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Messina A, Mariani A, Brandolisio R, Tavella E, Germano C, Lipari G, Leo L, Masturzo B, Manzoni P. Candidiasis in Pregnancy: Relevant Aspects of the Pathology for the Mother and the Fetus and Therapeutic Strategies. Trop Med Infect Dis 2024; 9:114. [PMID: 38787047 PMCID: PMC11125970 DOI: 10.3390/tropicalmed9050114] [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: 02/19/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Vulvovaginal candidiasis (VVC) is a common condition that can lead to significant discomfort, affecting approximately 70-75% of women at least once in their lives. During pregnancy, the prevalence of VVC is estimated to be around 20%, peaking at about 30% in the third trimester, with a number of specific risk factors predisposing to yeast infection being identified and needing elucidation. This review aims to provide updated knowledge on candidiasis during pregnancy, addressing risk factors and maternal and neonatal outcomes, as well as discussing optimal therapeutic strategies to safeguard mothers and newborns. The bibliographic search involved two biomedical databases, PubMed and Embase, without imposing time limits. Among all Candida spp., Candida albicans remains the most frequent causative species. The hyperestrogenic environment of the vaginal mucosa and reduced immune defenses, physiological effects of pregnancy, create conditions favorable for Candida spp. vaginal colonization and hence VVC. Recent evidence shows an association between VVC and adverse obstetric outcomes, including premature membrane rupture (PROM), chorioamnionitis, preterm birth, and puerperal infections. Prompt and effective management of this condition is therefore crucial to prevent adverse obstetric outcomes, maternal-fetal transmission, and neonatal disease. Additional studies are required to confirm the benefits of systemic treatment for maternal candida infection or colonization in preventing premature birth or neonatal systemic candidiasis.
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Affiliation(s)
- Alessandro Messina
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Alessia Mariani
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Romina Brandolisio
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy; (R.B.); (E.T.)
- Department of Maternal, Neonatal and Infant Medicine, University of Torino School of Medicine, 10125 Turin, Italy
| | - Elena Tavella
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy; (R.B.); (E.T.)
- Department of Maternal, Neonatal and Infant Medicine, University of Torino School of Medicine, 10125 Turin, Italy
| | - Chiara Germano
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Giovanni Lipari
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Livio Leo
- Division of Obstetrics and Gynecology, Hopital Beauregard, AUSL Valleè d’Aoste, 11100 Aosta, Italy;
| | - Bianca Masturzo
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy; (R.B.); (E.T.)
- Department of Maternal, Neonatal and Infant Medicine, University of Torino School of Medicine, 10125 Turin, Italy
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Kan S, Song N, Pang Q, Mei H, Zheng H, Li D, Cui F, Lv G, An R, Li P, Xiong Z, Fan S, Zhang M, Chen Y, Qiao Q, Liang X, Cui M, Li D, Liao Q, Li X, Liu W. In Vitro Antifungal Activity of Azoles and Other Antifungal Agents Against Pathogenic Yeasts from Vulvovaginal Candidiasis in China. Mycopathologia 2022; 188:99-109. [PMID: 36378354 DOI: 10.1007/s11046-022-00687-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vulvovaginal candidiasis (VVC) is a public health issue worldwide. Little is known of the optimal treatment of recurrent VVC (RVVC) has not been established. OBJECTIVE Through the in vitro antifungal susceptibility profiling of VVC isolates, we hope to foster significant improvements in the control and treatment of this disease. METHODS Candida isolates from VVC patients were collected from 12 hospitals in 10 cities across China. Species were identified by phenotype analysis and DNA sequencing. Species were identified by phenotype analysis and DNA sequencing. Susceptibilities to 11 drugs were determined by Clinical and Laboratory Standards Institute broth microdilution. RESULTS 543 strains were isolated from those VVC patients enrolled in this study, of which, 15.7% were from RVVC. The most commonly identified species was C. albicans (460, 84.71%), and the most commonly non-albicans Candida spp. (NAC) was C. glabrata (47, 8.66%). NAC also included C. Krusei, Meyerozyma Guillermondii, Meyerozyma Caribbica, C. Tropicalis, C. Parapsilosis, and C. Nivariensis. Most C. albicans isolates were susceptible to caspofungin (99.8%), followed by fluconazole (92%) and voriconazole (82.6%). The proportion of C. albicans strains with wild type (WT) MICs that were susceptible to amphotericin B and caspofungin were 98%, followed by posaconazole at 95%, itraconazole at 86%, fluconazole at 74% and voriconazole at 54%. The fluconazole MICs for C. albicans were lower than those for NAC (P < 0.05), while the itraconazole MICs showing no significant difference (P > 0.05). The susceptible rate of uncomplicated VVC to fluconazole was 92%. The proportion of WT strains to fluconazole in RVVC was much lower than that in other types of VVC (67 vs. 77%, P < 0.05). However, the proportions of WT strains to itraconazole in RVVC was over 85%, which was much higher than that to fluconazole (87 vs. 67%, P < 0.05). CONCLUSIONS C. albicans was still the predominant pathogen for VVC in China, while C. glabrata was the main species in NAC. Fluconazole could still be used as an empirical treatment for uncomplicated VVC. However, fluconazole may not be the first choice for the therapy of RVVC. In such cases, itraconazole appears to be the more appropriate treatment. As for VVC caused by NAC, nonfluconazole drugs, such as itraconazole, may be a good choice.
