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Gomaa SE, Abbas HA, Mohamed FA, Ali MAM, Ibrahim TM, Abdel Halim AS, Alghamdi MA, Mansour B, Chaudhary AA, Elkelish A, Boufahja F, Hegazy WAH, Yehia FAZA. The anti-staphylococcal fusidic acid as an efflux pump inhibitor combined with fluconazole against vaginal candidiasis in mouse model. BMC Microbiol 2024; 24:54. [PMID: 38341568 PMCID: PMC10858509 DOI: 10.1186/s12866-024-03181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Candida albicans is the most common fungus that causes vaginal candidiasis in immunocompetent women and catastrophic infections in immunocompromised patients. The treatment of such infections is hindered due to the increasing emergence of resistance to azoles in C. albicans. New treatment approaches are needed to combat candidiasis especially in the dwindled supply of new effective and safe antifungals. The resistance to azoles is mainly attributed to export of azoles outside the cells by means of the efflux pump that confers cross resistance to all azoles including fluconazole (FLC). OBJECTIVES This study aimed to investigate the possible efflux pump inhibiting activity of fusidic acid (FA) in C. albicans resistant isolates and the potential use of Fusidic acid in combination with fluconazole to potentiate the antifungal activity of fluconazole to restore its activity in the resistant C. albicans isolates. METHODS The resistance of C. albicans isolates was assessed by determination of minimum inhibitory concentration. The effect of Fusidic acid at sub-inhibitory concentration on efflux activity was assayed by rhodamine 6G efflux assay and intracellular accumulation. Mice model studies were conducted to evaluate the anti-efflux activity of Fusidic acid and its synergistic effects in combination with fluconazole. Impact of Fusidic acid on ergosterol biosynthesis was quantified. The synergy of fluconazole when combined with Fusidic acid was investigated by determination of minimum inhibitory concentration. The cytotoxicity of Fusidic acid was tested against erythrocytes. The effect of Fusidic acid on efflux pumps was tested at the molecular level by real-time PCR and in silico study. In vivo vulvovaginitis mice model was used to confirm the activity of the combination in treating vulvovaginal candidiasis. RESULTS Fusidic acid showed efflux inhibiting activity as it increased the accumulation of rhodamine 6G, a substrate for ABC-efflux transporter, and decreased its efflux in C. albicans cells. The antifungal activity of fluconazole was synergized when combined with Fusidic acid. Fusidic acid exerted only minimal cytotoxicity on human erythrocytes indicating its safety. The FA efflux inhibitory activity could be owed to its ability to interfere with efflux protein transporters as revealed by docking studies and downregulation of the efflux-encoding genes of both ABC transporters and MFS superfamily. Moreover, in vivo mice model showed that using fluconazole-fusidic acid combination by vaginal route enhanced fluconazole antifungal activity as shown by lowered fungal burden and a negligible histopathological change in vaginal tissue. CONCLUSION The current findings highlight FA's potential as a potential adjuvant to FLC in the treatment of vulvovaginal candidiasis.
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Affiliation(s)
- Salwa E Gomaa
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Hisham A Abbas
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Fatma A Mohamed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
- Department of Medical Microbiology and Immunology-Medical School, University of Pécs, Szigeti Út 12, Pécs, H-7624, Hungary
| | - Mohamed A M Ali
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 11623, Saudi Arabia
- Department of Biochemistry, Faculty of Science, Ain Shams University, Abbassia, Cairo, 11566, Egypt
| | - Tarek M Ibrahim
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Alyaa S Abdel Halim
- Department of Biochemistry, Faculty of Science, Ain Shams University, Abbassia, Cairo, 11566, Egypt
| | - Mashael A Alghamdi
- Department of Chemistry, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 11623, Saudi Arabia
| | - Basem Mansour
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa, Belqas, 11152, Egypt
| | - Anis Ahmad Chaudhary
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 11623, Saudi Arabia
| | - Amr Elkelish
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 11623, Saudi Arabia
- Department of Botany and Microbiology, Faculty of Science, Suez Canal University, Ismailia, 41522, Egypt
| | - Fehmi Boufahja
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 11623, Saudi Arabia
| | - Wael A H Hegazy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt.
- Pharmacy Program, Department of Pharmaceutical Sciences, Oman College of Health Sciences, Muscat, 113, Oman.
| | - Fatma Al-Zahraa A Yehia
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
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Arrieta-Aguirre I, Menéndez-Manjón P, Carrano G, Diez A, Fernandez-de-Larrinoa Í, Moragues MD. Molecular Identification of Fungal Species through Multiplex-qPCR to Determine Candidal Vulvovaginitis and Antifungal Susceptibility. J Fungi (Basel) 2023; 9:1145. [PMID: 38132746 PMCID: PMC10744653 DOI: 10.3390/jof9121145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Vulvovaginal candidiasis (VVC) is a prevalent condition affecting women worldwide. This study aimed to develop a rapid qPCR assay for the accurate identification of VVC etiological agents and reduced azole susceptibility. One hundred and twenty nine vaginal samples from an outpatient clinic (Bilbao, Spain) were analyzed using culture-based methods and a multiplex qPCR targeting fungal species, which identified Candida albicans as the predominant species (94.2%). Antifungal susceptibility tests revealed reduced azole susceptibility in three (3.48%) isolates. Molecular analysis identified several mutations in genes associated with azole resistance as well as novel mutations in TAC1 and MRR1 genes. In conclusion, we developed a rapid multiplex qPCR assay that detects C. albicans in vulvovaginal specimens and reported new mutations in resistance-related genes that could contribute to azole resistance.
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Affiliation(s)
- Inés Arrieta-Aguirre
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Biscay, Spain; (P.M.-M.); (M.-D.M.)
| | - Pilar Menéndez-Manjón
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Biscay, Spain; (P.M.-M.); (M.-D.M.)
- Department of Immunology, Microbiology and Parasitology, University of the Basque Country UPV/EHU, 48940 Leioa, Biscay, Spain; (G.C.); (A.D.)
| | - Giulia Carrano
- Department of Immunology, Microbiology and Parasitology, University of the Basque Country UPV/EHU, 48940 Leioa, Biscay, Spain; (G.C.); (A.D.)
| | - Ander Diez
- Department of Immunology, Microbiology and Parasitology, University of the Basque Country UPV/EHU, 48940 Leioa, Biscay, Spain; (G.C.); (A.D.)
| | | | - María-Dolores Moragues
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Biscay, Spain; (P.M.-M.); (M.-D.M.)
- IIS BioCruces Bizkaia, 48903 Barakaldo, Biscay, Spain
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Farr A, Swidsinski S, Surbek D, Tirri BF, Willinger B, Hoyme U, Walter G, Reckel-Botzem I, Mendling W. Bacterial Vaginosis: Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/028, June 2023). Geburtshilfe Frauenheilkd 2023; 83:1331-1349. [PMID: 37928409 PMCID: PMC10624544 DOI: 10.1055/a-2169-8539] [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: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023] Open
Abstract
Aim This official guideline was coordinated and published by the DGGG, OEGGG and SGGG with the involvement of additional professional societies. The aim of the guideline is to evaluate the relevant literature and use it to provide a consensus-based overview of the diagnosis and management of bacterial vaginosis. Methods This S2k-guideline was developed by representative members from different medical professional societies on behalf of the guidelines commission of the above-listed societies using a structured consensus process. Recommendations This guideline provides recommendations on the diagnosis, management, counselling, prophylaxis, and other aspects related to bacterial vaginosis.
