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Spaggiari L, Sala A, Ardizzoni A, De Seta F, Singh DK, Gacser A, Blasi E, Pericolini E. Lactobacillus acidophilus, L. plantarum, L. rhamnosus, and L. reuteri Cell-Free Supernatants Inhibit Candida parapsilosis Pathogenic Potential upon Infection of Vaginal Epithelial Cells Monolayer and in a Transwell Coculture System In Vitro. Microbiol Spectr 2022; 10:e0269621. [PMID: 35499353 PMCID: PMC9241606 DOI: 10.1128/spectrum.02696-21] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/13/2022] [Indexed: 12/12/2022] Open
Abstract
Vulvovaginal candidiasis (VVC) is a common clinical condition with symptoms and signs of vaginal inflammation in the presence of Candida species. At least one episode of VVC is experienced in up to 75% of women in the reproductive age group during their lifetime, and 5% to 8% of such women suffer from the chronic form. Most cases of VVC are still caused by C. albicans. However, the incidence of VVC cases by non-albicans Candida (NAC) species, such as C. parapsilosis, is continuously increasing. Despite the prevalence of VVC from NAC, little is known about these species and almost nothing about the mechanisms that trigger the VVC. Lactobacillus spp. are the most widely before represented microorganisms in the vaginal microbiota of healthy women. Here, cell-free supernatants (CFS) obtained from L. acidophilus, L. plantarum, L. rhamnosus, and L. reuteri were assessed for their effect on C. parapsilosis virulence traits. Moreover, we assessed if such an effect persisted even after the removal of the CFS (CFS preincubation effect). Moreover, a transwell coculture system was employed by which the relevant antifungal effect was shown to be attributable to the compounds released by lactobacilli. Our results suggest that lactobacilli can work (i) by reducing C. parapsilosis virulence traits, as indicated by the reduced fungal proliferation, viability, and metabolic activity, and (ii) by improving epithelial resistance to the fungus. Overall, these data suggest that, in the context of the vaginal microbiota, the lactobacilli may play a role in preventing the onset of mucosal C. parapsilosis infection. IMPORTANCE The incidence of VVC by non-albicans Candida (NAC) species, such as C. parapsilosis, is increasing. Treatment failure is common in NAC-VVC because some species are resistant or poorly susceptible to the antifungal agents normally employed. Research on C. parapsilosis's pathogenic mechanisms and alternative treatments are still lacking. C. albicans triggers the VVC by producing hyphae, which favor the loss of epithelial tolerance. Differently, C. parapsilosis only produces pseudohyphae. Hence, different virulence factors may trigger the VVC. Likewise, the therapeutic options could also involve different fungal targets. Substantial in vitro and in vivo studies on the pathogenicity mechanisms of C. parapsilosis are lacking. The data presented here ascribe a novel beneficial role to different Lactobacillus spp., whose CFS provides a postbiotic-like activity against C. parapsilosis. Further studies are needed to unravel the mechanisms involved in the bioactivities of such compounds, to better understand the role of single postbiotics in the CFS.
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Affiliation(s)
- Luca Spaggiari
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Arianna Sala
- Department of Surgical, Medical, Dental, and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Ardizzoni
- Department of Surgical, Medical, Dental, and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco De Seta
- Department of Medical Sciences, University of Trieste, Institute for Maternal and Child Health- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Burlo Garofolo, Trieste, Italy
| | - Dhirendra Kumar Singh
- Hungarian Centre of Excellence for Molecular Medicine (HCEMM) - University of Szeged (USZ) Fungal Pathogens Research Group, Department of Microbiology, University of Szeged, Szeged, Hungary
| | - Attila Gacser
- Hungarian Centre of Excellence for Molecular Medicine (HCEMM) - University of Szeged (USZ) Fungal Pathogens Research Group, Department of Microbiology, University of Szeged, Szeged, Hungary
| | - Elisabetta Blasi
- Department of Surgical, Medical, Dental, and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Eva Pericolini
- Department of Surgical, Medical, Dental, and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Yano J, Fidel PL. Methods Related to the Immunopathogenesis of Vulvovaginal Candidiasis and Associated Neutrophil Anergy. Methods Mol Biol 2022; 2542:193-218. [PMID: 36008666 DOI: 10.1007/978-1-0716-2549-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Vulvovaginal candidiasis (VVC) is a common mucosal disease, caused primarily by Candida albicans that affects up to 75% of women of childbearing age. The pathogenesis of VVC and recurrent VVC (RVVC) is largely understood after decades of research. In this regard, an immunopathological response involving the migration of neutrophils that become dysfunctional (anergic) in the vaginal environment leads to the symptomatic conditions. However, immunotherapeutic strategies to correct the immunopathogenesis are still elusive. Much of the mechanistic discoveries have been uncovered using the established mouse model of chronic VVC. This chapter details the methods widely used for the mouse model of experimental VVC and associated outcome measures of the immunopathologic response and resulting symptomatic condition and focuses further on assays used to demonstrate "neutrophil anergy" in the model. These methods may serve as a source or resource for further experimentation with the ultimate goal to reduce or eliminate VVC/RVVC.