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Affiliation(s)
- Siyue Kan
- Department of Medical Mycology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
| | - Nana Song
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, China
| | - Qiuyu Pang
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Huan Mei
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, China
| | - Hailin Zheng
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, Jiangsu, People's Republic of China
| | - Dongmei Li
- Department of Microbiology/Immunology, Georgetown University, Washington, DC, 20057, USA
| | - Fan Cui
- Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32, Western 2nd Section, 1st Ring Road, Chengdu, Sichuan, China
| | - Guixia Lv
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, China
| | - Ruifang An
- The First Affiliated Teaching Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Ping Li
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Zhengai Xiong
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Shangrong Fan
- Peking University Shenzhen Hospital, Shenzhen, 518035, China
| | - Mengzhen Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yanhong Chen
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Qiao Qiao
- The Affiliated Hospital of Inner Mongolia Medical University, Huhehaote, 010050, China
| | - Xudong Liang
- Peking University People's Hospital, Beijing, 100044, China
| | - Manhua Cui
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Dongyan Li
- The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Qinping Liao
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medical, Tsinghua University, Beijing, 102218, China
| | - Xiaofang Li
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, China.
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, Jiangsu, People's Republic of China.
| | - Weida Liu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, China.
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, Jiangsu, People's Republic of China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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Molecular epidemiology, antifungal susceptibility, and ERG11 gene mutation of candida species isolated from vulvovaginal candidiasis: Comparison between recurrent and non-recurrent infections. Microb Pathog 2022; 170:105696. [DOI: 10.1016/j.micpath.2022.105696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/22/2022]
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Alsudani AA, Al-Awsi GRL. DETECTION OF CANDIDA SPP. THAT CAUSES VULVOVAGINITIS IN WOMEN THAT USE CONTRACEPTIVE METHODS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1965-1969. [PMID: 36129079 DOI: 10.36740/wlek202208204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: To determine the distribution of Candida spp. within different age groups and contraceptive methods in women with vulvovaginitis, as well as the susceptibility of Candida spp. to commonly used antifungals. PATIENTS AND METHODS Materials and methods: High vaginal swabs were taken from 98 women aged 18 to 50 with vulvovaginitis who used contraceptives and attended the Women and Children Hospital in Al-Diwaniyah; after diagnosis of Candida species, the sensitivity of Candida spp. to some antifungals was studied. RESULTS Results: The results showed (43/98) women (43.87%) used IUD, (15/98) women (15.30%) used birth control pills, (7/98) women (7.14%) used an injection of contraceptive, (5/98) women (5.10%) used contraceptive suppositories, and (28/98) women (28.57%) did not use any contraceptives. Candida spp. was found in (48/83) specimens (57.831%) from women who used contraceptives and only (11/28) specimens (39.285%) from women who did not use contraceptives. Only (59/98) vaginal specimens tested positive for vaginal candidiasis, (28/59) isolates (47.457%) for C. albicans, then (16/59) isolates for C. glabrata (27.118%), (9/59) isolates (15.254%) for C. tropicalis and (6/59) isolates (10.169%) for C. krusei. Nystatin was the best treatment for all Candida spp. under study, and the MIC was 6.25, and the MFC was 50 for all antifungals and Candida species under study. CONCLUSION Conclusions: C. albicans was the most prevalent cause of vulvovaginal candidiasis, while C. glabrata was the most common non-albicans species in women aged 26 to 35; using an IUD was associated with an increased infection of vulvovaginal candidiasis, and nystatin was the most effective treatment.
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Affiliation(s)
- Ali A Alsudani
- ENVIRONMENTAL RESEARCH AND POLLUTION PREVENTION UNIT, UNIVERSITY OF AL-QADISIYAH, AL DIWANIYAH, IRAQ
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Shao MK, Qi WJ, Hou MY, Luo DD. Analysis of pathogenic factors of Candida albicans and the effect of vaginal immunization on recurrent vulvovaginal candidiasis in mice. J Obstet Gynaecol Res 2021; 48:857-865. [PMID: 34970814 DOI: 10.1111/jog.15140] [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: 05/25/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role of fungal pathogenic factors and the immune response of the vaginal epithelium in vulvovaginal candidiasis (VVC) and recurrent vulvovaginal candidiasis (RVVC) are still unclear. Our study wants to clarify whether there are differences in pathogenic factors between VVC and RVVC strains, confirm the roles of pathogenic factors in the pathogenesis of RVVC, and analyze the influence of pathogenic factors on vaginal host immunity. METHODS VVC- and RVVC-causing Candida albicans strains were genotyped with 25S rDNA. Drug susceptibility assays using a modified alamarBlue broth microdilution method were carried out. Milk culture medium and egg yolk culture medium were used to measure the secreted aspartate protease (Sap) and phospholipase (Plb) activity of the samples. We used C. albicans with different Sap activity levels to induce RVVC in mice and measured interleukin 4 (IL4), interleukin 8 (IL8), and interleukin 17 (IL17) in vaginal lavage fluid at different stages of RVVC infection. RESULTS There were no significant differences between VVC and RVVC fungi except that the Sap activity was lower for RVVC-causing C. albicans than for VVC-causing C. albicans. C. albicans with both strong Sap and weak Sap induced RVVC in mice. C. albicans with strong Sap had a reduced RVVC infection rate. In addition, C. albicans with strong Sap stimulated the vaginal epithelium to secrete more IL4, IL8, and IL17. CONCLUSION Compared with that of VVC-causing C. albicans, the Sap activity of RVVC-causing C. albicans was lower. C. albicans with strong Sap was less capable of causing repeated vaginal infections than that with weak Sap and stimulated the vaginal epithelium to produce more cytokines.