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Affiliation(s)
- Alex Farr
- Universitätsklinik für Frauenheilkunde, Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Wien, Austria
| | | | - Daniel Surbek
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Feto-maternale Medizin, Inselspital Bern, Universität Bern, Bern, Switzerland
| | | | - Birgit Willinger
- Abteilung für Klinische Mikrobiologie, Medizinische Universität Wien, Wien, Austria
| | - Udo Hoyme
- Klinik für Frauenheilkunde und Geburtshilfe, Ilm-Kreis-Kliniken, Arnstadt, Germany
| | - Gisela Walter
- Ärztliche Gesellschaft zur Gesundheitsförderung e. V. (ÄGGF), Hamburg, Germany
- Deutsche STI-Gesellschaft (DSTIG), Bochum, Germany
| | - Inge Reckel-Botzem
- Berufsverband der Frauenärzte e. V. (BVF), Landesverband Hessen, Hainburg, Germany
| | - Werner Mendling
- Deutsches Zentrum für Infektionen in Gynäkologie und Geburtshilfe, Wuppertal, Germany
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Rigo GV, Cardoso FG, Devereux M, McCann M, Macedo AJ, Santos ALS, Tasca T. Antimicrobial and Antibiofilm Activities of Copper(II)-1,10-phenanthroline-5,6-pione Against Commensal Bacteria and Fungi Responsible for Vaginal Microbiota Dysbiosis. Curr Microbiol 2023; 80:383. [PMID: 37870614 DOI: 10.1007/s00284-023-03500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023]
Abstract
The disbalance of vaginal eubiotic microbiota can lead to overgrowth of Candida species and bacteria responsible for aerobic vaginitis, activating inflammatory pathways. The presence of Trichomonas vaginalis, a sexually transmitted protozoan pathogen, can be a predisposing factor for disordering the growth of bacterial/fungal pathogenic species due to the increase in pH and reduction of eubiotic microbiota. Herein, we evaluated the effects of the potent trichomonacidal compound, copper(II)-1,10-phenanthroline-5,6-dione (Cu-phendione), against pathogens responsible for candidiasis and aerobic vaginitis. Cu-phendione showed antimicrobial activity against Candida albicans, non-albicans Candida species (C. glabrata, C. krusei, C. parapsilosis, and C. tropicalis) and Gram-negative (Escherichia coli) and Gram-positive (Staphylococcus aureus, Enterococcus faecalis, and Streptococcus agalactiae) bacteria. Moreover, Cu-phendione was able to interfere with the fungal biofilm formation. These results highlight the antimicrobial potential of Cu-phendione against bacterial and fungal strains of vaginitis-causing infectious agents.
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Affiliation(s)
- Graziela V Rigo
- Faculdade de Farmácia and Centro de Biotecnologia, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Fernanda G Cardoso
- Faculdade de Farmácia and Centro de Biotecnologia, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Michael Devereux
- The Inorganic Pharmaceutical and Biomimetic Research Centre, Focas Research Institute, Dublin Institute of Technology, Dublin, Ireland
| | - Malachy McCann
- Chemistry Department, Maynooth University, National University of Ireland, Maynooth, Ireland
| | - Alexandre J Macedo
- Faculdade de Farmácia and Centro de Biotecnologia, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - André L S Santos
- Laboratório de Estudos Avançados de Microrganismos Emergentes E Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Tiana Tasca
- Faculdade de Farmácia and Centro de Biotecnologia, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil.
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David H, Solomon AP. Molecular association of Candida albicans and vulvovaginal candidiasis: focusing on a solution. Front Cell Infect Microbiol 2023; 13:1245808. [PMID: 37900321 PMCID: PMC10611527 DOI: 10.3389/fcimb.2023.1245808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Candida albicans-mediated vulvovaginal candidiasis (VVC) is a significant challenge in clinical settings, owing to the inefficacy of current antifungals in modulating virulence, development of resistance, and poor penetration into the biofilm matrix. Various predisposition factors are molecular drivers that lead to the dysbiosis of normal microflora of the vagina, upregulation of central metabolic pathways, morphogenesis, hyphal extension, adhesion, invasion, and biofilm formation leading to chronic infection and recurrence. Hence, it is crucial to understand the molecular mechanism behind the virulence pathways driven by those drivers to decode the drug targets. Finding innovative solutions targeting fungal virulence/biofilm may potentiate the antifungals at low concentrations without affecting the recurrence of resistance. With this background, the present review details the critical molecular drivers and associated network of virulence pathways, possible drug targets, target-specific inhibitors, and probable mode of drug delivery to cross the preclinical phase by appropriate in vivo models.
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Affiliation(s)
| | - Adline Princy Solomon
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
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Tan Y, Lin Q, Yao J, Zhang G, Peng X, Tian J. In vitro outcomes of quercetin on Candida albicans planktonic and biofilm cells and in vivo effects on vulvovaginal candidiasis. Evidences of its mechanisms of action. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 114:154800. [PMID: 37043980 DOI: 10.1016/j.phymed.2023.154800] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/29/2023] [Accepted: 04/01/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND PURPOSE Candida albicans is a fungus that produces common fungal infection in humans, including vulvovaginal candidiasis (VVC). While quercetin (QC) has potential antifungal activities against C. albicans, studies on the in vivo anti-VVC activity of QC are limited. This study evaluated the antifungal capacity of QC against cultured C. albicans strain SC5314 or in C. albicans-infected mice. METHODS Microdilution and XTT reduction assay were used to determine the minimum inhibitory concentration (MIC) and biofilm formation of QC on C. albicans, respectively. Immunofluorescence was performed to detect the anti-invasive capacity of QC upon co-culturing C. albicans with VK2/E6E7 cells. The potential anti-VVC effects of QC were assessed in C. albicans-infected mice with VVC. Further, inflammatory cytokine levels were determined using ELISA. PAS and Papanicolaou staining were used to detect C. albicans cells and polymorphonuclear leukocytes (PMNs) in vaginal tissues. Western blotting and immunohistochemistry were performed to measure the expression of MAPK, ERK, JUN, and P38. RESULTS MIC and minimal fungicidal concentration (MFC) of QC for C. albicans were 128 μM and > 512 μM, respectively. QC concentration lower than 128 μM (32-128 μM) could not inhibit C. albicans. QC (16 μM) notably inhibited C. albicans biofilm formation and suppressed the adhesion and invasion of C. albicans to VK2/E6E7 cells. In addition, the pharmacokinetic parameters of orally administered QC in mice showed rapid absorption (approximately 1 h) and slow elimination (approximately 6 h). Oral QC showed an effective protective function against C. albicans infection with no toxic effects a in mouse VVC model. QC significantly reduced IL-1α, TNF-α, IL-22 and IL-23 levels in vaginal lavage solution, inhibited invasive C. albicans and PMN infiltration in vaginal tissue, and effectively protected the integrity of vaginal mucosa. CONCLUSIONS The present study showed that QC has rapid oral absorption, slow elimination, good viral distribution, and a lack of toxicity. QC not only inhibited biofilm formation, adhesion, and invasion of C. albicans in vitro, but also ameliorated C. albicans-induced inflammation and protected the integrity of the vaginal mucosa in vivo, suggesting that QC has the potential for the treatment of candidiasis.
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Affiliation(s)
- Yujun Tan
- School of Life Science, Jiangsu Normal University, Xuzhou, Jiangsu Province 221116, P R China; State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co., Ltd., Linyi, China
| | - Qian Lin
- School of Life Science, Jiangsu Normal University, Xuzhou, Jiangsu Province 221116, P R China
| | - Jingchun Yao
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co., Ltd., Linyi, China
| | - Guimin Zhang
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co., Ltd., Linyi, China
| | - Xue Peng
- School of Life Science, Jiangsu Normal University, Xuzhou, Jiangsu Province 221116, P R China.
| | - Jun Tian
- School of Life Science, Jiangsu Normal University, Xuzhou, Jiangsu Province 221116, P R China.
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Martínez-García E, Martínez-Martínez JC, Martín-Salvador A, González-García A, Pérez-Morente MÁ, Álvarez-Serrano MA, García-García I. Epidemiological Profile of Patients with Vulvovaginal Candidiasis from a Sexually Transmitted Infection Clinic in Southern Spain. Pathogens 2023; 12:756. [PMID: 37375446 DOI: 10.3390/pathogens12060756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/23/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Epidemiological data on women suffering from vulvovaginal candidiasis and its recurrence are outdated and vague. The aim of this study was to identify the prevalence of women diagnosed with vulvovaginal candidiasis, as well as the epidemiological profile and associated risk factors in the province of Granada (Spain). Data from the Centre for Sexually Transmitted Infections of the Granada province between 2000 and 2018 (N = 438) were used in this study. Associations between sociodemographic and sexual behaviour variables with vulvovaginal candidiasis were analysed using the Chi-square test and bivariate logistic regression. The prevalence of candidiasis was 14.6%. The sociodemographic profile corresponded to a woman aged 25.14 ± 4.8 years on average, who is of Spanish nationality (60.9%), a student (55.7%), in non-active employment (59.7%), with a higher education (56.7%), single (93.5%), and under 30 years of age (79.7%). Variables associated with this diagnosis were the absence of oro-genital contact (OR = 1.99; 95% CI = 0.25-0.74), having a regular partner (OR = 1.99; 95% CI = 1.05-3.75), and age of sexual debut, with the probability increasing by 12% (95% CI = 1.00-1.24) with each year. In this context, vulvovaginal candidiasis infection is common, and its epidemiological profile is contradictory, so our results do not suggest a relevant role of sexual risk behaviours in the diagnosis. Further research is needed to improve the estimates and factors associated with this infection.