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Affiliation(s)
- Junko Yano
- Louisiana State University Health, New Orleans, LA, USA
| | - Paul L Fidel
- Louisiana State University Health, New Orleans, LA, USA.
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Menon S, Vartak R, Patel K, Billack B. Evaluation of the antifungal activity of an ebselen-loaded nanoemulsion in a mouse model of vulvovaginal candidiasis. Nanomedicine 2021; 37:102428. [PMID: 34217850 DOI: 10.1016/j.nano.2021.102428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/01/2021] [Accepted: 05/03/2021] [Indexed: 12/20/2022]
Abstract
Vulvovaginal candidiasis (VVC), caused by Candida albicans, is a common infection in women affecting their quality of life. Standard antifungal drugs (e.g., fluconazole, itraconazole) are typically fungistatic or rendered ineffective due to drug resistance indicating an urgent need to build an arsenal of novel antifungal agents. To surmount this issue, we tested the hypothesis that the organoselenium compound ebselen (EB) possesses antifungal efficacy in a mouse model of VVC. EB is a poorly water-soluble drug and DMSO as a vehicle has the potential to exhibit cytotoxic effects when administered in vivo. EB loaded self-nanoemulsifying preconcentrate (EB-SNEP) was developed, characterized in vitro, and tested in a mouse model of VVC. In vivo studies carried out with EB-SNEP (12.5 mg/kg) showed a remarkable decrease in infection by ~562-fold compared to control (infected, untreated animals). Taken together, EB nanoemulsion proved to be an effective and promising antifungal agent.
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Affiliation(s)
- Suvidha Menon
- Department of Pharmaceutical Sciences, St. John's University, Queens, Jamaica, NY, USA
| | - Richa Vartak
- Department of Pharmaceutical Sciences, St. John's University, Queens, Jamaica, NY, USA
| | - Ketankumar Patel
- Department of Pharmaceutical Sciences, St. John's University, Queens, Jamaica, NY, USA.
| | - Blase Billack
- Department of Pharmaceutical Sciences, St. John's University, Queens, Jamaica, NY, USA.
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Arumugam G, Rajendran R. Callophycin A loaded chitosan and spicules based nanocomposites as an alternative strategy to overcome vaginal candidiasis. Int J Biol Macromol 2020; 161:656-665. [PMID: 32544582 DOI: 10.1016/j.ijbiomac.2020.06.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/23/2020] [Accepted: 06/11/2020] [Indexed: 12/16/2022]
Abstract
The present study aimed to understand the killing effects of seaweed derived metabolite Callophycin A (Cal A). In vitro studies confirmed that the beneficial effects of Cal A on the viability of C. albicans. To enhance the biological activity, we used to demonstrated that chitosan and spicules as a drug carrier. The Callophycin A loading was confirmed by spectral variation of FT-IR and morphological variation by SEM. Moreover, around 65% and 38% of Cal A was successfully loaded in chitosan and spicules respectively. Further, VVC induced animal model experiments confirmed that the candidicidal activity of 1% clotrimazole, Cal A, Cal@Chi and Cal@Spi. After 6 days of treatment Cal@Chi produces a significant reduction in the fungal burden of vaginal lavage. The histo-morphological alterations also evidenced that the protective role of Cal@Chi in VVC model. The present investigations are known to be the first and foremost study to discriminate the potentiality of Cal A composites. Cal A loaded chitosan nanoparticles could be used as an alternative strategy for the development of the novel marine natural product based topical applications.
