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BMC Women's Health
Published in: BMC Women's Health 1/2018

Open Access 01-12-2018 | Research article

Vulvovaginal candidiasis: species distribution of Candida and their antifungal susceptibility pattern

Authors: Adane Bitew, Yeshiwork Abebaw

Published in: BMC Women's Health | Issue 1/2018

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Abstract

Background

Vulvovaginal candidiasis is a global issue of concern due to its association with economic costs, sexually transmitted infections, and ascending genital tract infection. The aim of this study was to determine species distribution and antifungal susceptibility pattern of Candida species causing vulvovaginal candidiasis.

Methods

A cross sectional study was conducted from November 2015 to December 2016 at the Family Guidance Association of Ethiopia. Vaginal swabs collected from study subjects that were clinically diagnosed with vulvovaginal candidiasis were cultured. Yeast identification and antifungal susceptibility testing were determined by the automated VITEK 2 compact system. The association of vulvovaginal candidiasis with possible risk factors was assessed and analyzed using SPSS version 20.

Results

The overall prevalence of vulvovaginal candidiasis was 41.4%. The association of vulvovaginal candidiasis was statistically significant with previous genital tract infection (p = 0.004), number of life-time male sex partners (p = .037), and number of male sex partners in 12 month (p = 0.001). Of 87 Candida isolates recovered, 58.6% were C. albicans while 41.4% were non-albicans Candida species. The highest overall drug resistance rate of Candida species was observed against fluconazole (17.2%), followed by flycytosine (5.7%). All Candida isolates were 100% susceptible to voriconazole, caspofungin, and micafungin. C. albicans, was 100% susceptible to all drugs tested except fluconazole and flycytosine with a resistance rate of 2% each drug. C. krusei, was 100 and 33.3% resistant to fluconazole and flycytosine, respectively.