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Affiliation(s)
- Encarnación Martínez-García
- Guadix High Resolution Hospital, Andalusian Health Service, 18500 Granada, Spain
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | | | - Adelina Martín-Salvador
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Alberto González-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
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Nikoomanesh F, Falahatinejad M, Černáková L, Dos Santos ALS, Mohammadi SR, Rafiee M, Rodrigues CF, Roudbary M. Combination of Farnesol with Common Antifungal Drugs: Inhibitory Effect against Candida Species Isolated from Women with RVVC. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040743. [PMID: 37109701 PMCID: PMC10143126 DOI: 10.3390/medicina59040743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Vulvovaginal candidiasis (VVC) is a mucous membrane infection, with an increased rate of antifungal resistance of Candida species. In this study, the in vitro efficacy of farnesol alone or in combination with traditional antifungals was assessed against resistant Candida strains recovered from women with VVC. Materials and Methods: Eighty Candida isolates were identified by multiplex polymerase chain reaction (PCR), and the antifungal susceptibility to amphotericin B (AMB), fluconazole (FLU), itraconazole (ITZ), voriconazole (VOR), clotrimazole (CTZ), and farnesol was tested by the standard microdilution method. The combinations of farnesol with each antifungal were calculated based on the fractional inhibitory concentration index (FICI). Result: Candida glabrata was the predominant species (48.75%) isolated from vaginal discharges, followed by C. albicans (43.75%), C. parapsilosis (3.75%), a mixed infection of C. albicans and C. glabrata (2.5%) and C. albicans and C. parapsilosis (1%). C. albicans and C. glabrata isolates had lower susceptibility to FLU (31.4% and 23.0%, respectively) and CTZ (37.1% and 33.3%, respectively). Importantly, there was "synergism" between farnesol-FLU and farnesol-ITZ against C. albicans and C. parapsilosis (FICI = 0.5 and 0.35, respectively), reverting the original azole-resistant profile. Conclusion: These findings indicate that farnesol can revert the resistance profile of azole by enhancing the activity of FLU and ITZ in resistant Candida isolates, which is a clinically promising result.
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Affiliation(s)
- Fatemeh Nikoomanesh
- Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Mahsa Falahatinejad
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115111, Iran
| | - Lucia Černáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 842 15 Bratislava, Slovakia
| | - André Luis Souza Dos Santos
- Department of General Microbiology, Microbiology Institute Paulo de Góes, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-901, RJ, Brazil
| | - Shahla Roudbar Mohammadi
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115111, Iran
| | - Mitra Rafiee
- Department of Immunology, School of Medicine, Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Célia Fortuna Rodrigues
- LEPABE-Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- ALiCE-Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- TOXRUN-Toxicology Research Unit, Cooperativa de Ensino Superior Politécnico e Universitário-CESPU, 4585-116 Gandra PRD, Portugal
| | - Maryam Roudbary
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran
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Klesiewicz K, Mrowiec P, Kania K, Skiba-Kurek I, Białecka J, Namysł M, Małek M. Prevalence of Closely Related Candida albicans Species among Patients with Vulvovaginal Candidiasis in Southern Poland Based on the hwp1 Gene Amplification. Pol J Microbiol 2023; 72:69-77. [PMID: 36929889 DOI: 10.33073/pjm-2023-011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
Candida albicans remains the most common species isolated from women with vulvovaginal candidiasis. However, closely related species such as Candida africana and Candida dubliniensis may also occur, although they are often misidentified. The aim of the study was to confirm the phenotypic identification of C. albicans and its closely related species isolated from women with genital tract infections by amplification of the hwp1 (hyphal wall protein 1) gene in a PCR assay. We report a detailed molecular identification of C. albicans and its closely related species among 326 patients in the Małopolska region, Poland. Initial phenotypic identifications were confirmed by amplification of the hwp1 gene. Based on molecular analysis, we revealed 307 strains (94.17%) as C. albicans and 17 as C. dubliniensis (5.22%). No strain of C. africana was detected. Two patients h ad co-infection with C. albicans and C. dubliniensis (0.61%). A PCR assay targeting the hwp1 gene was reliable for correctly identifying species among the C. albicans complex.
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Affiliation(s)
- Karolina Klesiewicz
- 1Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Cracow, Poland
| | - Paulina Mrowiec
- 1Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Kania
- 1Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Cracow, Poland
| | - Iwona Skiba-Kurek
- 1Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Cracow, Poland
| | - Joanna Białecka
- 1Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Cracow, Poland
- 2Centre of Microbiological Research and Autovaccines, Cracow, Poland
| | | | - Marianna Małek
- 1Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Cracow, Poland
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Pandey M, Ting JSS, Gorain B, Jain N, Mayuren J. Miniaturized Polymeric Systems for the Intravaginal Gene Therapies: Recent Update on Unconventional Delivery. Curr Pharm Des 2023; 29:3254-3262. [PMID: 37438899 DOI: 10.2174/1381612829666230712162540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/01/2023] [Accepted: 04/14/2023] [Indexed: 07/14/2023]
Abstract
The prevalence of vaginal infection is increasing among women, especially at reproductive age. For proper eradication of infection, the effective concentration of a drug is required at the infection site. Therefore, local delivery is recommended to exert a direct therapeutic effect at the site action that causes a reduction in dose and side effects. The main focus of vaginal drug delivery is to enhance retention time and patient compliance. The high recurrence rate of vaginal infection due to the lack of effective treatment strategies opens the door for new therapeutic approaches. To combat these setbacks, intravaginal gene therapies have been investigated. High attention has been gained by vaginal gene therapy, especially for sexually transmitted infection treatment. Despite much research, no product is available in the market, although in vitro and preclinical data support the vaginal route as an effective route for gene administration. The main focus of this review is to discuss the recent advancement in miniaturized polymeric systems for intravaginal gene therapies to treat local infections. An overview of different barriers to vaginal delivery and challenges of vaginal infection treatment are also summarised.
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Affiliation(s)
- Manisha Pandey
- Department of Pharmaceutical Sciences, Central University of Haryana, Haryana 123031, India
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | | | - Bapi Gorain
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi 835215, India
| | - Neha Jain
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, India
| | - Jayashree Mayuren
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
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11
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Salmanov AG, Netskar IP, Kostikov VV, Korniyenko SM, Artyomenko V, Rud VO, Kovalyshyn OA, Zarichanska K. VULVOVAGINAL CANDIDIASIS AFTER GYNECOLOGICAL SURGERIES AND ADVERSE PREGNANCY OUTCOME IN UKRAINE: A MULTICENTRE STUDY. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:2556-2563. [PMID: 38290017 DOI: 10.36740/wlek202312102] [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: 02/01/2024]
Abstract
OBJECTIVE The aim: To investigate the epidemiology and microbiology of vulvovaginal candidiasis (VVC) after gynecological surgeries, and adverse pregnancy outcomes in Ukraine. PATIENTS AND METHODS Materials and methods: Multicenter prospective cohort study was conducted from January 2020 to December 2022 and recruited pregnant and non-pregnant women aged 15-65 years who had sought medical help for vaginal dysbiosis the seven medical clinic from five regions of Ukraine. RESULTS Results: Between 2020 and 2022, 2,341 women were followed in gynecological practices, and 1,056 (41.5%) women were diagnosed with VVC during the same period. Of the total VVC cases, 31.9% were in non-pregnant and 68.1% in pregnant women. The use of antibiotics (OR=3.48), use hormonal contracep¬tives (OR=2.75) and pregnancy (OR=1.13) were associated with an increase in the risk of VVC diagnosis. Diabetes mellitus (OR=0.44) were additional risk factors. The most common pathogen of VVC was C. albicans, Nakaseomyces glabratus (C. glabrata), followed by Pichia kudriavzevii (C. krusei), C. parapsilosis, C. tropicalis, C. kefyr, C. guillieromondii, C. lusitaniae, and C. rugosa. We found no significant difference in adverse pregnancy outcomes between Candida-positive and Candida-negative women. CONCLUSION Conclusions: Vulvovaginal candidiasis after gynecological surgeries in Ukraine is a common medical problem in women that is associated with significant morbidity, and hence frequent medical visits. High prevalence rate of vulvovaginal candidiasis in the present study warrants, the importance of conducting continuous epidemiological surveys to measure changes in species distribution from C. albicans to non-albicans Candida species in Ukraine.
