMID: 23660575 DOI: 10.1097/qad.0b013e32836290b6] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A 2012 WHO consultation concluded that combined oral contraception (COC) does not increase HIV acquisition in women, but the evidence for depot medroxyprogesterone acetate (DMPA) is conflicting. We evaluated the effect of COC and DMPA use on the vaginal microbiome because current evidence suggests that any deviation from a 'healthy' vaginal microbiome increases women's susceptibility to HIV. METHODS We conducted a systematic review and reanalysed the Hormonal Contraception and HIV Acquisition (HC-HIV) study. Vaginal microbiome outcomes included bacterial vaginosis by Nugent scoring, vaginal candidiasis by culture or KOH wet mount and microbiome compositions as characterized by molecular techniques. RESULTS Our review of 36 eligible studies found that COC and DMPA use reduce bacterial vaginosis by 10-20 and 18-30%, respectively. The HC-HIV data showed that COC and DMPA use also reduce intermediate microbiota (Nugent score of 4-6) by 11% each. In contrast, COC use (but not DMPA use) may increase vaginal candidiasis. Molecular vaginal microbiome studies (n=4) confirm that high oestrogen levels favour a vaginal microbiome composition dominated by 'healthy' Lactobacillus species; the effects of progesterone are less clear and not well studied. CONCLUSION DMPA use does not increase HIV risk by increasing bacterial vaginosis or vaginal candidiasis. COC use may predispose for vaginal candidiasis, but is not believed to be associated with increased HIV acquisition. However, the potential role of Candida species, and vaginal microbiome imbalances other than bacterial vaginosis or Candida species, in HIV transmission cannot yet be ruled out. Further in-depth molecular studies are needed.
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Neppelenbroek KH, Seó RS, Urban VM, Silva S, Dovigo LN, Jorge JH, Campanha NH. Identification of
Candida
species in the clinical laboratory: a review of conventional, commercial, and molecular techniques. Oral Dis 2013; 20:329-44. [DOI: 10.1111/odi.12123] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/25/2013] [Accepted: 04/15/2013] [Indexed: 01/24/2023]
Affiliation(s)
- KH Neppelenbroek
- Department of Prosthodontics Bauru Dental School University of São Paulo‐USP Bauru São PauloBrazil
| | - RS Seó
- Department of Prosthodontics Varzea Grande School of Dentistry Varzea Grande Mato GrossoBrazil
| | - VM Urban
- Department of Dentistry Ponta Grossa State University‐UEPG Ponta Grossa Paraná Brazil
| | - S Silva
- Department of Biological Engineering Institute for Biotechnology and Bioengineering University of Minho Braga Portugal
| | - LN Dovigo
- Department of Social Dentistry Araraquara Dental School UNESP – Univ. Estadual Paulista Araraquara São PauloBrazil
| | - JH Jorge
- Department of Dental Materials and Prosthodontics Araraquara Dental School UNESP – Univ. Estadual Paulista Araraquara São Paulo Brazil
| | - NH Campanha
- Department of Dentistry Ponta Grossa State University‐UEPG Ponta Grossa Paraná Brazil
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Kalkanci A, Güzel AB, Jabban IIK, Aydin M, Ilkit M, Kuştimur S. Candidavaginitis in non-pregnant patients: A study of antifungal susceptibility testing and virulence factors. J OBSTET GYNAECOL 2013; 33:378-83. [DOI: 10.3109/01443615.2013.767323] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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40
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Barsoumian A, Calvano T, Markelz AE, Cassidy R, Murray CK, Beckius ML, Mende K, Akers KS. Variations of CHROMagar Acinetobacter to detect imipenem-resistant Acinetobacter baumannii–calcoaceticus complex. ACTA ACUST UNITED AC 2013; 45:446-52. [DOI: 10.3109/00365548.2013.759270] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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41
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Mintz JD, Martens MG. Prevalence of Non-<i>Albicans Candida</i> Infections in Women with Recurrent Vulvovaginal Symptomatology. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/aid.2013.34035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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42