Conclusions

High prevalence rate of vulvovaginal candidiasis and observation of high prevalence rate of non-albicans Candida species in the present study substantiate, the importance of conducting continuous epidemiological surveys to measure changes in species distribution from C. albicans to non-albicans Candida species in Ethiopia. Although, fluconazole still appeared to be active against all isolates of C. albicans and non-albicans Candida species high resistance rate of C. krusei against the drug may demonstrate a search for alternative antifungal drugs when treating vulvovaginal candidiasis caused by C. krusei.
Literature
1.
Nyirjesy P, Sobel JD. Vulvovaginal candidiasis. Obstet Gynecol Clin N Am. 2003;30:671–84.CrossRef
2.
3.
Ahmad A, Khan AU. Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India. Eur J Obstet Gynecol Reprod Biol. 2009;144:68–71.CrossRefPubMed
4.
Ilkit M, Guzel AB. The epidemiology, pathogenesis, and diagnosis of vulvovaginal candidosis: a mycological perspective. Crit Rev Microbiol. 2011;37:250–61.CrossRefPubMed
5.
6.
Amouri I, Sellami H, Borji N, Abbes S, Sellami A, Cheikhrouhou F, et al. Epidemiological survey of vulvovaginal candidosis in Sfax, Tunisia. Mycoses. 2011;54:499–505.CrossRef
7.
Amouri I, Sellami H, Abbes S, Hadrich I, Mahfoudh N, Makni H, et al. Microsatellite analysis of Candida isolates from recurrent vulvovaginal candidiasis. J Med Microb. 2012;61:1091–6.CrossRef
8.
CDC. Sexually transmitted diseases treatment guidelines, 2010. MMWR. 2010;59(RR12):1–110.
9.
Olowe OA, Makanjuola OB, Olowe R, Adekanle DA. Prevalence of vulvovaginal candidiasis, trichomoniasis and bacterial vaginosis among pregnant women receiving antenatal care in Southwestern Nigeria. Eur J Microbiol Immunol. 2014;4:193–7.CrossRef
10.
Patel DA, Gillespie B, Sobel JD, Leaman D, Nyirjesy P, Weitz MV, et al. Risk factors for recurrent vulvovaginal candidiasis in women receiving maintenance antifungal therapy: results of a prospective cohort study. Am J Obst Gynecol. 2004;190:644–53.CrossRef
11.
Sobe JD, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy PR, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obst Gynecol. 1998;178:203–11.CrossRef
12.
Donder GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. Inter J Obstet Gynaecol. 2002;109:34–43.CrossRef
13.
Foxman B, Barlow R, d'Arcy H, Gillepsie B, Sobel JD. Candida vaginitis: self-reported incidence and associated costs. Sex Transm Dis. 2000;27:230–5.CrossRefPubMed
14.
Schaller M. Candida albicans-interactions with the mucosa and the immune system. J Dtsch Dermatol Ges. 2006;4:328–36.CrossRefPubMed
15.
Ferrer J. Vaginal candidosis: epidemiological and etiological factors. Int J Gynecol Obstet. 2000;71:S 21–7.CrossRef
16.
Sobel JD, Ohmit SE, Schuman P, Klein RS, Mayer K, Duerr A, et al. The evolution of Candida spp. and fluconazole susceptibility among oral and vaginal isolates recovered from human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women. J Infect Dis. 2001;183:286–93.CrossRefPubMed
17.
Beltrame A, Matteelli A, Cristina A, Carvalho C, Saleri N, Casalini C, et al. Vaginal colonization with Candida spp. in human immunodeficiency virus-infected women: a cohort study. Int J STD AIDS. 2006;17:260–6.CrossRefPubMed
18.
Melhem MSC, Bertoletti A, Lucca HRL, Silva RBO, Meneghin FA, Szeszs MW. Use of the VITEK 2 system to identify and test the antifungal susceptibility of clinically relevant yeast species. Braz J Microbiol. 2013;44:1257–66.CrossRefPubMed
19.
Donay JL, Mathieu D, Fernandes P, Pregermain C, Bruel P, Wargnier A, et al. Evaluation of the automated phoenix system for potential routine use in the clinical microbiology laboratory. J Clin Microbiol. 2004;42:1542–6.CrossRefPubMedPubMedCentral
20.
WHO. Provisional Guidelines on Standard International Age Classifications: Statistical Papers, Series M, vol. 74. New York: United Nations; 1982. p. 4–11.
21.
ERylander E, Berglund A-L, Krassny C, Petrini B. Vulvovaginal candida in a young sexually active population: prevalence and association with oro-genital sex and frequent pain at intercourse. Sex Transm Infect. 2004;80:54–7.CrossRef
22.
Xu J, Schwartz K, Bartoces M, Joseph M, Severson R, Sobel JD. Effect of antibiotics on vulvovaginal candidiasis: a Metro Net study. J Am Board Fam Med. 2008;21:261–8.CrossRefPubMed
23.
Spinillo A, Capuzzo E, Nicola S, Baltaro F, Ferrari A, Monaco A. The impact of oral contraception on vulvovaginal candidiasis. Contraception. 1995;51:293–7.CrossRefPubMed
24.
25.