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Affiliation(s)
- Aidyn G Salmanov
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; INSTITUTE OF PEDIATRICS, OBSTETRICS AND GYNECOLOGY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | - Iryna P Netskar
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
| | | | | | | | - Victor O Rud
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
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12
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Al-Madboly LA, Abd El-Salam MA, Bastos JK, El-Shorbagy SH, El-Morsi RM. Novel Preclinical Study of Galloylquinic Acid Compounds from Copaifera lucens with Potent Antifungal Activity against Vaginal Candidiasis Induced in a Murine Model via Multitarget Modes of Action. Microbiol Spectr 2022; 10:e0272421. [PMID: 35972130 PMCID: PMC9603814 DOI: 10.1128/spectrum.02724-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/11/2022] [Indexed: 01/04/2023] Open
Abstract
Vaginal candidiasis is a medical condition characterized by the overgrowth of Candida spp. in the vaginal cavity with complex recurrent pathogenicity as well as tolerance to antifungal therapy and hence is awaiting more safe and effective treatments. This work aimed to assess the potential antifungal activity of galloylquinic acid compounds (GQAs) from Copaifera lucens leaves against vaginal Candida albicans. The antifungal susceptibility test was performed against 20 isolates of multidrug-resistant (MDR) C. albicans using agar diffusion and broth microdilution assays. The results showed that GQAs exhibited strong antagonistic activity against the test isolates, with inhibition zone diameters ranging from 26 to 38 mm and low MICs (1 to 16 μg/mL) as well as minimum fungicidal concentrations (2 to 32 μg/mL). The MTT [3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide] assay confirmed the safety of GQAs against the Vero cell line, showing a 50% inhibitory concentration (IC50) of 168.17 mg/mL. A marked difference in the growth pattern of the treated and untreated pathogens was also observed, where a concentration-dependent reduction in the growth rate occurred. Moreover, a pronounced fungicidal effect was demonstrated 6 h after treatment with 1× the minimum fungicidal concentration (MFC), as evidenced by time-kill assays, where the number of survivors was decreased a 6-fold. GQAs effectively inhibited and eradicated about 80% of C. albicans biofilm at 6 μg/mL and 32 μg/mL, respectively. Interestingly, GQAs disturbed the fungal membrane integrity, induced cell lysis, and reduced the virulence factors (proteinase and phospholipase) as well as the catalase activity. Moreover, the ergosterol content in the plasma membrane decreased in a concentration-dependent manner. Additionally, the altered mitochondrial membrane potential was associated with an increased release of cytochrome c from mitochondria to the cytosol, suggesting the initiation of early apoptosis in GQA-treated cells. Transcriptional analysis revealed that all test genes encoding virulence traits, including SAP1, PLB1, LIP1, HWP1, and ALS1, were markedly downregulated in GQA-treated cells compared to the control. The in vivo murine model of vaginal candidiasis further confirmed the therapeutic activity of GQAs (4 mg/kg of body weight) against C. albicans. This work comprehensively evaluated the antifungal, antivirulence, and antibiofilm activities of GQAs against C. albicans isolates using in vitro and in vivo models, providing molecular-level insights into the antifungal mechanism of action and experimental evidence that supports the potential use of GQAs for the treatment of vaginal candidiasis. IMPORTANCE Our work presents a new perspective on the potential use of GQAs as safe and highly effective phytochemicals against MDR C. albicans. This microorganism colonizes the human vaginal epithelium, causing vaginal candidiasis, a condition characterized by recurrent pathogenicity and tolerance to traditional antifungal therapy. Based on the results of in vitro tests, our study reports GQAs antifungal modes of action. These compounds exhibited an anticandidal effect by deactivating the fungal hydrolytic enzymes, reducing ergosterol content in the plasma membrane, altering the potential of the mitochondrial membrane, and inducing apoptosis. Additionally, GQAs showed high activity in eradicating the biofilm formed by the fungus via the downregulation of HWP1, ALS, SAP, PLB, and LIP genes, which are constitutively expressed in the biofilm. In an in vivo murine model of vaginal candidiasis, GQAs further demonstrated strong evidence of their effectiveness as an antifungal therapy. In this regard, our findings provide novel insights into the potential therapeutic use of these phytoactive molecules for vaginal candidiasis treatment.
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Affiliation(s)
- Lamiaa A. Al-Madboly
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Mohamed A. Abd El-Salam
- Institute for Research in Biomedicine Barcelona, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Department of Pharmacognosy, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa, Egypt
- Department of Medicine, Harvard Medical School, Harvard University, Program in Research at VA West Roxbury, Massachusetts, USA
| | - Jairo K. Bastos
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Rasha M. El-Morsi
- Department of Microbiology, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa, Egypt
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Talapko J, Meštrović T, Škrlec I. Growing importance of urogenital candidiasis in individuals with diabetes: A narrative review. World J Diabetes 2022; 13:809-821. [PMID: 36311997 PMCID: PMC9606786 DOI: 10.4239/wjd.v13.i10.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/06/2022] [Accepted: 09/07/2022] [Indexed: 02/05/2023] Open
Abstract
Both diabetes and fungal infections contribute significantly to the global disease burden, with increasing trends seen in most developed and developing countries during recent decades. This is reflected in urogenital infections caused by Candida species that are becoming ever more pervasive in diabetic patients, particularly those that present with unsatisfactory glycemic control. In addition, a relatively new group of anti-hyperglycemic drugs, known as sodium glucose cotransporter 2 inhibitors, has been linked with an increased risk for colonization of the urogenital region with Candida spp., which can subsequently lead to an infectious process. In this review paper, we have highlighted notable virulence factors of Candida species (with an emphasis on Candida albicans) and shown how the interplay of many pathophysiological factors can give rise to vulvovaginal candidiasis, potentially complicated with recurrences and dire pregnancy outcomes. We have also addressed an increased risk of candiduria and urinary tract infections caused by species of Candida in females and males with diabetes, further highlighting possible complications such as emphysematous cystitis as well as the risk for the development of balanitis and balanoposthitis in (primarily uncircumcised) males. With a steadily increasing global burden of diabetes, urogenital mycotic infections will undoubtedly become more prevalent in the future; hence, there is a need for an evidence-based approach from both clinical and public health perspectives.
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Affiliation(s)
- Jasminka Talapko
- Laboratory for Microbiology, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Tomislav Meštrović
- University North, University Centre Varaždin, Varaždin 42000, Croatia
- Institute for Health Metrics and Evaluation, Department for Health Metrics Sciences, University of Washington School of Medicine, Seattle, Washington 98195, United States
| | - Ivana Škrlec
- Department of Biophysics, Biology, and Chemistry, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
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Lin Y, Yin Q, Zhuge D, Hu Y, Yang X, Tian D, Li L, Wang H, Liu S, Weng C, Zhang X, Wen B, Wang F, Yan L, Chen M, Wang L, Chen Y. Enhanced Targeting, Retention, and Penetration of Amphotericin B Through a Biomimetic Strategy to Treat Against Vulvovaginal Candidiasis. ADVANCED THERAPEUTICS 2022. [DOI: 10.1002/adtp.202200086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yijing Lin
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Qingqing Yin
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Deli Zhuge
- Department of Pharmaceutics School of Pharmaceutical Sciences of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
| | - Yiqin Hu
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Xuewei Yang
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Dongyan Tian
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Li Li
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Haonan Wang
- Department of Pharmaceutics School of Pharmaceutical Sciences of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
| | - Shuangshuang Liu
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Cuiye Weng
- Laboratory Animal Center of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
| | - Xufei Zhang
- Laboratory Animal Center of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
| | - Bin Wen
- Laboratory Animal Center of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
| | - Fang Wang
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Linzhi Yan
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Mengchun Chen
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
- Department of Pharmaceutics School of Pharmaceutical Sciences of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
- Department of Pharmacy The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Ledan Wang
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Yijie Chen
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
- Department of Pharmaceutics School of Pharmaceutical Sciences of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
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15
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Donders G, Sziller IO, Paavonen J, Hay P, de Seta F, Bohbot JM, Kotarski J, Vives JA, Szabo B, Cepuliené R, Mendling W. Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion. Front Cell Infect Microbiol 2022; 12:934353. [PMID: 36159646 PMCID: PMC9504472 DOI: 10.3389/fcimb.2022.934353] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
Recurrent vulvovaginal candidosis (RVVC) is a chronic, difficult to treat vaginal infection, caused by Candida species, which affects women of all ages and ethnic and social background. A long-term prophylactic maintenance regimen with antifungals is often necessary. In most clinical practice guidelines, oral fluconazole is recommended as the first-line treatment. Although clinical resistance to antifungal agents remains rare, overexposure to azoles may increase the development of fluconazole-resistant C. albicans strains. In addition, non-albicans Candida species are frequently dose-dependent susceptible or resistant to fluconazole and other azoles, and their prevalence is rising. Available therapeutic options to treat such fluconazole-resistant C. albicans and low susceptibility non-albicans strains are limited. Ten experts from different European countries discussed problematic issues of current RVVC diagnosis and treatment in two audiotaped online sessions and two electronic follow-up rounds. A total of 340 statements were transcribed, summarized, and compared with published evidence. The profile of patients with RVVC, their care pathways, current therapeutic needs, and potential value of novel drugs were addressed. Correct diagnosis, right treatment choice, and patient education to obtain adherence to therapy regimens are crucial for successful RVVC treatment. As therapeutic options are limited, innovative strategies are required. Well- tolerated and effective new drugs with an optimized mechanism of action are desirable and are discussed. Research into the impact of RVVC and treatments on health-related quality of life and sex life is also needed.
