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

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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.

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Most cited references 40

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Sexually transmitted diseases treatment guidelines, 2010.

Kimberly Workowski, Stuart Berman (2010)

These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 18-30, 2009. The information in this report updates the 2006 Guidelines for Treatment of Sexually Transmitted Diseases (MMWR 2006;55[No. RR-11]). Included in these updated guidelines is new information regarding 1) the expanded diagnostic evaluation for cervicitis and trichomoniasis; 2) new treatment recommendations for bacterial vaginosis and genital warts; 3) the clinical efficacy of azithromycin for chlamydial infections in pregnancy; 4) the role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications; 5) lymphogranuloma venereum proctocolitis among men who have sex with men; 6) the criteria for spinal fluid examination to evaluate for neurosyphilis; 7) the emergence of azithromycin-resistant Treponema pallidum; 8) the increasing prevalence of antimicrobial-resistant Neisseria gonorrhoeae; 9) the sexual transmission of hepatitis C; 10) diagnostic evaluation after sexual assault; and 11) STD prevention approaches.

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Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis.

Deepak Talwar, Raghunadharao Digumarti, P Pappas … (2007)

Invasive candidiasis is an important cause of morbidity and mortality among patients with health care-associated infection. The echinocandins have potent fungicidal activity against most Candida species, but there are few data comparing the safety and efficacy of echinocandins in the treatment of invasive candidiasis. This was an international, randomized, double-blind trial comparing micafungin (100 mg daily) and micafungin (150 mg daily) with a standard dosage of caspofungin (70 mg followed by 50 mg daily) in adults with candidemia and other forms of invasive candidiasis. The primary end point was treatment success, defined as clinical and mycological success at the end of blinded intravenous therapy. A total of 595 patients were randomized to one the treatment groups and received at least 1 dose of study drug. In the modified intent-to-treat population, 191 patients were assigned to the micafungin 100 mg group, 199 to the micafungin 150 mg group, and 188 to the caspofungin group. Demographic characteristics and underlying disorders were comparable across the groups. Approximately 85% of patients had candidemia; the remainder had noncandidemic invasive candidiasis. At the end of blinded intravenous therapy, treatment was considered successful for 76.4% of patients in the micafungin 100 mg group, 71.4% in the micafungin 150 mg group, and 72.3% in the caspofungin group. The median time to culture negativity was 2 days in the micafungin 100 mg group and the caspofungin group, compared with 3 days in the micafungin 150 mg groups. There were no significant differences in mortality, relapsing and emergent infections, or adverse events between the study arms. Dosages of micafungin 100 mg daily and 150 mg daily were noninferior to a standard dosage of caspofungin for the treatment of candidemia and other forms of invasive candidiasis.

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Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases.

R Galask, Weston R. Hollis, S. Richter … (2005)

There are limited data regarding the antifungal susceptibility of yeast causing vulvovaginal candidiasis, since cultures are rarely performed. Susceptibility testing was performed on vaginal yeast isolates collected from January 1998 to March 2001 from 429 patients with suspected vulvovaginal candidiasis. The charts of 84 patients with multiple positive cultures were reviewed. The 593 yeast isolates were Candida albicans (n = 420), Candida glabrata (n = 112), Candida parapsilosis (n = 30), Candida krusei (n = 12), Saccharomyces cerevisiae ( n = 9), Candida tropicalis (n = 8), Candida lusitaniae (n = 1), and Trichosporon sp. (n = 1). Multiple species suggesting mixed infection were isolated from 27 cultures. Resistance to fluconazole and flucytosine was observed infrequently (3.7% and 3.0%); 16.2% of isolates were resistant to itraconazole (MIC > or = 1 microg/ml). The four imidazoles (econazole, clotrimazole, miconazole, and ketoconazole) were active: 94.3 to 98.5% were susceptible at or = 16 microg/ml) were only observed in C. glabrata (15.2% resistant [R], 51.8% susceptible-dose dependent [S-DD]), C. parapsilosis (3.3% S-DD), S. cerevisiae (11.1% S-DD), and C. krusei (50% S-DD, 41.7% R, considered intrinsically fluconazole resistant). Resistance to itraconazole was observed among C. glabrata (74.1%), C. krusei (58.3%), S. cerevisiae (55.6%), and C. parapsilosis (3.4%). Among 84 patients with recurrent episodes, non-albicans species were more common (42% versus 20%). A > or = 4-fold rise in fluconazole MIC was observed in only one patient with C. parapsilosis. These results support the use of azoles for empirical therapy of uncomplicated candidal vulvovaginitis. Recurrent episodes are more often caused by non-albicans species, for which azole agents are less likely to be effective.

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Author and article information

Contributors

Adane Bitew:

ORCID: http://orcid.org/0000-0002-5518-1342

Adane.Bitew81@gmail.com

Yeshiwork Abebaw: Yeshi885@gmail.com

Journal

Journal ID (nlm-ta): BMC Womens Health

Journal ID (iso-abbrev): BMC Womens Health

Title: BMC Women's Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6874

Publication date (Electronic): 15 June 2018

Publication date PMC-release: 15 June 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 94

Affiliations

[1 ]ISNI 0000 0001 1250 5688, GRID grid.7123.7, Department of Medical Laboratory Sciences, , College of Health Sciences, Addis Ababa University, ; P.O. Box1176, Addis Ababa, Ethiopia

[2 ]Department Clinical Laboratory, Fitche Hospital, P.O. Box 46, Oromia Administrative Region, Ethiopia

Author information

Adane Bitew http://orcid.org/0000-0002-5518-1342

Article

Publisher ID: 607

DOI: 10.1186/s12905-018-0607-z

PMC ID: 6003188

PubMed ID: 29902998

SO-VID: ebf651aa-636a-4be5-81a5-b3586adc1761

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 21 July 2017

Date accepted : 8 June 2018

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: vulvovaginal candidiasis,non-albicans candida species antifungal drugs,ethiopia

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: vulvovaginal candidiasis, non-albicans candida species antifungal drugs, ethiopia

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

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Abstract

Background

Methods

Results

Conclusions

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Bacterial vaginosis and biofilm

Most cited references 40

Sexually transmitted diseases treatment guidelines, 2010.

Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis.

Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases.

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