Vulvovaginal Candidiasis and its Antifungal Susceptibility Pattern: Single center experience
Keywords:
Vaginal Candidiasis, Candida, Vulvovaginal candidiasis
Abstract
Introduction: Candidiasis is the most common vaginal infection affecting about 70% of women. Our aim was isolation and identification of Candida from high vaginal swabs and in vitro antifungal activity of Fluconazole, Voriconazole, Nystatin, Amphotericin B.
Materials and Methods: This study was carried out in NIMS Medical College, Jaipur during June 2013 to May 2014. The study group consisted of 100 women of reproductive age having symptomatic vaginal discharge, vulval purities or lower abdominal pain. High vaginal swabs were collected from each and processed by Gram Staining, culture on Sabroud’s dextrose agar & CHROM agar. Antifungal susceptibility was performed by disc diffusion method as per CLSI guidelines.
Results: Vulvovaginal candidiasis accounted for 22 % of cases. Species distribution is as follows: C.albicans 12, C tropicalis 7, C krusei 2, C glabrata 1. Senstivity to Voriconazole was 91.6% for C albicans, 71.42 % for C.tropicalis, 50% for C.krusei. Senstivity to Fluconazole was seen in 91.6 % of C.albicans & 42.85 % of C.tropicalis. C. glabrata was resistant to both Voriconazole & Fluconazole. Senstivity to Amphotericin B was 75 % for C. albicans, 100 % for C.tropicalis, 100% for C.krusei & C. glabrata. Senstivity to Nystatin was 91.6% for C.albicans & 100% for C.tropicalis, C.krusei & C.glabrata.
Conclusions: There is an increase in non-albicans Candida infection and few like C.krusei are intrinsically resistant to azoles. This signifies the need of species identification & antifungal susceptibility as a routine laboratory procedure in diagnosis of vaginal candidiasis.
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References
1.Nyirjesy P, Seeney SM, Grody MH, Jordan CA, Buckley HR. Chronic fungal vaginitis :The value of cultures. Am J Obstet Gynecol. 1995 Sep;173(3 Pt 1):820-3. [PubMed]
2. Dota KF, Consolaro ME, Svidzinski TI, Bruschi ML.Antifungal activity of Brazlian propolis microparticales against yeast isolated from vulvovaginal candidiasis . Evid Based Complement Alternat Med. 2011;2011:201953. doi: 10.1093/ecam/neq029. Epub 2011 Mar 9.
3. Esmaeilzadeh S, Omran SM, Rahmani Z. Frequency and etiology of vulvovaginal candidiasis in women referred to a gynecological center in Babol, Iran. Int J Fertil Steril 2009;3:74-7. [PubMed]
4. Nabhan A. Vulvovaginal candidiasis. Ain Shams J Obstet Gynecol 2006;3:73-8.
5. Ferrer J. Vaginal candidosis: epidemiological and etiological factors. Int J Gynaecol Obstet. 2000 Dec;71 Suppl 1:S21-7. [PubMed]
6. Spinillo A, Capuzzo E, Gulminetti R, Marone P, Colonna L, Piazzi G.. Prevalence of and risk factors for fungal vaginitis caused by non-albicans species. Am J Obstet Gynecol. 1997 Jan;176(1 Pt 1):138-41. [PubMed]
7. Simoes JA, Giraldo PC, Faundes A. Prevalence of cervicovaginal infections during gestation and accuracy of clinical diagnosis. Infect Dis Obstet Gynecol 1998;6:129-33. [PubMed]
8. Sobel JD. Candida vulvovaginitis. Sem Dermatol 1996; 15 :17-28. [PubMed]
9. Ehrstrom S, Yu A, Rylander E. Glucose in vaginal secretions be¬fore and after oral glucose tolerance testing in women with and without recurrent vulvovaginal candidiasis. Obstet Gyne¬col. 2006;108 (6):1432-7. [PubMed]
10. Nyirjesy P, Peyton C, Weitz MV, Mathew L, Culhane JF. Causes of chronic vaginitis: analysis of a prospective database of affected women. Obstet Gynecol. 2006;108 (5):1185-91. [PubMed]
11. Paulitsch A, Weger W, Ginter-Hanselmayer G, Marth E, Buzina W. A 5-year (2000-2004) epidemiological survey of Candida and non-Candida yeast species causing vulvovaginal candidiasis in Graz, Austria. Mycoses. 2006;49 (6):471-5.