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Affiliation(s)
- Ganeshkumar Arumugam
- DNA Barcoding and Marine Genomics Laboratory, Department of Marine Science, Bharathidasan University, Tiruchirappalli, Tamilnadu, India
| | - Rajaram Rajendran
- DNA Barcoding and Marine Genomics Laboratory, Department of Marine Science, Bharathidasan University, Tiruchirappalli, Tamilnadu, India.
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Borghi M, Pariano M, Solito V, Puccetti M, Bellet MM, Stincardini C, Renga G, Vacca C, Sellitto F, Mosci P, Brancorsini S, Romani L, Costantini C. Targeting the Aryl Hydrocarbon Receptor With Indole-3-Aldehyde Protects From Vulvovaginal Candidiasis via the IL-22-IL-18 Cross-Talk. Front Immunol 2019; 10:2364. [PMID: 31681274 PMCID: PMC6798081 DOI: 10.3389/fimmu.2019.02364] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/20/2019] [Indexed: 12/21/2022] Open
Abstract
Vulvovaginal candidiasis (VVC) is a common mucosal infection caused by Candida spp., most frequently by Candida albicans, which may become recurrent and severely impacting the quality of life of susceptible women. Although it is increasingly being recognized that mucosal damage is mediated by an exaggerated inflammatory response, current therapeutic approaches are only based on antifungals that may relieve the symptomatology, but fail to definitely prevent recurrences. The unrestrained activation of the NLRP3 inflammasome with continuous production of IL-1β and recruitment of neutrophils is recognized as a pathogenic factor in VVC. We have previously shown that IL-22 is required to dampen pathogenic inflammasome activation in VVC via the NLRC4/IL-1Ra axis. However, IL-22 also regulates IL-18, a product of the inflammasome activity that regulates IL-22 expression. Here we describe a cross-regulatory circuit between IL-18 and IL-22 in murine VVC that is therapeutically druggable. We found that IL-18 production was dependent on IL-22 and NLRC4, and that IL-18, in turn, contributes to IL-22 activity. Like in IL-22 deficiency, IL-18 deficiency was associated with an increased susceptibility to VVC and unbalanced Th17/Treg response, suggesting that IL-18 can regulate both the innate and the adaptive responses to the fungus. Administration of the microbial metabolite indole-3-aldehyde, known to stimulate the production of IL-22 via the aryl hydrocarbon receptor (AhR), promoted IL-18 expression and protection against Candida infection. Should low levels of IL-18 be demonstrated in the vaginal fluids of women with recurrent VVC, targeting the AhR/IL-22/IL-18 pathway could be exploited for future therapeutic approaches in VVC. This study suggests that a deeper understanding of the mechanisms regulating inflammasome activity may lead to the identification of novel targets for intervention in VVC.
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MESH Headings
- Animals
- Basic Helix-Loop-Helix Transcription Factors/agonists
- Basic Helix-Loop-Helix Transcription Factors/genetics
- Basic Helix-Loop-Helix Transcription Factors/immunology
- Candida albicans/immunology
- Candidiasis, Vulvovaginal/drug therapy
- Candidiasis, Vulvovaginal/genetics
- Candidiasis, Vulvovaginal/immunology
- Candidiasis, Vulvovaginal/pathology
- Female
- Indoles/pharmacology
- Inflammasomes/genetics
- Inflammasomes/immunology
- Interleukin-18/genetics
- Interleukin-18/immunology
- Interleukins/genetics
- Interleukins/immunology
- Mice
- Mice, Knockout
- NLR Family, Pyrin Domain-Containing 3 Protein/genetics
- NLR Family, Pyrin Domain-Containing 3 Protein/immunology
- Receptors, Aryl Hydrocarbon/agonists
- Receptors, Aryl Hydrocarbon/genetics
- Receptors, Aryl Hydrocarbon/immunology
- Signal Transduction/drug effects
- Signal Transduction/genetics
- Signal Transduction/immunology
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/pathology
- Th17 Cells/immunology
- Th17 Cells/pathology
- Interleukin-22
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Affiliation(s)
- Monica Borghi
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Marilena Pariano
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Valentina Solito
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Matteo Puccetti
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Marina M. Bellet
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Giorgia Renga
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Carmine Vacca
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Federica Sellitto
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Paolo Mosci
- Department of Veterinary Medicine, University of Perugia, Perugia, Italy
| | | | - Luigina Romani
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Claudio Costantini
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