Yadav K, Prakash S. Prevalence of vulvovaginal candidiasis in pregnancy. Glob J Med Med Sci. 2016;4:108–16.
26.
Spinillo A, Carrata L, Pizzolia G. Reccurent volvovaginal candidiasis: result of a cohort study of sexually transmitted transmission and intestinal reservoir. J Repord Med. 1992;37:343–7.
27.
Janković S, Bojović D, Vukadinović D, Daglar E, Janković M, Laudanović D, et al. Risk factors for recurrent vulvovaginal candidiasis. Vojnosanit Pregl. 2010;67:819–24.CrossRefPubMed
28.
Ttrama JP, Adelson ME, Raphaelli I, Stemmer SM, Mmordechai E. Detection of Candida species in vaginal samples in a clinical laboratory setting. Infect Dis Obstet Gynecol. 2005;13(2):63–7.CrossRef
29.
Bauters TGM, Dhont MA, Temmerman MI, Nelis HJ. Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women. Am J Obstet Gynecol. 2002;187:569–74.CrossRefPubMed
30.
Haleim MMA, El-Feky EAM, Sayed A, Ismail DK, Sayed AM, Abdella RMA. Provence of non albicans species associated with vulvovaginal candidiasis in Egyptian women. Int J Adv Int Health Sci. 2015;12:304–13.
31.
32.
Nyirjesy P, Seeney SM, Grody MHT, Jordan CA, Buckley HR. Chronic fungal vaginitis: the value of cultures. Am J Obstet Gynecol. 1995;173:820–3.CrossRefPubMed
33.
Sobel JD, Wiesenfeld HC, Martens M, Danna P, Hooton TH, Rompalo A, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med. 2004;351:876–83.CrossRefPubMed
34.
Hasanvand S, Qomi HA, Kord M, Didehdar M. Molecular epidemiology and in vitro antifungal susceptibility of Candida isolates from women with vulvovaginal candidiasis in northern cities of Khuzestan Province. Iran Jundishapur J Microbiol. 2017;10(8):12804. https://​doi.​org/​10.​5812/​jjm.​12804.​ CrossRef
35.
Guidelines for Management of Opportunistic Infections and Antiretroviral Treatment in Adolescents and Adults in Ethiopia. Federal HIV/AIDS Prevention and Control. Addis Ababa: Office Federal Ministry of Health; 2007.
36.
Ministry of Health. Standard Treatment Guideline. Addis Ababa: Drug Administration and Control Authority, Ministry of Health; 2004.
37.
Alexander BD, Perfect JR. Antifungal resistance trends towards the year 2000: implications for therapy and new approaches. Drugs. 1997;54:657–78.CrossRefPubMed
38.
Safdar A, Chaturvedi V, Cross EW, Park S, Bernard EM, Armstrong D, et al. Prospective study of Candida species in patients at a comprehensive cancer center. Antimicrob Agents Chemother. 2001;45:2129–33.CrossRefPubMedPubMedCentral
39.
Richter SS, Rudolph P, Galask RP, Shawn A, Messer SA, Richard J, et al. Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases. J Clin Microbiol. 2005;43:2155–62.CrossRefPubMedPubMedCentral
40.
Lyon GM, Karatela S, Sunay S, Adiri Y. Antifungal susceptibility testing of Candida isolates from the Candida surveillance study. J Clin Microbiol. 2010;48:1270–5.CrossRefPubMedPubMedCentral
41.
Pfaller MD, Diekema D, Gibbs V, Newell J, Meis I, Gould W, et al. Results from the ARTEMIS DISK global antifungal surveillance study, 1997 to 2005: an 8.5-year analysis of susceptibilities of Candida species and other yeast species to fluconazole and voriconazole determined by CLSI 30 standardized disk diffusion testing. J Clin Microbiol. 2007;45:1735–45.CrossRefPubMedPubMedCentral
42.
Diekema DJ, Messer SA, Brueggemann AB, Coffman SL, Doern GV, Herwaldt LA, et al. Epidemiology of candidemia: 3-year results from the emerging infections and the epidemiology of Iowa organisms study. J Clin Microbiol. 2002;40:1298–302.CrossRefPubMedPubMedCentral
43.
Rex J, Stevens D. Systemic antifungal agents. In: Mandell G, Bennett J, Dolin R, editors. Principles and practice of infectious diseases, vol. 1. 6th ed. Philadelphia: Elsevier; 2005. p. 501–11.
44.
Pappas PC, Rotstein R, Betts M, Nucci D, Talwar J, De Waele J, et al. Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis. Clin Infect Dis. 2007;45:883–93.CrossRefPubMed
45.
Ostrosky-Zeichne LA, Lashof MO, Kullberg BJ, Rex JH. Voriconazole salvage treatment of invasive candidiasis. Eur J Clin Microbiol Infect Dis. 2003;22:651–5.CrossRef
46.
47.
Kanafani ZA, Perfect JR. Antimicrobial resistance: resistance to antifungal agents: mechanisms and clinical impact. Clin Infec Dis. 2008;46:120–8.CrossRef
Metadata
Title
Vulvovaginal candidiasis: species distribution of Candida and their antifungal susceptibility pattern
Authors
Adane Bitew
Yeshiwork Abebaw
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Women's Health / Issue 1/2018
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/s12905-018-0607-z

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