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Affiliation(s)
- Ming-Kun Shao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Wen-Jin Qi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Meng-Yao Hou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Dan-Dan Luo
- Department of Obstetrics and Gynecology, Kunming City Maternal and Child Health Service Center, Yunnan, China
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Song N, Kan S, Pang Q, Mei H, Zheng H, Li D, Cui F, Lv G, An R, Li P, Xiong Z, Fan S, Zhang M, Chen Y, Qiao Q, Liang X, Cui M, Li D, Liao Q, Li X, Liu W. A prospective study on vulvovaginal candidiasis: multicentre molecular epidemiology of pathogenic yeasts in China. J Eur Acad Dermatol Venereol 2021; 36:566-572. [PMID: 34908189 DOI: 10.1111/jdv.17874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/17/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Vulvovaginal candidiasis (VVC) is frequent in women of reproductive age, but very limited data are available on the epidemiology in cases of VVC in China. OBJECTIVES The current study has been conducted to reveal the prevalence, species distribution of yeast causing VVC and molecular genetics of Candida albicans in China. METHODS Vaginal swabs were collected from 543 VVC outpatients recruited in 12 hospitals in China between September 2017 and March 2018. They were preliminarily incubated on Sabouraud dextrose agar and then positive subjects of which were then transmitted to our institute for further identification. CHROMagar™ was used to isolate Candida species, and all isolates were finally identified by DNA sequencing. Multilocus sequence typing (MLST) was used to analyse phylogenetic relationships of the various C. albicans isolates. RESULTS Eleven different yeast species were identified in 543 isolates, among which C. albicans (84.7%) was the most frequent, followed by C. glabrata (8.7%). We obtained 117 unique diploid sequence types from 451 clinical C. albicans isolates and 92 isolates (20.4%) belonged to a New Clade. All the strains appearing in the New Clade were from northern China and they were isolated from non-recurrent VVC. CONCLUSIONS Our findings suggest that C. albicans are still the main cause of VVC in China and the majority of C. albicans isolates belongs to Clade 1 with DST 79 and DST 45 being two most common. Moreover, the New Clade revealed in our study seems to be specific to northern China.
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Affiliation(s)
- N Song
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - S Kan
- Shanghai Skin Disease Hospital, Department of Medical Mycology, Tongji University School of Medicine, Shanghai, China
| | - Q Pang
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - H Mei
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - H Zheng
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - D Li
- Department of Microbiology/Immunology, Georgetown University, Washington, DC, USA
| | - F Cui
- Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - G Lv
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - R An
- The First Affiliated Teaching Hospital of Xi'an Jiaotong University, Xi'an, China
| | - P Li
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Z Xiong
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - S Fan
- Peking University Shenzhen Hospital, Shenzhen, China
| | - M Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Y Chen
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Q Qiao
- The Affiliated Hospital of Inner Mongolia Medical University, Huhehaote, China
| | - X Liang
- Peking University People's Hospital, Beijing, China
| | - M Cui
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - D Li
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Q Liao
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medical, Tsinghua University, Beijing, China
| | - X Li
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - W Liu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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7
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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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8
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Alvendal C, Mohanty S, Bohm-Starke N, Brauner A. Anti-biofilm activity of chlorhexidine digluconate against Candida albicans vaginal isolates. PLoS One 2020; 15:e0238428. [PMID: 32941438 PMCID: PMC7498037 DOI: 10.1371/journal.pone.0238428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/17/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Recurrent vulvovaginal candidiasis (RVVC) causes significant morbidity. Candida albicans is the main pathogen associated with both sporadic and recurrent candidiasis. Due to unsatisfactory treatment effect, the impact of chlorhexidine digluconate and fluconazole alone or in combination on C. albicans and biofilm was investigated. METHODS Vaginal C. albicans isolates from 18 patients with recurrent candidiasis and commensals from 19 asymptomatic women were isolated by culture. Crystal violet, XTT and colony forming unit assay were used to analyze the effect of chlorhexidine digluconate and fluconazole on growth of C. albicans, formation of new and already established, mature, biofilm. RESULTS Fluconazole reduced the growth of planktonic C. albicans. However, in established biofilm, fluconazole had no effect on the candida cells and was not able to disperse and reduce the biofilm. By contrast, chlorhexidine digluconate had a direct killing effect on C. albicans grown both planktonically and in biofilm. Chlorhexidine digluconate also dispersed mature biofilm and inhibited formation of new biofilm. No major differences were observed between commensal isolates and candida causing recurrent vulvovaginitis with respect to biofilm or growth after chlorhexidine digluconate treatment. CONCLUSION Biofilm is a problem in patients with recurrent vulvovaginal candidiasis reducing the effect of antifungal treatment. Development of new treatment strategies are urgently needed to decrease the recurrences. In already established biofilm, chlorhexidine digluconate dispersed the biofilm and was more effective in eradicating candida compared to fluconazole. Future treatment strategy may thus be a combination of chlorhexidine digluconate and fluconazole and prophylactic use of chlorhexidine digluconate to prevent biofilm formation and restrict infections.