12. Geiger AM, Foxman B, Gillespie BW. The epidemiology of Vulvovaginal candidiasis among university students. Am. J. Public Health. 1995; 85:1146-8.
13. Pfaller MA, Messer SA, Boyken LB, Rice C, Tendolkar S, Hollis RJ, Doern GV, Diekema DJ. 2005. Global trends in the antifungal susceptibility of Cryptococcus neoformans (1990 to 2004). J. Clin. Microbiol. 43:2163–2167.
14. NormaT G, Arias M L, Moraga M, Baddasarow Y , Jarstrand C.Species distribution and susceptibility to azoles of vaginal yeasts isolated prostitutes. Infec. Dis .Obstet. Gynaecol.2007; 10.1155:1-5. [PubMed]
15. Jackson S T, Mullings AM, Ranford L ,and Miller A.The epidemiology of mycotic vulvovaginitis and the use of Antifungal agents in suspected mycotic vulvovaginitis and its implications for clinical practice. West Indian Med.J.2005;54:3:192-95.
16. Aali BS, Tohidi A. Prevalence of Candida vaginitis among symp¬tomatic patients in Kerman. J Qazvin Uni Med Sci. 2000;13:42-8.
17. Richter SS, Galask RP, Messer SA, Hollis RJ, Diekema DJ, Pfaller MA. Antifungal susceptibilities of Candida species causing vul¬vovaginitis and epidemiology of recurrent cases. J Clin Micro¬biol. 2005;43 (5):2155-62. [PubMed]
18. Spinillo A, Capuzzo E, Gulminetti R, Marone P, Colonna L,Piazzi G. Prevalence of and risk factors for fungal vaginitis caused by non-albicans species. Am J Obstet Gynecol 1997;176 : 138-41.
19. Clinical Laboratory Standards Institute(CLSI). Method for antifungal disk diffusion Susceptibility testing of Yeasts; Approved Guideline-second edition. CLSI document M44-A2 (ISBN 1-56238-703-0). Clinical Laboratory Standard Institute, Wayne: Pennsylvania; 2009. [PubMed]
20. Dota KFD, Freitas AR, Consolaro MEL, Svidzinski TIE. A challenge for clinical laboratories: Detection of antifungal resistance in Candida Species causing vulvovaginal candidiasis. Laboratory Medicine 2011;42(2):87-93.
21. Susceptibility testing of yeasts [internet]. 2011 [cited 2011 MAR 16]. Available from : http://rosco.dk/gfx/yeasts.pdf
22. Sobel JD. Vulvovaginal candidosis. Lancet. 2007 Jun 9;369(9577):1961-71. [PubMed]
23. Jacqueline MA, Bettina CF. Candida infections in genitourinary tract. Clin Microbiol Rev. 2010;23(2):253–273. [PubMed]
24. Ako-Nai AK, Kassim OO, Adeniran MO, Taiwo O. A study of urinary tract infections at Ile-Ife, Nigeria. East Afr Med J 1993;70(1):10-14. [PubMed]
25. Sehgal SC, Epidemiology of male urethritis in Nigeria. J Trop Med Hyg. 1990 Apr;93(2):151-2. [PubMed]
26. Sobel JD. Candidal vulvovaginitis. Clin Obstet Gynecol. 1993;36:153-65. [PubMed]
27. Okungbowa FI ,.Isikhuemhen OS, Dede AP, The distribution frequency of Candida species in the genitourinary tract among symptomatic individuals in Nigerian cities. Rev Iberoam Micol. 2003 Jun;20(2):60-3.