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Russo R, Superti F, Karadja E, De Seta F. Randomised clinical trial in women with Recurrent Vulvovaginal Candidiasis: Efficacy of probiotics and lactoferrin as maintenance treatment. Mycoses 2019; 62:328-335. [PMID: 30565745 DOI: 10.1111/myc.12883] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/27/2018] [Accepted: 12/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Vulvovaginal candidiasis (VVC) is a recurrent vaginal condition in childbearing women. OBJECTIVES The aim of this study was to assess the efficacy of an oral formulation containing Lactobacillus acidophilus GLA-14, Lactobacillus rhamnosus HN001 and bovine lactoferrin on symptoms and recurrence of VVC as adjuvant therapy to topical clotrimazole. PATIENTS/METHODS Forty-eight women positive for C. albicans, symptoms of VVC and documented history of recurrences were randomised into 2 groups receiving verum or placebo (2 capsules/day for 5 days followed by 1 capsule/day for additional 10 days) as adjuvant treatment to clotrimazole (induction phase) followed by a maintenance cycle of 6 months (1 capsule/day verum or placebo for 10 consecutive days each month). Symptoms, overall cure rate and recurrence rate were assessed. RESULTS After clotrimazole therapy, a significant improvement of symptoms was shown in both groups. However, only women treated with probiotics and lactoferrin showed a significant improvement of itching and discharge at 3 and 6 months. During the six-month follow-up, recurrences were significantly less in the intervention group vs placebo (33.3% vs 91.7% after 3 months and 29.2% vs 100% after 6 months). CONCLUSIONS The results show that the investigated lactobacilli mixture in combination with lactoferrin represents a safe and effective adjuvant approach for reducing symptoms and recurrences of RVVC.
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Affiliation(s)
| | - Fabiana Superti
- National Centre for Innovative Technologies in Public Health, National Institute of Health, Rome, Italy
| | - Eugen Karadja
- Emergency Clinical County Hospital "Pius Branzeu", Timisoara, Romania
| | - Francesco De Seta
- Department of Medical Science, University of Trieste, Trieste, Italy
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Yang L, Wu H, Qiu W, Guo L, Du X, Yu Q, Gao J, Luo S. Pulsatilla decoction inhibits Candida albicans proliferation and adhesion in a mouse model of vulvovaginal candidiasis via the Dectin-1 signaling pathway. J Ethnopharmacol 2018; 223:51-62. [PMID: 29775695 DOI: 10.1016/j.jep.2018.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/12/2018] [Accepted: 05/12/2018] [Indexed: 06/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Pulsatilla decoction (PD) is a classical prescription in Traditional Chinese Medicine (TCM) and has been reported to have inhibitory effects on Candida albicans proliferation. STUDY AIM To investigate the therapeutic effects of PD in the treatment of Vulvovaginal candidiasis (VVC) and elucidate the potential mechanism. MATERIALS AND METHODS Female BALB/c mice (N = 90) were randomized to six treatment groups, including the Control group, Model group, three PD groups and Fluconazole group which served as a positive control (20 mg/kg weekly). The three PD groups (low dose group, medium dose group and high dose group) were given a daily intragastric gavage of PD at doses of 5, 10 and 20 g/kg, respectively. Five animals from each group were euthanized on Day 4, Day 7 and Day 14 after treatment. Colony forming unit (CFU) was measured by the serial dilution method. The degree of infection was assessed by Gram staining, Periodic acid schiff (PAS) staining, Hematoxylin and eosin (H&E) staining and Scanning electron microscopy (SEM). The serum inflammation levels were determined by a Luminex assay. Gene and protein expression levels of components of the Dectin-1 signaling pathway were determined by Real-time PCR, Western-blot and immunohistochemistry, respectively. RESULTS The administration of PD significantly decreased the fungal load from Day 7 post-infection onwards and decreased the number of visible microorganisms based on findings from Gram staining, PAS staining and SEM. H&E staining indicated that the impaired histological profiles were improved in all three PD groups. PD led to a significantly lower level of IL-23 in the serum; the levels of IL-10 and TNF-α were also decreased, although the differences were not significant. Furthermore, a substantial downregulation of Dectin-1, CARD9 and NF-κB mRNA levels and Dectin-1, Syk, CARD9 and NF-κB protein levels was observed after the administration of PD. CONCLUSION This study suggests that PD exerts inhibitory effects on C. albicans proliferation, adhesion and inflammation and simultaneously downregulates the expression levels of important genes and proteins associated with the Dectin-1 pathway, highlighting the potential application of PD to improve the clinical management of VVC.