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Affiliation(s)
- Cathrin Alvendal
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
- * E-mail:
| | - Soumitra Mohanty
- Division of Clinical Microbiology, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Nina Bohm-Starke
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Annelie Brauner
- Division of Clinical Microbiology, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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9
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Mosca V, S Arita G, Vilegas LV, Faria DR, Sakita KM, Vendramini FA, Capoci IR, Becker TC, de Oliveira AG, Kioshima ÉS, S Bonfim-Mendonça PD, Svidzinski TI. Vulvovaginal candidiasis in a murine model of diabetes emphasizing the invasive ability of etiological agents. Future Microbiol 2020; 15:1001-1013. [PMID: 32811174 DOI: 10.2217/fmb-2019-0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare the pathogenesis of vulvovaginal candidiasis by three Candida species in diabetic mice. Materials & methods: Estrogenized and diabetic mice were challenged with C. albicans, C. tropicalis and C. glabrata. Results: Diabetic animals infected with C. albicans and C. tropicalis maintained the highest fungal burden, despite of high levels of proinflammatory cytokines (IL-6 and TNF-α), respectively. For C. glabrata, the results were similar in diabetic and nondiabetic groups. Conclusion: C. tropicalis was as invasive as C. albicans, and both were more effective than C. glabrata. This ability was attributed to filamentation, which may be stimulated by glucose levels from vaginal fluid. In addition, the high burden may be attributed to the apparent immunological inefficiency of the diabetic host.
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Affiliation(s)
- Valéria Mosca
- State University of Maringá, Maringá, PR 87020-900, Brazil.,Laboratory of Medical Mycology, Department of Clinical Analysis & Biomedicine Maringá, PR 87020-900, Brazil
| | - Glaucia S Arita
- State University of Maringá, Maringá, PR 87020-900, Brazil.,Laboratory of Medical Mycology, Department of Clinical Analysis & Biomedicine Maringá, PR 87020-900, Brazil
| | - Lenisa V Vilegas
- State University of Maringá, Maringá, PR 87020-900, Brazil.,Laboratory of Medical Mycology, Department of Clinical Analysis & Biomedicine Maringá, PR 87020-900, Brazil
| | - Daniella R Faria
- State University of Maringá, Maringá, PR 87020-900, Brazil.,Laboratory of Medical Mycology, Department of Clinical Analysis & Biomedicine Maringá, PR 87020-900, Brazil
| | - Karina M Sakita
- State University of Maringá, Maringá, PR 87020-900, Brazil.,Laboratory of Medical Mycology, Department of Clinical Analysis & Biomedicine Maringá, PR 87020-900, Brazil
| | - Franciele Avr Vendramini
- State University of Maringá, Maringá, PR 87020-900, Brazil.,Laboratory of Medical Mycology, Department of Clinical Analysis & Biomedicine Maringá, PR 87020-900, Brazil
| | - Isis Rg Capoci
- State University of Maringá, Maringá, PR 87020-900, Brazil.,Laboratory of Medical Mycology, Department of Clinical Analysis & Biomedicine Maringá, PR 87020-900, Brazil
| | - Tania Ca Becker
- Laboratory of Pathology, Department of Basic Health Sciences, Maringá, PR 87020-900, Brazil
| | - Admilton G de Oliveira
- Laboratory of Electron Microscopy & Microanalysis - LMEM, Londrina, PR 86057-970, Brazil
| | - Érika S Kioshima
- State University of Maringá, Maringá, PR 87020-900, Brazil.,Laboratory of Medical Mycology, Department of Clinical Analysis & Biomedicine Maringá, PR 87020-900, Brazil
| | - Patrícia de S Bonfim-Mendonça
- State University of Maringá, Maringá, PR 87020-900, Brazil.,Laboratory of Medical Mycology, Department of Clinical Analysis & Biomedicine Maringá, PR 87020-900, Brazil
| | - Terezinha Ie Svidzinski
- State University of Maringá, Maringá, PR 87020-900, Brazil.,Laboratory of Medical Mycology, Department of Clinical Analysis & Biomedicine Maringá, PR 87020-900, Brazil
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10
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Wu X, Zhang S, Li H, Shen L, Dong C, Sun Y, Chen H, Xu B, Zhuang W, Deighton M, Qu Y. Biofilm Formation of Candida albicans Facilitates Fungal Infiltration and Persister Cell Formation in Vaginal Candidiasis. Front Microbiol 2020; 11:1117. [PMID: 32582081 PMCID: PMC7289921 DOI: 10.3389/fmicb.2020.01117] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 05/05/2020] [Indexed: 01/14/2023] Open
Abstract