28. Guzel AB, Ilkit M, Burgut R, 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 Jul;172(1):25-36. doi: 10.1007/s11046-011-9392-z. Epub 2011 Feb 4. [PubMed]
29. Jindal N, Aggarwal A, Gill P. Significance of Candida culture in women with vulvovaginal symptoms. J Obstet Gynecol India. 2006;56 (2):139-41.
30. 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 May;144(1):68-71. doi: 10.1016/j.ejogrb.2008.12.020. [PubMed]
31. Mohanty S, Xess I, Hasan F, Kapil A, Mittal S, Tolosa JE. Prevalence & susceptibility to fluconazole of Candida species causing vulvovaginitis. Indian J Med Res. 2007;126(3): 216-9.
32. Bauters TG, Dhont MA, Temmerman MI, Nelis HJ. Prevalence of Vulvovaginal Candidiasis and susceptibility to Fluconazole in women. Am J Obstet Gynecol. 2002 Sep;187(3):569-74.
33. Sara A, Laura S,Rossana D, etal . Trends in frequency and in vitro antifungal susceptibility patterns of Candida isolates from women attending the STD out patients clinic of a tertiary care hospital in Northern Italy during the 2002-2007. New Micro. 2009; 32 : 199-204. [PubMed]
34. Quindós G, Abarca L, Carrillo-Muñoz AJ, et al. Multicenter survey of in vitro antifungal resistance in yeasts of medical importance isolated from Spanish patients. Rev Iberoam Micol. 1999 Jun;16(2):97-100.
35. Manzano-Gayosso P, Hernández-Hernández F, Méndez-Tovar LJ, González-Monroy J, López-Martínez R. Fungal peritonitis in 15 patients on continuous ambulatory peritoneal dialysis (CAPD). Mycoses. 2003;46(9-10):425-9. [PubMed]
36. Araj GF, Daher NK, Tabbarah LA. Antifungal susceptibility of Candida isolates at the American University of Beirut Medical Center. Int J Antimicrob Agents. 1998 Nov;10(4):291-6.
37. Sobel JD, Zervos M, Reed BD etal. Fluconazole susceptiblity of vaginal isolates obtained from women with complicated Candida vaginitis :Clinical implications. Antimicrob Agents Chemother. 2003 Jan;47(1):34-8.
38. Sandra S R, Rudolph P G , Shawn A M, Richard J H, Daniel J D and Michael A P. Antifungal susceptibility of Candida species causing vulvovaginitis and epidemiology of recurrent cases. Amer. Soci. Micro.2005; 43:2155-2162.
39. Akortha E E,Nwaugo V O, Chikwe N O. Antifungal resistance among Candida species from patients with genitourinary tract infection isolated in Benin city, Edo state,Nigeria. African J.Microl. Research.2009;3:694-699.
40. Ribeiro MA, Dietze R, Paula CR, Da-Matta DA, Colombo AL. Susceptibility profile of vaginal yeast isolates from Brazil. Mycopathologia 2000;151:5-10.
2. Dota KF, Consolaro ME, Svidzinski TI, Bruschi ML.Antifungal activity of Brazlian propolis microparticales against yeast isolated from vulvovaginal candidiasis . Evid Based Complement Alternat Med. 2011;2011:201953. doi: 10.1093/ecam/neq029. Epub 2011 Mar 9.
3. Esmaeilzadeh S, Omran SM, Rahmani Z. Frequency and etiology of vulvovaginal candidiasis in women referred to a gynecological center in Babol, Iran. Int J Fertil Steril 2009;3:74-7. [PubMed]