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Affiliation(s)
- Gilbert Donders
- Femicare VZW, Clinical Research for Women, Tienen, Belgium
- Department of Obstetrics and Gynecology, University Hospital Antwerp, Antwerp, Belgium
- Department of Obstetrics and Gynecology, Regional Hospital Tienen, Tienen, Belgium
| | - István Oszkár Sziller
- Dél-budai Centrumkórház, Szent Imre Egyetemi Oktatókórház, Szülészet és Nőgyógyászati Osztály, Budapest, Hungary
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Phillip Hay
- Guys and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Francesco de Seta
- Department of Medical, Surgical and Health Sciences, Institute for Maternal and Child Health, University of Trieste, IRCCS Burlo Garofolo, Trieste, Italy
| | - Jean Marc Bohbot
- Department of Sexually Transmitted Infections, Institut Alfred Fournier, Paris, France
| | - Jan Kotarski
- Department of Oncological Gynecology and Gynecology, Medical University of Lublin, Lublin, Poland
| | - Jordi Antoni Vives
- Department of Gynecology and Obstetrics, Hospital CIMA, Barcelona, Spain
| | - Bela Szabo
- Department of Obstetrics-Gynecology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
| | - Ramona Cepuliené
- Gedeon Richter Plc., Budapest, Hungary
- *Correspondence: Ramona Cepuliené,
| | - Werner Mendling
- Deutsches Zentrum für Infektionen in Gynäkologie und Geburtshilfe, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
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16
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Wang S, Wang P, Liu J, Yang C, Wang Q, Su M, Wei M, Gu L. Antibiofilm Activity of Essential Fatty Acids Against Candida albicans from Vulvovaginal Candidiasis and Bloodstream Infections. Infect Drug Resist 2022; 15:4181-4193. [PMID: 35946033 PMCID: PMC9357398 DOI: 10.2147/idr.s373991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/28/2022] [Indexed: 12/20/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Shuai Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Peng Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jun Liu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chunxia Yang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Qiangyi Wang
- Department of Clinical Laboratory, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Mingze Su
- Department of Clinical Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ming Wei
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Ming Wei; Li Gu, Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86-10-85231513, Email ;
| | - Li Gu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
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17
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Jafarzadeh L, Ranjbar M, Nazari T, Naeimi Eshkaleti M, Aghaei Gharehbolagh S, Sobel JD, Mahmoudi S. Vulvovaginal candidiasis: An overview of mycological, clinical, and immunological aspects. J Obstet Gynaecol Res 2022; 48:1546-1560. [PMID: 35445492 DOI: 10.1111/jog.15267] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/11/2022] [Accepted: 04/04/2022] [Indexed: 12/28/2022]
Abstract
AIM To provide an overview of clinical, immunological, and mycological aspects of vulvovaginal candidiasis (VVC). METHODS A literature search was conducted to find relevant articles about different aspects of VVC. Related data from retrieved articles were summarized in different headings. RESULTS VVC has a global distribution and Candida albicans is the leading cause of infection except for specific patient groups like postmenopausal, diabetic, or immunocompromised women. VVC has a range of clinical presentations, accordingly, its diagnosis should be based on clinical examination coupled with laboratory investigations. The best therapeutic regimen depends on the patient's conditions and the causative agent. Moreover, factors like drug resistance of the causative agents and different mutations in the immunity-related genes could affect the treatment outcome. CONCLUSION As a globally distributed disease, VVC needs further attention, especially in areas related to the treatment failure and recurrence of the disease.
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Affiliation(s)
- Leila Jafarzadeh
- Department of Immunology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Maryam Ranjbar
- Department of Persian Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tina Nazari
- Department of Medical Geriatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Naeimi Eshkaleti
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Aghaei Gharehbolagh
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jack D Sobel
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Shahram Mahmoudi
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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18
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Prevalence and species distribution of microorganisms isolated among non-pregnant women affected by vulvovaginal candidiasis: a retrospective study over a 20 year-period. J Mycol Med 2022; 32:101278. [DOI: 10.1016/j.mycmed.2022.101278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/09/2022] [Accepted: 04/14/2022] [Indexed: 11/19/2022]
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19
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Dhabhai N, Chaudhary R, Wi T, Mburu G, Chowdhury R, More D, Chatterjee L, De D, Kabra R, Kiarie J, Habib N, Dang A, Dang M, Mazumder S. Prevalence of reproductive tract infections including sexually transmitted infections among married women in urban and peri-urban mid to low socioeconomic neighbourhoods of Delhi, North India: an observational study protocol. BMJ Open 2022; 12:e059583. [PMID: 35304404 PMCID: PMC8935169 DOI: 10.1136/bmjopen-2021-059583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The Global Health Sector Strategy on sexually transmitted infections (STIs), endorsed by the World Health Assembly in 2016 aims to end STIs as public health threat by 2030. WHO conducts global estimates of prevalence to monitor progress towards achieving the same. However, limited laboratory confirmed data exist of STIs and reproductive tract infections (RTIs) apart from few prevalence surveys among key populations and clinic-based reports, including in India. Syndromic approach is the cornerstone of RTI/STI management and to maximise the diagnostic accuracy, there is a need to determine the main aetiologies of vaginal discharge. This study aims to estimate the prevalence of common STIs and RTIs and their aetiological organisms in symptomatic and asymptomatic women living in the urban and peri-urban, mid to low socioeconomic neighbourhoods of Delhi, North India. METHODS AND ANALYSIS A cross-sectional study will be conducted among 440 married women who participated in the 'Women and Infants Integrated Interventions for Growth Study (WINGS)'. Information on sociodemographic profile, sexual and reproductive health will be collected, followed by examination and collection of vaginal swabs for nucleic acid amplification tests to diagnose Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis and microscopy to identify bacterial vaginosis and Candida albicans. Treatment will be as per the syndromic approach recommendations in the Indian National Guidelines. Data will be analysed to estimate prevalence, presence of symptoms and signs associated with laboratory confirmed RTIs/STIs using STATA V.16.0 (StataCorp). ETHICS AND DISSEMINATION This study protocol has been approved by the ethics review committees of the WHO and Society for Applied Studies (SAS/ERC/RHR-RTI/STI/2020). Approval has been obtained by the WINGS investigators from SAS ethics research committee to share the contact details of the participants with the investigators. The findings will be published in peer-reviewed journals and disseminated through scientific conferences. TRIAL REGISTRATION NUMBER CTRI/2020/03/023954.