Background Vaginal candidiasis is an important medical condition awaiting more effective treatment. How Candida albicans causes this disease and survives antifungal treatment is not yet fully understood. This study aimed to establish a comprehensive understanding of biofilm-related defensive strategies that C. albicans uses to establish vaginal candidiasis and to survive antifungal treatment. Methods A mouse model of vaginal candidiasis was adopted to examine the formation of biotic biofilms on the vaginal epithelium and fungal infiltration by laboratory and clinical strains of C. albicans. Histopathological changes and local inflammation in the vaginal epithelium caused by C. albicans of different biofilm phenotypes were compared. Antifungal susceptibility testing was carried out for C. albicans grown as planktonic cells, microplate-based abiotic biofilms, and epithelium-based biotic biofilms. Formation of persister cells by C. albicans in different growth modes was also quantified and compared. Results C. albicans wild-type reference strains and clinical isolates, but not the biofilm-defective mutants, formed a significant number of biotic biofilms on the vaginal epithelium of mice and infiltrated the epithelium. Biofilm formation and epithelial invasion induced local inflammatory responses and histopathological changes in the vaginal epithelium including neutrophil infiltration and subcorneal microabscesses. Biofilm growth on the vaginal epithelium also led to high resistance to antifungal treatments and promoted the formation of antifungal-tolerant persister cells. Conclusion This study comprehensively assessed biofilm-related microbial strategies that C. albicans uses in vaginal candidiasis and provided experimental evidence to support the important role of biofilm formation in the histopathogenesis of vaginal candidiasis and the recalcitrance of the infection to antifungal treatment.
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Affiliation(s)
- Xueqing Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, China
| | - Sisi Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiying Li
- Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, China
| | - Laien Shen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chenle Dong
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yao Sun
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huale Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Boyun Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenyi Zhuang
- Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, China
| | - Margaret Deighton
- School of Applied Sciences, RMIT University, Bundoora, VIC, Australia
| | - Yue Qu
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Wenzhou Medical University-Monash BDI Alliance in Clinical and Experimental Biomedicine, Monash University, Clayton, VIC, Australia
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11
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Khan Z, Ahmad S, Al-Sweih N, Mokaddas E, Al-Banwan K, Alfouzan W, Al-Obaid I, Al-Obaid K, Varghese S. Increasing Trends of Reduced Susceptibility to Antifungal Drugs Among Clinical Candida glabrata Isolates in Kuwait. Microb Drug Resist 2020; 26:982-990. [PMID: 32101082 DOI: 10.1089/mdr.2019.0437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Among non-albicans Candida species, Candida glabrata is the leading cause of invasive infections in critically ill patients. It is intrinsically less susceptible to fluconazole/other azoles that limits therapeutic options. This study determined distribution of C. glabrata in clinical specimens and determined their susceptibility to fluconazole, caspofungin, and amphotericin B by E test. During 8-year period (2011-2018), 1,410 isolates were obtained from 1,410 patients including 600, 409, and 131 isolates from respiratory, urine, and bloodstream specimens, respectively. Proportion of C. glabrata isolates was nearly the same during the two 4-year periods. Demographic details were available from 731 patients and susceptibility data for 1,225 isolates. C. glabrata isolation from bloodstream, respiratory, and urine specimens was higher from elderly (>60 years) versus younger patients. More bloodstream and urine isolates were obtained from female patients, however, more respiratory isolates were recovered from male patients (p = <0.05). Resistance to all three drugs increased during 2015-2018 compared with 2011-2014 but was more pronounced for fluconazole (p = 0.001). More isolates with reduced susceptibility to fluconazole/amphotericin B were obtained from elderly patients versus younger subjects and urine versus respiratory samples (p = <0.05). Our data show increasing trends of reduced susceptibility to antifungals, particularly fluconazole, among clinical C. glabrata isolates in Kuwait. Most isolates with reduced susceptibility to fluconazole/amphotericin B were obtained from elderly patients and urine/respiratory samples with urinary tract appearing as the most favorable niche for antifungal drug resistance development. The study also highlights the need for continued surveillance and better antifungal drug stewardship to control resistance development in C. glabrata.