4. Nabhan A. Vulvovaginal candidiasis. Ain Shams J Obstet Gynecol 2006;3:73-8.
5. Ferrer J. Vaginal candidosis: epidemiological and etiological factors. Int J Gynaecol Obstet. 2000 Dec;71 Suppl 1:S21-7. [PubMed]
6. Spinillo A, Capuzzo E, Gulminetti R, Marone P, Colonna L, Piazzi G.. Prevalence of and risk factors for fungal vaginitis caused by non-albicans species. Am J Obstet Gynecol. 1997 Jan;176(1 Pt 1):138-41. [PubMed]
7. Simoes JA, Giraldo PC, Faundes A. Prevalence of cervicovaginal infections during gestation and accuracy of clinical diagnosis. Infect Dis Obstet Gynecol 1998;6:129-33. [PubMed]
8. Sobel JD. Candida vulvovaginitis. Sem Dermatol 1996; 15 :17-28. [PubMed]
9. Ehrstrom S, Yu A, Rylander E. Glucose in vaginal secretions be¬fore and after oral glucose tolerance testing in women with and without recurrent vulvovaginal candidiasis. Obstet Gyne¬col. 2006;108 (6):1432-7. [PubMed]
10. Nyirjesy P, Peyton C, Weitz MV, Mathew L, Culhane JF. Causes of chronic vaginitis: analysis of a prospective database of affected women. Obstet Gynecol. 2006;108 (5):1185-91. [PubMed]
11. Paulitsch A, Weger W, Ginter-Hanselmayer G, Marth E, Buzina W. A 5-year (2000-2004) epidemiological survey of Candida and non-Candida yeast species causing vulvovaginal candidiasis in Graz, Austria. Mycoses. 2006;49 (6):471-5.
12. Geiger AM, Foxman B, Gillespie BW. The epidemiology of Vulvovaginal candidiasis among university students. Am. J. Public Health. 1995; 85:1146-8.
13. Pfaller MA, Messer SA, Boyken LB, Rice C, Tendolkar S, Hollis RJ, Doern GV, Diekema DJ. 2005. Global trends in the antifungal susceptibility of Cryptococcus neoformans (1990 to 2004). J. Clin. Microbiol. 43:2163–2167.
14. NormaT G, Arias M L, Moraga M, Baddasarow Y , Jarstrand C.Species distribution and susceptibility to azoles of vaginal yeasts isolated prostitutes. Infec. Dis .Obstet. Gynaecol.2007; 10.1155:1-5. [PubMed]
15. Jackson S T, Mullings AM, Ranford L ,and Miller A.The epidemiology of mycotic vulvovaginitis and the use of Antifungal agents in suspected mycotic vulvovaginitis and its implications for clinical practice. West Indian Med.J.2005;54:3:192-95.
16. Aali BS, Tohidi A. Prevalence of Candida vaginitis among symp¬tomatic patients in Kerman. J Qazvin Uni Med Sci. 2000;13:42-8.
17. Richter SS, Galask RP, Messer SA, Hollis RJ, Diekema DJ, Pfaller MA. Antifungal susceptibilities of Candida species causing vul¬vovaginitis and epidemiology of recurrent cases. J Clin Micro¬biol. 2005;43 (5):2155-62. [PubMed]
18. Spinillo A, Capuzzo E, Gulminetti R, Marone P, Colonna L,Piazzi G. Prevalence of and risk factors for fungal vaginitis caused by non-albicans species. Am J Obstet Gynecol 1997;176 : 138-41.
19. Clinical Laboratory Standards Institute(CLSI). Method for antifungal disk diffusion Susceptibility testing of Yeasts; Approved Guideline-second edition. CLSI document M44-A2 (ISBN 1-56238-703-0). Clinical Laboratory Standard Institute, Wayne: Pennsylvania; 2009. [PubMed]
20. Dota KFD, Freitas AR, Consolaro MEL, Svidzinski TIE. A challenge for clinical laboratories: Detection of antifungal resistance in Candida Species causing vulvovaginal candidiasis. Laboratory Medicine 2011;42(2):87-93.