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Affiliation(s)
- Neeta Dhabhai
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ritu Chaudhary
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Teodora Wi
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Gitau Mburu
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Deepak More
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | | | - Rita Kabra
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Ndema Habib
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | | | | | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
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Paulovičová E, Hrubiško M. Humoral immune responses against facultative pathogen Candida utilis in atopic patients with vulvovaginal candidiasis. Candida utilis glucomannan - New serologic biomarker. Immunobiology 2021; 227:152154. [PMID: 34826687 DOI: 10.1016/j.imbio.2021.152154] [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: 07/13/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 11/05/2022]
Abstract
Vulvovaginal candidiasis is one of the most commonly reported female genital tract infections, affecting approximately 70-75% of childbearing age women at least once during their lifetime. Approximately 50% of patients have refractory episodes and in 5-10% of cases the disease has a chronic course. The fungal cell wall represents the important host-invader interface. Cell-wall polysaccharides represent biological response modifiers and the pathogen-associated molecular patterns and virulence factors. Glycans are sensed by germ-line encoded pattern recognition receptors and reactively participate in immune system cell signaling. The most dominant cell-wall antigenic structures of Candida species as ß-glucan, α- and ß-mannans, glucomannan and other immunogenic polysaccharides are of particular relevancy for specific in vitro diagnosis and long-term follow-up of the Candida infection. In this study we assessed the immunobiological activity of facultative pathogen Candida utilis cell glucomannan and its effectivity as in vitro serological marker for antibody testing. The novel serologic assay has been developed and optimized for C. utilis serodiagnosis. The comparison assays were performed to establish relationship between antibodies against C. utilis, C. albicans and S. cerevisiae main cell-wall antigens in patient sera. The study evaluates applicability of glucomannan as serodiagnostic antigen and as a trigger of antigenspecific IgG, IgM and IgA antibody isotypes in the cohort of 35 atopic female subjects with recurrent vulvovaginal candidiasis. Statistically significant sera values of specific anti-glycan IgM and IgA class antibodies were revealed. The results are suggestive for efficient serological application of C.utilis glucomannan as in vitro disease marker and prospectively for follow-up of the specific long-term antimycotic therapy.
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Affiliation(s)
- E Paulovičová
- Immunol. & Cell Culture Labs, Dept. Glycoconjugate Immunochemistry, Center for Glycomics, Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovakia.
| | - M Hrubiško
- Dept. Clin. Immunol .and Allergy, Oncology Institute of St. Elisabeth and Slovak Medical University, Bratislava, Slovakia
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21
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Comparing the Effects of Two Cream Formulations, Henna (Lawsonia inermis) and Clotrimazole, on Vaginal Candidiasis: A Randomized Controlled Trial. Jundishapur J Nat Pharm Prod 2021. [DOI: 10.5812/jjnpp.118510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Vaginal candidiasis is the most prevalent infection among reproductive-aged women. The current treatment for this disorder includes azole compounds. Objectives: The aim of this study was to compare the effects of two creams, henna (Lawsonia inermis) and clotrimazole, on vaginal candidiasis. Methods: In this trial, 80 women with vaginal candidiasis were recruited and randomly assigned into two groups to receive either henna (n = 40) or clotrimazole (n = 40) for one week. The ethanol extract of henna was prepared. Vaginal discharge was cultured, and vaginal pH, colony formation, lactobacillus formation, and vaginitis subjective symptoms were evaluated before and one, two, and four weeks after the intervention. The chi-square test, independent t-test, and Generalized Estimating Equations were were used for analyzing the data using SPSS version 22. Results: After four weeks of the intervention, almost 90% of the women in the henna group declared no burning sensation, itching, discharge, irritation, or dyspareunia, while only 45%, 5%, 37.5%, 52.5%, and 27.5% of the participants in the clotrimazole group did not have these symptoms, respectively (P < 0.001). The means (SD) of colony formation were 290.85 (47.35) and 265.12 (37.46) in the henna and clotrimazole groups, respectively, at the baseline, which reduced to zero and 25.45 (25.09) in the 4th week of the intervention (P = 0.001). Compared with the clotrimazole group, there was a significant increase in the mean of lactobacillus formation and a significant decrease in vaginal pH in the henna group (P < 0.001). Conclusions: Henna vaginal cream could significantly reduce the symptoms of vaginal candidiasis, such as burning sensation, itching, discharge, irritation, and dyspareunia. Also, it could decrease colony formation and vaginal pH and increase lactobacillus formation.
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Sobel R, Nyirjesy P, Ghannoum MA, Delchev DA, Azie NE, Angulo D, Harriott IA, Borroto-Esoda K, Sobel JD. Efficacy and safety of oral ibrexafungerp for the treatment of acute vulvovaginal candidiasis: a global phase 3, randomised, placebo-controlled superiority study (VANISH 306). BJOG 2021; 129:412-420. [PMID: 34676663 PMCID: PMC9299454 DOI: 10.1111/1471-0528.16972] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 01/25/2023]
Abstract
Objective To evaluate the efficacy and safety of ibrexafungerp versus placebo for acute vulvovaginal candidiasis (VVC) treatment. Design Global phase 3, randomised, placebo‐controlled superiority study. Setting Study sites in the USA (n = 19) and Bulgaria (n = 18). Population Female patients aged ≥12 years with acute VVC and a vulvovaginal signs and symptoms (VSS) score ≥4 at baseline. Methods Patients were randomly assigned 2:1 to ibrexafungerp (300 mg twice for 1 day) or placebo. Main outcome measures The primary endpoint was the percentage of patients with a clinical cure (VSS = 0) at the test‐of‐cure visit (day 11 ± 3). Secondary endpoints included percentages of patients with mycological eradication, clinical cure and mycological eradication (overall success), clinical improvement (VSS ≤1) at test‐of‐cure visit, and complete resolution of symptoms at follow‐up visit (day 25 ± 4). Results At the test‐of‐cure visit, patients receiving ibrexafungerp had significantly higher rates of clinical cure (63.3% [119/188] versus 44.0% [37/84]; P = 0.007), mycological eradication (58.5% [110/188] versus 29.8% [25/84]; P < 0.001), overall success (46.1% [82/188] versus 28.4% [23/84]; P = 0.022) and clinical improvement (72.3% [136/188] versus 54.8% [46/84]; P = 0.01) versus those receiving placebo. Symptom resolution was sustained and further increased with ibrexafungerp (73.9%) versus placebo (52.4%) at follow‐up (P = 0.001). Ibrexafungerp was generally well tolerated. Adverse events were primarily gastrointestinal and were mild to moderate in severity. Conclusions Ibrexafungerp demonstrated statistical superiority over placebo for the primary and secondary endpoints. Ibrexafungerp is a promising novel, well‐tolerated and effective oral 1‐day treatment for acute VVC. Tweetable abstract Ibrexafungerp is statistically superior to placebo for the treatment of vulvovaginal candidiasis. Ibrexafungerp is statistically superior to placebo for the treatment of vulvovaginal candidiasis. Linked article This article is commented on by KSJ Olah, p. 421–422 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17000.
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Affiliation(s)
- R Sobel
- Department of Obstetrics and Gynecology, Jefferson Vulvovaginal Health Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - P Nyirjesy
- Department of Obstetrics and Gynecology, Jefferson Vulvovaginal Health Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M A Ghannoum
- Department of Dermatology, Center for Medical Mycology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - D A Delchev
- Department of Gynaecology, MHAT Dr. Bratan Shukerov AD, Smolyan, Bulgaria
| | - N E Azie
- Departments of Clinical Development and Medical Affairs, SCYNEXIS, Inc., Jersey City, NJ, USA
| | - D Angulo
- Department of Clinical Research, SCYNEXIS, Inc., Jersey City, NJ, USA
| | - I A Harriott
- Department of Medical Affairs, SCYNEXIS, Inc., Jersey City, NJ, USA
| | | | - J D Sobel
- Infectious Diseases, Department of Internal Medicine, Wayne State University, Detroit, MI, USA
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Pfavayi LT, Denning DW, Baker S, Sibanda EN, Mutapi F. Determining the burden of fungal infections in Zimbabwe. Sci Rep 2021; 11:13240. [PMID: 34168204 PMCID: PMC8225815 DOI: 10.1038/s41598-021-92605-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023] Open
Abstract
Zimbabwe currently faces several healthcare challenges, most notably HIV and associated infections including tuberculosis (TB), malaria and recently outbreaks of cholera, typhoid fever and COVID-19. Fungal infections, which are also a major public health threat, receive considerably less attention. Consequently, there is dearth of data regarding the burden of fungal diseases in the country. We estimated the burden of fungal diseases in Zimbabwe based on published literature and 'at-risk' populations (HIV/AIDS patients, survivors of pulmonary TB, cancer, chronic obstructive pulmonary disease, asthma and patients receiving critical care) using previously described methods. Where there was no data for Zimbabwe, regional, or international data was used. Our study revealed that approximately 14.9% of Zimbabweans suffer from fungal infections annually, with 80% having tinea capitis. The annual incidence of cryptococcal meningitis and Pneumocystis jirovecii pneumonia in HIV/AIDS were estimated at 41/100,000 and 63/100,000, respectively. The estimated prevalence of recurrent vulvovaginal candidiasis (RVVC) was 2,739/100,000. The estimated burden of fungal diseases in Zimbabwe is high in comparison to other African countries, highlighting the urgent need for increased awareness and surveillance to improve diagnosis and management.