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Affiliation(s)
- Ziauddin Khan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Noura Al-Sweih
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Eiman Mokaddas
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Khalifa Al-Banwan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Wadha Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Inaam Al-Obaid
- Department of Microbiology, Al-Sabah Hospital, Shuwaikh, Kuwait
| | - Khaled Al-Obaid
- Department of Microbiology, Mubarak Al-Kabir Hospital, Jabriya, Kuwait
| | - Soumya Varghese
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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12
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Antifungal Susceptibility Profile of Candida Albicans Isolated from Vulvovaginal Candidiasis in Xinjiang Province of China. Mycopathologia 2019; 184:413-422. [PMID: 30968320 DOI: 10.1007/s11046-018-0305-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/30/2018] [Indexed: 12/12/2022]
Abstract
We investigated the antifungal susceptibility profiles of 207 independent Candida albicans strains isolated from patients with vulvovaginal candidiasis (VVC) in Xinjiang Province of China. Using CLSI M27-A3 and M27-S4 guidelines, anidulafungin and micafungin were the most active drugs against C. albicans showing an MIC50/MIC90 corresponding to 0.016/0.0313 µg/mL, followed by caspofungin (0.25/0.25 µg/mL), posaconazole (0.125/0.5 µg/mL), ravuconazole (0.063/1 µg/mL), itraconazole (0.125/1 µg/mL), amphotericine B (0.5/1 µg/mL), isavuconazole (0.063/2 µg/mL), 5-flucytosine (1/2 µg/mL), voriconazole (0.125/4 µg/mL), and fluconazole (0.5/4 µg/mL). 96.1% (199)-100.0% (207) isolates were sensitive to the three echinocandins tested, amphotericine B and 5-flucytosine. The in vitro activity of triazoles against all isolates tested was variable; itraconazole and voriconazole had reduced the activity to almost half of the isolates (55.1% (114) and 51.2% (106) susceptible, respectively). Fluconazole was active against 76.3% (158) isolates tested. The new triazoles ravuconazole, isavuconazole and posaconazole showed good in vitro potency against 89.9% (186)-95.2% (197) of isolates with the geometric mean MIC (µg/mL) of 0.10, 0.12 and 0.14 µg/mL, respectively. In conclusion, our study indicates that for effective management of systemic candidiasis in Xinjiang Province of China, it is important to determine the susceptibility profiles of isolated C. albicans from patients with VVC.
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13
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Hacioglu M, Guzel CB, Savage PB, Tan ASB. Antifungal susceptibilities, in vitro production of virulence factors and activities of ceragenins against Candida spp. isolated from vulvovaginal candidiasis. Med Mycol 2019; 57:291-299. [PMID: 29846682 DOI: 10.1093/mmy/myy023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/01/2018] [Accepted: 04/04/2018] [Indexed: 12/12/2022] Open
Abstract
Vulvovaginal candidiasis (VVC) is the second most common cause of vaginitis after bacterial vaginosis, affecting millions of women worldwide every year. Candida albicans is the most frequent agent of VVC followed by other species of Candida such as C. glabrata and C. parapsilosis. Out of a total of 100 clinical isolates of Candida spp. obtained from patients diagnosed with VVC, 84 were identified as C. albicans, while the remaining isolates were identified as non--albicans Candida strains. Phospholipases and proteinases were produced by a majority of the C. albicans strains and esterases and hemolysins a minority of these strains. Among the non-C. albicans strains, only a few of the strains produced these proteins. Nearly all of the isolates formed biofilms. Our results showed that the butoconazole, clotrimazole, and fluconazole were active against C. albicans and less so against the non-albicans Candida strains. The MIC90 of amphotericin B and nystatins were 2 and 4 μg/ml, respectively, against either C. albicans or non-albicans Candida spp. Representative ceragenins (CSA-13, CSA-131, and CSA-138), developed as mimics of endogenous antimicrobial peptides, were active against fluconazole-resistant strains, both alone and in combination with fluconazole. These results suggest the potential use of ceragenins in treating VVC, including infections caused by fluconazole-resistant isolates.
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Affiliation(s)
- Mayram Hacioglu
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Beyazit, Istanbul, 34116, Turkey
| | - Cagla Bozkurt Guzel
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Beyazit, Istanbul, 34116, Turkey
| | - Paul B Savage
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, Utah, 84602, USA
| | - A Seher Birteksoz Tan
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Beyazit, Istanbul, 34116, Turkey
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14
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Emergence of Resistance to Fluconazole in Candida albicans Isolated From Vaginal Discharge. CURRENT FUNGAL INFECTION REPORTS 2018. [DOI: 10.1007/s12281-018-0329-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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Abbasi Nejat Z, Farahyar S, Falahati M, Ashrafi Khozani M, Hosseini AF, Faiazy A, Ekhtiari M, Hashemi-Hafshenjani S. Molecular Identification and Antifungal Susceptibility Pattern of Non-albicans Candida Species Isolated from Vulvovaginal Candidiasis. IRANIAN BIOMEDICAL JOURNAL 2018; 22:33-41. [PMID: 28688376 PMCID: PMC5712382 DOI: 10.22034/ibj.22.1.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Vulvovaginal candidiasis (VVC) is an important health problem caused by Candida spp. The aim of this study was molecular identification, phylogenetic analysis, and evaluation of antifungal susceptibility of non-albicans Candida isolates from VVC. Methods Vaginal secretion samples were collected from 550 vaginitis patients at Sayyad Shirazi Medical and Educational Center of Gorgan (Golestan Province, Iran) from May to October 2015. Samples were analyzed using conventional mycological and molecular approaches. Clinical isolates were analyzed with specific PCR using CGL primers, and the internal transcribed spacer region and the D1-D2 domain of the large-subunit rRNA gene were amplified and sequenced. Susceptibility to amphotericin B, fluconazole, itraconazole, and clotrimazole was determined by the guidelines of the Clinical and Laboratory Standard Institute. Results In total, 35 non-albicans Candida isolates were identified from VVC patients. The isolates included 27 strains of Candida glabrata (77.1%), 5 Candida krusei (Pichia kudriavzevii; 14.3%), 2 Candida kefyr (Kluyveromyces marxianus; 5.7%), and 1 Candida lusitaniae (Clavispora lusitaniae; 2.9%). The fungicides itraconazole and amphotericin B were effective against all species. One isolate of C. glabrata showed resistance to fluconazole and clotrimazole, and 26 isolates of C. glabrata indicated dose-dependent susceptibility to fluconazole. C. lusitaniae was susceptible in a dose-dependent manner to fluconazole and resistant to clotrimazole. Conclusion Non-albicans Candida spp. are common agents of vulvovaginitis, and C. glabrata is the most common species in the tested patients.