21. Susceptibility testing of yeasts [internet]. 2011 [cited 2011 MAR 16]. Available from : http://rosco.dk/gfx/yeasts.pdf
22. Sobel JD. Vulvovaginal candidosis. Lancet. 2007 Jun 9;369(9577):1961-71. [PubMed]
23. Jacqueline MA, Bettina CF. Candida infections in genitourinary tract. Clin Microbiol Rev. 2010;23(2):253–273. [PubMed]
24. Ako-Nai AK, Kassim OO, Adeniran MO, Taiwo O. A study of urinary tract infections at Ile-Ife, Nigeria. East Afr Med J 1993;70(1):10-14. [PubMed]
25. Sehgal SC, Epidemiology of male urethritis in Nigeria. J Trop Med Hyg. 1990 Apr;93(2):151-2. [PubMed]
26. Sobel JD. Candidal vulvovaginitis. Clin Obstet Gynecol. 1993;36:153-65. [PubMed]
27. Okungbowa FI ,.Isikhuemhen OS, Dede AP, The distribution frequency of Candida species in the genitourinary tract among symptomatic individuals in Nigerian cities. Rev Iberoam Micol. 2003 Jun;20(2):60-3.
28. Guzel AB, Ilkit M, Burgut R, 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 Jul;172(1):25-36. doi: 10.1007/s11046-011-9392-z. Epub 2011 Feb 4. [PubMed]
29. Jindal N, Aggarwal A, Gill P. Significance of Candida culture in women with vulvovaginal symptoms. J Obstet Gynecol India. 2006;56 (2):139-41.
30. 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 May;144(1):68-71. doi: 10.1016/j.ejogrb.2008.12.020. [PubMed]
31. Mohanty S, Xess I, Hasan F, Kapil A, Mittal S, Tolosa JE. Prevalence & susceptibility to fluconazole of Candida species causing vulvovaginitis. Indian J Med Res. 2007;126(3): 216-9.
32. Bauters TG, Dhont MA, Temmerman MI, Nelis HJ. Prevalence of Vulvovaginal Candidiasis and susceptibility to Fluconazole in women. Am J Obstet Gynecol. 2002 Sep;187(3):569-74.
33. Sara A, Laura S,Rossana D, etal . Trends in frequency and in vitro antifungal susceptibility patterns of Candida isolates from women attending the STD out patients clinic of a tertiary care hospital in Northern Italy during the 2002-2007. New Micro. 2009; 32 : 199-204. [PubMed]
34. Quindós G, Abarca L, Carrillo-Muñoz AJ, et al. Multicenter survey of in vitro antifungal resistance in yeasts of medical importance isolated from Spanish patients. Rev Iberoam Micol. 1999 Jun;16(2):97-100.
35. Manzano-Gayosso P, Hernández-Hernández F, Méndez-Tovar LJ, González-Monroy J, López-Martínez R. Fungal peritonitis in 15 patients on continuous ambulatory peritoneal dialysis (CAPD). Mycoses. 2003;46(9-10):425-9. [PubMed]
36. Araj GF, Daher NK, Tabbarah LA. Antifungal susceptibility of Candida isolates at the American University of Beirut Medical Center. Int J Antimicrob Agents. 1998 Nov;10(4):291-6.
37. Sobel JD, Zervos M, Reed BD etal. Fluconazole susceptiblity of vaginal isolates obtained from women with complicated Candida vaginitis :Clinical implications. Antimicrob Agents Chemother. 2003 Jan;47(1):34-8.
38. Sandra S R, Rudolph P G , Shawn A M, Richard J H, Daniel J D and Michael A P. Antifungal susceptibility of Candida species causing vulvovaginitis and epidemiology of recurrent cases. Amer. Soci. Micro.2005; 43:2155-2162.
39. Akortha E E,Nwaugo V O, Chikwe N O. Antifungal resistance among Candida species from patients with genitourinary tract infection isolated in Benin city, Edo state,Nigeria. African J.Microl. Research.2009;3:694-699.
40. Ribeiro MA, Dietze R, Paula CR, Da-Matta DA, Colombo AL. Susceptibility profile of vaginal yeast isolates from Brazil. Mycopathologia 2000;151:5-10.
CITATION
DOI: 10.17511/ijmrr.2015.i1.12
Published: 2015-02-28
How to Cite
1.
Rati R, Patel J, Rishi S. Vulvovaginal Candidiasis and its Antifungal Susceptibility Pattern: Single center experience. Int J Med Res Rev [Internet]. 2015Feb.28 [cited 2024Nov.8];3(1):72-8. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/188
Section
Original Article
OAI - Open Archives Initiative