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Affiliation(s)
- Lorraine T. Pfavayi
- grid.4991.50000 0004 1936 8948Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG UK ,grid.4305.20000 0004 1936 7988Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL UK ,grid.4305.20000 0004 1936 7988NIHR Global Health Research Unit Tackling Infections To Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, UK
| | - David W. Denning
- grid.5379.80000000121662407Manchester Fungal Infection Group, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen Baker
- grid.5335.00000000121885934University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0AW UK ,grid.5335.00000000121885934Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 2QQ UK
| | - Elopy N. Sibanda
- Asthma Allergy and Immunology Clinic, Twin Palms Medical Centre, Harare, Zimbabwe ,grid.4305.20000 0004 1936 7988TIBA Zimbabwe, NIHR Global Health Research Unit Tackling Infections To Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK ,grid.440812.bDepartment of Pathology, National University of Science and Technology (NUST) Medical School, Bulawayo, Zimbabwe
| | - Francisca Mutapi
- grid.4305.20000 0004 1936 7988Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL UK ,grid.4305.20000 0004 1936 7988NIHR Global Health Research Unit Tackling Infections To Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, UK
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Anh DN, Hung DN, Tien TV, Dinh VN, Son VT, Luong NV, Van NT, Quynh NTN, Van Tuan N, Tuan LQ, Bac ND, Luc NK, Anh LT, Trung DM. Prevalence, species distribution and antifungal susceptibility of Candida albicans causing vaginal discharge among symptomatic non-pregnant women of reproductive age at a tertiary care hospital, Vietnam. BMC Infect Dis 2021; 21:523. [PMID: 34082699 PMCID: PMC8176683 DOI: 10.1186/s12879-021-06192-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022] Open
Abstract
Background Vaginal candidiasis is frequent in women of reproductive age. Accurate identification Candida provides helpful information for successful therapy and epidemiology study; however, there are very limited data from the Vietnam have been reported. This study was performed to determine the prevalence, species distribution of yeast causing vaginal discharge and antifungal susceptibility patterns of Candida albicans among symptomatic non-pregnant women of reproductive age. Methods Vaginal discharge samples were collected from 462 women of reproductive age in Hanoi, Vietnam between Sep 2019 and Oct 2020. Vaginal swabs from these patients were examined by direct microscopic examination (10% KOH). CHROMagar™ Candida medium and Sabouraud dextrose agar supplemented with chloramphenicol (0.5 g/l) were used to isolate yeast, and species identification was performed using morphological tests and molecular tools (PCR and sequencing). Antifungal susceptibility testing was determined according to the Clinical and Laboratory Standards Institute guidelines (M27-A3 and M27-S4). Results The prevalence of vaginal yeast colonization in non-pregnant women was 51.3% of 462 participants. Nine different yeast species were identified. Among these isolates, C. albicans (51.37%) was the most frequent, followed by C. parapsilosis (25.88%), C. glabrata (11.37%), C. tropicalis (4.31%), C. krusei (3.92%), C. africana (1.57%), Saccharomyces cerevisiae (0.78%), C. nivariensis (1 isolates, 0.39%), and C. lusitaniae (1 isolates, 0.39%), respectively. Among C. albicans, all 46 isolates were 100% susceptible to micafungin, caspofungin, and miconazole. The susceptibility rates to amphotericine B, 5-flucytosine, fluconazole, itraconazole and voriconazole were 95.65, 91.30, 91.30, 82.61 and 86.95%, respectively. Conclusions The prevalence of VVC among symptomatic non-pregnant women of reproductive age in Vietnam was higher than many parts of the world. The high frequency of non-albicans Candida species, which were often more resistant to antifungal agents, was a notable feature. Resistance rates of vaginal C. albicans isolates to antifungal agents was low. Our findings suggest that continued surveillance of changes in species distribution and susceptibility to antifungals should be routinely screened and treated. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06192-7.
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Affiliation(s)
- Do Ngoc Anh
- Department of Medical Parasitology, Vietnam Military Medical University, Hanoi, Vietnam. .,Laboratory of Parasitology and Medical Mycology, 103 Military Hospital, Hanoi, Vietnam.
| | - Dao Nguyen Hung
- 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Tran Viet Tien
- 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Vu Nhat Dinh
- 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Vu Tung Son
- Department of Epidemiology, Vietnam Military Medical University, Hanoi, Vietnam
| | | | - Nguyen Thi Van
- Laboratory of Parasitology and Medical Mycology, 103 Military Hospital, Hanoi, Vietnam
| | - Nguyen Thi Nhu Quynh
- Department of Medical Parasitology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Van Tuan
- Department of Medical Parasitology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Le Quoc Tuan
- Department of Medical Parasitology, Vietnam Military Medical University, Hanoi, Vietnam.,Laboratory of Parasitology and Medical Mycology, 103 Military Hospital, Hanoi, Vietnam
| | - Nguyen Duy Bac
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Khac Luc
- Department of Medical Parasitology, Vietnam Military Medical University, Hanoi, Vietnam.,Laboratory of Parasitology and Medical Mycology, 103 Military Hospital, Hanoi, Vietnam
| | - Le Tran Anh
- Department of Medical Parasitology, Vietnam Military Medical University, Hanoi, Vietnam.,Laboratory of Parasitology and Medical Mycology, 103 Military Hospital, Hanoi, Vietnam
| | - Do Minh Trung
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi, Vietnam.
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25
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Rosta K, Mazzucato-Puchner A, Kiss H, Malik V, Mandl P, Petricevic L, Foessleitner P, Shafran I, Temsch W, Farr A. Vaginal microbiota in pregnant women with inflammatory rheumatic and inflammatory bowel disease: A matched case-control study. Mycoses 2021; 64:909-917. [PMID: 33884668 PMCID: PMC8360144 DOI: 10.1111/myc.13288] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rheumatic diseases and vaginal infections both increase the risk of preterm birth. It is unclear whether pregnant women with rheumatic disease are more likely to experience vaginal infections, which might potentially accumulate modifiable risk factors. OBJECTIVE In this study, we sought to evaluate the vaginal microbiota of pregnant women with inflammatory rheumatic and inflammatory bowel disease. METHODS A total of 539 asymptomatic women with singleton pregnancy were routinely screened for an abnormal vaginal microbiota between 10 + 0 and 16 + 0 gestational weeks. Vaginal smears were Gram-stained and microscopically analysed. Those with inflammatory diseases (with or without immunomodulatory therapy) were assigned to the case group and matched in a 1:3 ratio to healthy pregnant controls. RESULTS Overall, an abnormal vaginal microbiota occurred more frequently among women of the case group, compared with those of the control group (33.8% vs 15.6%; 95% CI: 1.78-4.27, p < .001). In particular, Candida colonisation (22.3% vs 9.2%; 95% CI: 1.69-4.75, p < .001), but also bacterial vaginosis (14.9% vs 7.2%; 95% CI: 1.25-4.1, p = .006), occurred more often in the case than in the control group. No significant difference was found with regard to the occurrence of an abnormal vaginal microbiota between subgroups with and without immunomodulatory treatment (37.0% vs 27.1%; 95% CI: 0.29-1.35, p = .232). CONCLUSION Pregnant women with inflammatory rheumatic and inflammatory bowel disease are at risk for bacterial vaginosis and Candida colonisation, which might pose a risk for preterm birth. Prospective studies are needed to further evaluate the influence of autoimmune conditions and immunosuppressive therapy on the vaginal microbiota.
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Affiliation(s)
- Klara Rosta
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Veronika Malik
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Mandl
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Ljubomir Petricevic
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Foessleitner
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Inbal Shafran
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Wilhelm Temsch
- Section for Medical Statistics, Center of Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
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Emerging Fungi and Diagnosis of Fungal Infections: Current Knowledge and New Developments. J Fungi (Basel) 2021; 7:jof7040316. [PMID: 33921558 PMCID: PMC8074204 DOI: 10.3390/jof7040316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 12/18/2022] Open
Abstract
I would like to thank all the authors contributing to this Special Issue [...].