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Affiliation(s)
- Ziba Abbasi Nejat
- International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Farahyar
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Microbial Biotechnology Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehraban Falahati
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahtab Ashrafi Khozani
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Aga Fateme Hosseini
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Azamsadat Faiazy
- 5Department of Gynecology, Sayyad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Masoome Ekhtiari
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saeideh Hashemi-Hafshenjani
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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16
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Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016; 214:15-21. [PMID: 26164695 DOI: 10.1016/j.ajog.2015.06.067] [Citation(s) in RCA: 258] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 02/02/2023]
Abstract
Recurrent vulvovaginal candidiasis (RVVC) is a common cause of significant morbidity in women in all strata of society affecting millions of women worldwide. Previously, RVVC occurrence was limited by onset of menopause but the widespread use of hormone replacement therapy has extended the at-risk period. Candida albicans remains the dominant species responsible for RVVC, however optimal management of RVVC requires species determination and effective treatment measures are best if species-specific. Considerable progress has been made in understanding risk factors that determine susceptibility to RVVC, particularly genetic factors, as well as new insights into normal vaginal defense immune mechanisms and their aberrations in RVVC. While effective control of RVVC is achievable with the use of fluconazole maintenance suppressive therapy, cure of RVVC remains elusive especially in this era of fluconazole drug resistance. Vaccine development remains a critical challenge and need.
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17
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Wang B, Huang LH, Zhao JX, Wei M, Fang H, Wang DY, Wang HF, Yin JG, Xiang M. ERG11 mutations associated with azole resistance in Candida albicans isolates from vulvovaginal candidosis patients. Asian Pac J Trop Biomed 2015. [DOI: 10.1016/j.apjtb.2015.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Glöckner A, Cornely OA. Candida glabrata -unique features and challenges in the clinical management of invasive infections. Mycoses 2015. [DOI: 10.1111/myc.12348] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Glöckner
- BDH-Klinik Greifswald GmbH; Greifswald Germany
| | - O. A. Cornely
- Department I of Internal Medicine; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD); Clinical Trials Centre Cologne (ZKS Köln, BMBF 01KN1106) Center for Integrated Oncology (CIO Köln Bonn); German Centre for Infection Research (DZIF); University of Cologne; Cologne Germany
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19
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Shi XY, Yang YP, Zhang Y, Li W, Wang JD, Huang WM, Fan YM. Molecular identification and antifungal susceptibility of 186 Candida isolates from vulvovaginal candidiasis in southern China. J Med Microbiol 2015; 64:390-393. [PMID: 25596116 DOI: 10.1099/jmm.0.000024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/06/2015] [Indexed: 11/18/2022] Open
Abstract
There is limited information regarding the molecular epidemiology and antifungal susceptibilities of Candida isolates using the Neo-Sensitabs method in patients with vulvovaginal candidiasis (VVC). From August 2012 to March 2013, 301 non-pregnant patients aged 18-50 years with suspected VVC were prospectively screened at a teaching hospital in southern China. The vaginal isolates were identified by DNA sequencing of internal transcribed spacer and the D1/D2 domain. Antifungal susceptibility testing of seven antifungal agents was performed using the Neo-Sensitabs tablet diffusion method. Candida species were isolated from 186 cases (61.79 %). The most common pathogen was Candida albicans (91.4 %), followed by Candida glabrata (4.3 %), Candida tropicalis (3.2 %) and Candida parapsilosis (1.1 %). The susceptibility rates to C. albicans were higher for caspofungin, voriconazole and fluconazole than those for itraconazole, miconazole, ketoconazole and terbinafine (P<0.01). The resistance rates to C. albicans were 4.7, 6.5, 7.1, 7.6, 12.3, 27.7 and 74.7 % for caspofungin, miconazole, itraconazole, voriconazole, fluconazole, ketoconazole and terbinafine, respectively. No drugs tested apart from fluconazole exhibited differences in resistance between C. albicans and non-albicans Candida isolates. The results demonstrate that, using DNA sequencing, C. albicans is the most common isolate from Chinese patients with VVC. Caspofungin, voriconazole and fluconazole may be preferable to other azoles and terbinafine in the treatment of VVC.
