Abstract
Introduction: Vulvovaginal candidiasis is a common problem affecting reproductive aged women. Candida Albicans species were the most common pathogen implicated in these cases. But recently there has been reports of Non Albicans Candida species emerging as new pathogens from different parts of the world and they are reported to be less sensitive to the commonly used antifungal drugs. We tried to find out the most prevalent species of Candida among our antenatal population and their drug sensitivity patterns
Objectives of the study: 1) to isolate different candida species in culture from clinically diagnosed case of vulvovaginal candidiasis in reproductive aged women
2) To speciate the isolates using phenotypic characters and anti-fungal susceptibility of the isolates in vitro
Study Design: Cross sectional prospective study
Study Setting: Department of Obstetrics and Gynaecology, and Department of Microbiology, Government medical college, Thiruvananthapuram
Study Period: 2017 1st January to 31st December
Study Population: Antenatal women with clinical diagnosis of vulvo vaginal candidiasis attending the hospital for antenatal and intrapartum care.
Results: vaginal swabs from 400 clinically suspected cases of vulvo vaginal candidiasis were collected and examined in culture for identification of Candida species.70.5% of women belonged to 20-29 age group and 15.8% in 30-39 year age group.65 cultures (16.3%) were positive for candida .Rest of the cultures were negative for fungal growth. Out of 65 cases 30(46.2%) were Candida ALbicans species.And 35 cases( 53.8%) were Non albicans Candida species.(NAC) Amoung the NAC, Candida tropicalis was the most predominant strain in our study population(24.6%),followed by C. Glabrata(16.9%) and C.Parasilosis (12.3%) as the other isolates. Antifungal susceptibility was tested against 3 major antifungals namely fluconazole, clotrimazole and Amphotericin-B. Studies showed that drug resistance to all the 3 antifungals were present among 10% of Candida Albicans strains only. Among the NAC, all the strains were sensitive to the standard antifungals and drug resistance could not be demonstrated.
Conclusion: Among the antenatal women with vulvovaginal candidiasis, Non albicans Candida was a predominant strain and the strains were sensitiveto standard antifungals used.
Keywords: Vulvovaginal candidiasis, Candida Albicans, Non Albicans candida, Drug sensitivity.
References
- Ferrer J. Vaginal candidosis: epidemiological and etiological factors. Int J Gynecol Obstet. 2000; 71(S1):21–7.
- Donders GGG, Bellen G, Mendling W. Management of recurrent vulvo-vaginal candidosis as a chronic illness. Gynecol Obstet Invest. 2010; 70(4):306–21.
- 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.
- Subramanya SH, Baral BP, Sharan NK, Nayak N, Metok Y, Sathian B, et al. Antifungal susceptibility and phenotypic virulence markers of Candida species isolated from Nepal. BMC Res Notes [Internet]. 2017 Nov 2 [cited 2020 Aug 9]; 10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5669004/
- Farooqi JQ, Jabeen K, Saeed N, Iqbal N, Malik B, Lockhart SR, et al. Invasive candidiasis in Pakistan: clinical characteristics, species distribution and antifungal susceptibility. J Med Microbiol. 2013; 62(2):259–68.
- Watson C, Calabretto H. Comprehensive review of conventional and non-conventional methods of management of recurrent vulvovaginal candidiasis. Aust N Z J Obstet Gynaecol. 2007 Aug; 47(4):262–72.
- Das KH, Mangayarkarasi V, Sen M. Antifungal Resistant in Non-Albicans Candida Species are Emerging as a Threat to Antenatal Women with Vulvovaginal Candidiasis. Biomed Pharmacol J. 2019 Sep 25; 12(2):1369–78.
- Gunther LSA, Martins HPR, Gimenes F, Abreu ALP de, Consolaro MEL, Svidzinski TIE. Prevalence of Candida albicans and non-albicans isolates from vaginal secretions: comparative evaluation of colonization, vaginal candidiasis and recurrent vaginal candidiasis in diabetic and non-diabetic women. Sao Paulo Med J Rev Paul Med. 2014; 132(2):116–20.
- Ray D, Goswami R, Banerjee U, Dadhwal V, Goswami D, Mandal P, et al. Prevalence of Candida glabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis. Diabetes Care. 2007 Feb; 30(2):312–7.
- Fidel PL, Vazquez JA, Sobel JD. Candida glabrata: Review of Epidemiology, Pathogenesis, and Clinical Disease with Comparison toC. albicans. Clin Microbiol Rev. 1999 Jan 1; 12(1):80–96.
- M, Hukić M. CANDIDA ALBICANS AND NON-ALBICANS SPECIES AS ETIOLOGICAL AGENT OF VAGINITIS IN PREGNANT AND NONPREGNANT WOMEN. Bosn J Basic Med Sci. 2010 Feb; 10(1):89–97.
- Bitew A, Abebaw Y. Vulvovaginal candidiasis: species distribution of Candida and their antifungal susceptibility pattern. BMC Womens Health. 2018 15; 18(1):94.
- De Vos MM, Cuenca-Estrella M, Boekhout T, Theelen B, Matthijs N, Bauters T, et al. Vulvovaginal candidiasis in a Flemish patient population. Clin Microbiol Infect. 2005 Dec 1; 11(12):1005–11.
- Shi X-Y, Yang Y-P, Zhang Y, Li W, Wang J-D, Huang W-M, et al. Molecular identification and antifungal susceptibility of 186 Candida isolates from vulvovaginal candidiasis in southern China. J Med Microbiol. 2015 Apr;64(Pt 4):390–3.
- Subramanya SH, Baral BP, Sharan NK, Nayak N, Metok Y, Sathian B, et al. Antifungal susceptibility and phenotypic virulence markers of Candida species isolated from Nepal. BMC Res Notes [Internet]. 2017 Nov 2 [cited 2020 Aug 9];10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5669004/
- Deorukhkar SC, Saini S, Mathew S. Non- albicans Candida Infection: An Emerging Threat. Interdiscip Perspect Infect Dis. 2014; 2014:1–7.
- Richter SS, Galask RP, Messer SA, Hollis RJ, Diekema DJ, Pfaller MA. Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases. J Clin Microbiol. 2005 May; 43(5):2155–62.
- Nyirjesy P, Seeney SM, Terry Grody MH, Jordan CA, Buckley HR. Chronic fungal vaginitis: The value of cultures. Am J Obstet Gynecol. 1995 Sep 1; 173(3, Part 1):820–3.
- Sen M, Das KH. Prevalence and resistance pattern of candida isolated from vulvovaginal candidiasis of antenatal women. Int J Clin Obstet Gynaecol. 2019 Nov 1; 3(6):268–75.
Corresponding Author
Dr Preetha.R
Assistant Professor, Dept. of Microbiology, Govt Medical College, Thiruvananthapuram