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Validation of the SavvyCheck™ Vaginal Yeast Test for Screening Pregnant Women for Vulvovaginal Candidosis: A Prospective, Cross-Sectional Study. J Fungi (Basel) 2021; 7:jof7030233. [PMID: 33804805 PMCID: PMC8003914 DOI: 10.3390/jof7030233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
Pregnant women have an increased risk of vulvovaginal candidosis. Recurrent candidosis is under debate as a contributor to preterm birth, and vertical transmission may cause diaper dermatitis and oral thrush in the newborn. Apart from cultural methods, the gold standard for diagnosing candidosis is Gram staining, which is time-consuming and requires laboratory facilities. The objective of this prospective study was to validate a point-of-care vaginal yeast detection assay (SavvyCheck™ Vaginal Yeast Test) and to evaluate it in asymptomatic pregnant women. We enrolled 200 participants, 100 of whom had vulvovaginal candidosis according to Gram stain (study group) and 100 were healthy pregnant controls (control group). Of these, 22 participants (11%) had invalid test results. The point-of-care test of the remaining 85 and 93 study participants in the study and control groups, respectively, showed a sensitivity of 94.1%, specificity of 98.9%, positive predictive value of 90.3%, and negative predictive value of 99.4% when compared with Gram stain. In conclusion, we found a high correlation between the SavvyCheck™ Vaginal Yeast Test and Gram-stained smears during pregnancy. This suggests a potential role of this point-of-care test as a screening tool for asymptomatic pregnant women in early gestation.
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Ivanov M, Kannan A, Stojković DS, Glamočlija J, Calhelha RC, Ferreira ICFR, Sanglard D, Soković M. Flavones, Flavonols, and Glycosylated Derivatives-Impact on Candida albicans Growth and Virulence, Expression of CDR1 and ERG11, Cytotoxicity. Pharmaceuticals (Basel) 2020; 14:ph14010027. [PMID: 33396973 PMCID: PMC7824033 DOI: 10.3390/ph14010027] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022] Open
Abstract
Due to the high incidence of fungal infections worldwide, there is an increasing demand for the development of novel therapeutic approaches. A wide range of natural products has been extensively studied, with considerable focus on flavonoids. The antifungal capacity of selected flavones (luteolin, apigenin), flavonols (quercetin), and their glycosylated derivatives (quercitrin, isoquercitrin, rutin, and apigetrin) along with their impact on genes encoding efflux pumps (CDR1) and ergosterol biosynthesis enzyme (ERG11) has been the subject of this study. Cytotoxicity of flavonoids towards primary liver cells has also been addressed. Luteolin, quercitrin, isoquercitrin, and rutin inhibited growth of Candida albicans with the minimal inhibitory concentration of 37.5 µg/mL. The application of isoquercitrin has reduced C. albicans biofilm establishing capacities for 76%, and hyphal formation by yeast. In vitro treatment with apigenin, apigetrin, and quercitrin has downregulated CDR1. Contrary to rutin and apigenin, isoquercitrin has upregulated ERG11. Except apigetrin and quercitrin (90 µg/mL and 73 µg/mL, respectively inhibited 50% of the net cell growth), the examined flavonoids did not exhibit cytotoxicity. The reduction of both fungal virulence and expression of antifungal resistance-linked genes was the most pronounced for apigenin and apigetrin; these results indicate flavonoids’ indispensable capacity for further development as part of an anticandidal therapy or prevention strategy.
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Affiliation(s)
- Marija Ivanov
- Department of Plant Physiology, Institute for Biological Research “Siniša Stanković”, National Institute of Republic of Serbia, University of Belgrade, Bulevar Despota Stefana 142, 11000 Belgrade, Serbia; (M.I.); (D.S.S.); (J.G.)
| | - Abhilash Kannan
- Institute of Microbiology, University Hospital Lausanne and University Hospital Center, Rue du Bugnon 48, 1011 Lausanne, Switzerland; (A.K.); (D.S.)
| | - Dejan S. Stojković
- Department of Plant Physiology, Institute for Biological Research “Siniša Stanković”, National Institute of Republic of Serbia, University of Belgrade, Bulevar Despota Stefana 142, 11000 Belgrade, Serbia; (M.I.); (D.S.S.); (J.G.)
| | - Jasmina Glamočlija
- Department of Plant Physiology, Institute for Biological Research “Siniša Stanković”, National Institute of Republic of Serbia, University of Belgrade, Bulevar Despota Stefana 142, 11000 Belgrade, Serbia; (M.I.); (D.S.S.); (J.G.)
| | - Ricardo C. Calhelha
- Centro de Investigação de Montanha (CIMO), Instituto Politécnico de Bragança, Campus de Santa Apolónia, 5300-253 Bragança, Portugal; (R.C.C.); (I.C.F.R.F.)
| | - Isabel C. F. R. Ferreira
- Centro de Investigação de Montanha (CIMO), Instituto Politécnico de Bragança, Campus de Santa Apolónia, 5300-253 Bragança, Portugal; (R.C.C.); (I.C.F.R.F.)
| | - Dominique Sanglard
- Institute of Microbiology, University Hospital Lausanne and University Hospital Center, Rue du Bugnon 48, 1011 Lausanne, Switzerland; (A.K.); (D.S.)
| | - Marina Soković
- Department of Plant Physiology, Institute for Biological Research “Siniša Stanković”, National Institute of Republic of Serbia, University of Belgrade, Bulevar Despota Stefana 142, 11000 Belgrade, Serbia; (M.I.); (D.S.S.); (J.G.)
- Correspondence:
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29
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Zangl I, Beyer R, Pap IJ, Strauss J, Aspöck C, Willinger B, Schüller C. Human Pathogenic Candida Species Respond Distinctively to Lactic Acid Stress. J Fungi (Basel) 2020; 6:jof6040348. [PMID: 33302409 PMCID: PMC7762603 DOI: 10.3390/jof6040348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 01/08/2023] Open
Abstract
Several Candida species are opportunistic human fungal pathogens and thrive in various environmental niches in and on the human body. In this study we focus on the conditions of the vaginal tract, which is acidic, hypoxic, glucose-deprived, and contains lactic acid. We quantitatively analyze the lactic acid tolerance in glucose-rich and glucose-deprived environment of five Candida species: Candidaalbicans, Candida glabrata, Candida parapsilosis, Candida krusei and Candida tropicalis. To characterize the phenotypic space, we analyzed 40–100 clinical isolates of each species. Each Candida species had a very distinct response pattern to lactic acid stress and characteristic phenotypic variability. C. glabrata and C. parapsilosis were best to withstand high concentrations of lactic acid with glucose as carbon source. A glucose-deprived environment induced lactic acid stress tolerance in all species. With lactate as carbon source the growth rate of C. krusei is even higher compared to glucose, whereas the other species grow slower. C. krusei may use lactic acid as carbon source in the vaginal tract. Stress resistance variability was highest among C. parapsilosis strains. In conclusion, each Candida spp. is adapted differently to cope with lactic acid stress and resistant to physiological concentrations.
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Affiliation(s)
- Isabella Zangl
- Department of Applied Genetics and Cell Biology (DAGZ), Institute of Microbial Genetics, University of Natural Resources and Life Sciences, Vienna (BOKU), 3430 Tulln an der Donau, Austria; (I.Z.); (R.B.); (J.S.)
| | - Reinhard Beyer
- Department of Applied Genetics and Cell Biology (DAGZ), Institute of Microbial Genetics, University of Natural Resources and Life Sciences, Vienna (BOKU), 3430 Tulln an der Donau, Austria; (I.Z.); (R.B.); (J.S.)
| | - Ildiko-Julia Pap
- Institute for Hygiene and Microbiology, University Hospital of St. Pölten, Dunant-Platz 1, 3100 St Pölten, Austria; (I.-J.P.); (C.A.)
| | - Joseph Strauss
- Department of Applied Genetics and Cell Biology (DAGZ), Institute of Microbial Genetics, University of Natural Resources and Life Sciences, Vienna (BOKU), 3430 Tulln an der Donau, Austria; (I.Z.); (R.B.); (J.S.)
| | - Christoph Aspöck
- Institute for Hygiene and Microbiology, University Hospital of St. Pölten, Dunant-Platz 1, 3100 St Pölten, Austria; (I.-J.P.); (C.A.)
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Christoph Schüller
- Department of Applied Genetics and Cell Biology (DAGZ), Institute of Microbial Genetics, University of Natural Resources and Life Sciences, Vienna (BOKU), 3430 Tulln an der Donau, Austria; (I.Z.); (R.B.); (J.S.)
- Bioactive Microbial Metabolites (BiMM), Department of Applied Genetics and Cell Biology (DAGZ), Institute of Microbial Genetics, University of Natural Resources and Life Sciences, 3430 Vienna, Austria
- Correspondence: ; Tel.: +43-1-47654-94484
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