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Affiliation(s)
- Xiao-Yu Shi
- Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, PR China
| | - Yan-Ping Yang
- Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, PR China
| | - Ying Zhang
- Department of Gynecology and Obstetrics, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, PR China
| | - Wen Li
- Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, PR China
| | - Jie-Di Wang
- Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, PR China
| | - Wen-Ming Huang
- Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, PR China
| | - Yi-Ming Fan
- Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, PR China
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20
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Microbicidal activity of neutrophils is inhibited by isolates from recurrent vaginal candidiasis (RVVC) caused by Candida albicans through fungal thioredoxin reductase. Cell Immunol 2015; 293:22-9. [DOI: 10.1016/j.cellimm.2014.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 11/04/2014] [Accepted: 11/25/2014] [Indexed: 02/02/2023]
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21
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Machado-de-Sena RM, Corrêa L, Kato IT, Prates RA, Senna AM, Santos CC, Picanço DA, Ribeiro MS. Photodynamic therapy has antifungal effect and reduces inflammatory signals in Candida albicans-induced murine vaginitis. Photodiagnosis Photodyn Ther 2014; 11:275-82. [PMID: 24792453 DOI: 10.1016/j.pdpdt.2014.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/30/2014] [Accepted: 03/31/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vaginal candidiasis (VC) is a disease that affects thousands of women of childbearing age, mainly caused by Candida albicans fungus. Photodynamic therapy (PDT) uses photosensitizing substances that are nontoxic in the dark, but able to produce reactive oxygen species when they are subjected to a light source. In this work our purpose was to investigate PDT effects on fungal burden and inflammatory cells in a murine model of C. albicans-induced vaginal candidiasis. METHODS Female BALB/c mice 6-10 weeks were estrogenized and maintained in this state during all experiment. After 72h, mices were inoculated intravaginally (IV) with 20μL of 2×10(5)C. albicans cells suspension. Mice were separated into 5 groups after five days: H (healthy), PBS (control), laser, MB (methylene blue) and PDT. PDT and MB groups received IV 20μL solution with 1mM of MB, others received PBS. PDT and laser groups were irradiated with a red laser (100mW, 660nm) in one (36J, 6min) or two sessions (18J, 3min). After the end of treatment, mice were submitted to microbiological and histomorphometric analysis with ImageJ software. Data were plotted by mean values and standard deviations of CFU/mL and percentage of inflammatory cells area. ANOVA and Bonferroni post-test were used and data were considered significant when p<0.05. RESULTS PDT significantly reduced C. albicans after the two tested protocols, however, percentage area of inflammatory cells was significantly reduced just with two sessions of PDT. CONCLUSIONS PDT with MB and red laser is a promising therapy for VC. It is able to reduce fungal infection in biofilm and inflammatory signals associated with VC in a murine model of vaginitis.
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Affiliation(s)
- R M Machado-de-Sena
- Center for Lasers and Applications, IPEN-CNEN/SP, Av. Lineu Prestes, 2242, 05508-000 São Paulo, SP, Brazil; Department of Microbiology and Immunology, Federal Institute of Education, Science and Technology, IFTO, Av. Amazonas, Qd 56 - Lt 01, 77826-170 Araguaina, TO, Brazil
| | - L Corrêa
- Department of Stomatology, Dentistry School, University of São Paulo, FOUSP, Av. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil
| | - I T Kato
- Center for Lasers and Applications, IPEN-CNEN/SP, Av. Lineu Prestes, 2242, 05508-000 São Paulo, SP, Brazil
| | - R A Prates
- Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University, UNINOVE, Rua Vergueiro, 235, 01504-001 São Paulo, SP, Brazil
| | - A M Senna
- Department of Oral Surgery, Palmas General Hospital, Av. 201 SUL NS1, Conj. 02 - Lt 01, 77015-202 Palmas, TO, Brazil; Department of Lasers and Photomedicine, Tocantinense Institute President Antônio Carlos, Rua 02 Qd 07 s/n, 77500-000 Porto Nacional, TO, Brazil
| | - C C Santos
- Center for Lasers and Applications, IPEN-CNEN/SP, Av. Lineu Prestes, 2242, 05508-000 São Paulo, SP, Brazil
| | - D A Picanço
- Center for Lasers and Applications, IPEN-CNEN/SP, Av. Lineu Prestes, 2242, 05508-000 São Paulo, SP, Brazil
| | - M S Ribeiro
- Center for Lasers and Applications, IPEN-CNEN/SP, Av. Lineu Prestes, 2242, 05508-000 São Paulo, SP, Brazil.
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22
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Güzel AB, Döğen A, Aydın M, Serin A, Serin MS, Kalkancı A, İlkit M. Genotyping Reveals no Link Between Candida albicans Genotype and Vaginitis Severity in Turkish Women. Mycopathologia 2013; 175:287-94. [DOI: 10.1007/s11046-013-9643-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/25/2013] [Indexed: 10/27/2022]
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