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Fischer G. Chronic vulvovaginal candidiasis: What we know and what we have yet to learn. Australas J Dermatol 2012; 53:247-54. [DOI: 10.1111/j.1440-0960.2011.00860.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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MacCallum DM. Hosting infection: experimental models to assay Candida virulence. Int J Microbiol 2011; 2012:363764. [PMID: 22235206 PMCID: PMC3253448 DOI: 10.1155/2012/363764] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 10/13/2011] [Indexed: 02/01/2023] Open
Abstract
Although normally commensals in humans, Candida albicans, Candida tropicalis, Candida parapsilosis, Candida glabrata, and Candida krusei are capable of causing opportunistic infections in individuals with altered physiological and/or immunological responses. These fungal species are linked with a variety of infections, including oral, vaginal, gastrointestinal, and systemic infections, with C. albicans the major cause of infection. To assess the ability of different Candida species and strains to cause infection and disease requires the use of experimental infection models. This paper discusses the mucosal and systemic models of infection available to assay Candida virulence and gives examples of some of the knowledge that has been gained to date from these models.
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Affiliation(s)
- Donna M. MacCallum
- Aberdeen Fungal Group, School of Medical Sciences, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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Ilkit M, Guzel AB. The epidemiology, pathogenesis, and diagnosis of vulvovaginal candidosis: A mycological perspective. Crit Rev Microbiol 2011; 37:250-61. [DOI: 10.3109/1040841x.2011.576332] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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45
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Lack of Candida africana and Candida dubliniensis in Vaginal Candida albicans Isolates in Turkey Using HWP1 Gene Polymorphisms. Mycopathologia 2011; 172:73-6. [DOI: 10.1007/s11046-011-9401-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 02/10/2011] [Indexed: 11/26/2022]
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46
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Guzel AB, Ilkit M, Burgut R, Urunsak IF, Ozgunen FT. An evaluation of risk factors in pregnant women with Candida vaginitis and the diagnostic value of simultaneous vaginal and rectal sampling. Mycopathologia 2011; 172:25-36. [PMID: 21293929 DOI: 10.1007/s11046-011-9392-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 01/17/2011] [Indexed: 01/07/2023]
Abstract
In this study, we investigated the epidemiological characteristics of VVC among pregnant women. We conducted a prospective survey among 372 pregnant women to investigate the prevalence, clinical forms, etiological agents, and predisposing factors of VVC. In addition, we determined the relationship between vaginal and rectal flora by simultaneously obtaining one high vaginal swab and one rectal swab from each patient using sterile cotton-tipped swabs. Furthermore, we compared the recovery and identification performances of chromID Candida agar to Sabouraud dextrose agar with gentamicin and chloramphenicol. Clinically and mycologically confirmed cases of VVC were detected in 139 (37.4%) and vaginal colonization described in 42 (11.3%) of 372 pregnant women. Rectal cultures were also positive in 98 of the 139 (70.5%) VVC cases. Candida albicans and C. glabrata were identified in vaginal samples in 58.0 versus 19.0% and from rectal samples in 49.0 versus 13.5%, respectively. Increases in gestational week and gravidae were identified to be statistically significant in patients with acute VVC (AVVC) and symptomatic recurrent VVC (RVVC), and asymptomatic RVVC (P = 0.04 and P = 0.03, respectively). In the laboratory diagnosis of VVC, specifically tailored chromogenic media are reliable tools for both the recovery and rapid identification of common Candida spp., particularly C. albicans, as well as for the detection of polyfungal populations in vaginal samples (P > 0.05). In addition, rectal colonization is a common finding in cases of AVVC and symptomatic-RVVC cases and corresponds well with the presence of the same yeast species in the vagina.
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Affiliation(s)
- Ahmet Barış Guzel
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Cukurova, Adana, Turkey
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