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Affiliation(s)
- Lilin Yang
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haiwang Wu
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weiyu Qiu
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Longyi Guo
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Du
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qingying Yu
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie Gao
- Department of Gynecology, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Songping Luo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Sanches JM, Giraldo PC, Amaral R, Eberlin MN, Marques LA, Migliorini I, Nakahira M, Bieleveld MJM, Discacciati MG. Vaginal lipidomics of women with vulvovaginal candidiasis and cytolytic vaginosis: A non-targeted LC-MS pilot study. PLoS One 2018; 13:e0202401. [PMID: 30133508 PMCID: PMC6105002 DOI: 10.1371/journal.pone.0202401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 08/02/2018] [Indexed: 02/06/2023] Open
Abstract
Objective To characterize the lipid profile in vaginal discharge of women with vulvovaginal candidiasis, cytolytic vaginosis, or no vaginal infection or dysbiosis. Design Cross-sectional study. Setting Genital Infections Ambulatory, Department of Tocogynecology, University of Campinas, Campinas, São Paulo–Brazil. Sample Twenty-four women were included in this study: eight with vulvovaginal candidiasis, eight with cytolytic vaginosis and eight with no vaginal infections or dysbiosis (control group). Methods The lipid profile in vaginal discharge of the different study groups was determined by liquid chromatography-mass spectrometry and further analyzed with MetaboAnalyst 3.0 platform. Main outcome measures Vaginal lipids concentration and its correlation with vulvovaginal candidiasis and cytolytic vaginosis. Results PCA, PLS-DA and hierarchical clustering analyses indicated 38 potential lipid biomarkers for the different groups, correlating with oxidative stress, inflammation, apoptosis and integrity of the vaginal epithelial tissue. Among these, greater concentrations were found for Glycochenodeoxycholic acid-7-sulfate, O-adipoylcarnitine, 1-eicosyl-2-heptadecanoyl-glycero-3-phosphoserine, undecanoic acid, formyl dodecanoate and lipoic acid in the vulvovaginal candidiasis group; N–(tetradecanoyl)-sphinganine, DL-PPMP, 1-oleoyl-cyclic phosphatidic, palmitic acid and 5-aminopentanoic acid in the cytolytic vaginosis group; and 1-nonadecanoyl-glycero-3-phosphate, eicosadienoic acid, 1-stearoyl-cyclic-phosphatidic acid, 1-(9Z,12Z-heptadecadienoyl)-glycero-3-phosphate, formyl 9Z-tetradecenoate and 7Z,10Z-hexadecadienoic acid in the control group. Conclusions Lipids related to oxidative stress and apoptosis were found in higher concentrations in women with vulvovaginal candidiasis and cytolytic vaginosis, while lipids related to epithelial tissue integrity were more pronounced in the control group. Furthermore, in women with cytolytic vaginosis, we observed higher concentrations of lipids related to bacterial overgrowth.
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Affiliation(s)
- José Marcos Sanches
- Campinas State University, Department of Tocoginecology, Campinas, São Paulo, Brazil
- * E-mail:
| | - Paulo César Giraldo
- Campinas State University, Department of Tocoginecology, Campinas, São Paulo, Brazil
| | - Rose Amaral
- Campinas State University, Department of Tocoginecology, Campinas, São Paulo, Brazil
| | | | | | - Isabel Migliorini
- Campinas State University, Department of Tocoginecology, Campinas, São Paulo, Brazil
| | - Marcel Nakahira
- Campinas State University, Institute of Chemistry, Campinas, São Paulo, Brazil
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Pericolini E, Perito S, Castagnoli A, Gabrielli E, Mencacci A, Blasi E, Vecchiarelli A, Wheeler RT. Epitope unmasking in vulvovaginal candidiasis is associated with hyphal growth and neutrophilic infiltration. PLoS One 2018; 13:e0201436. [PMID: 30063729 PMCID: PMC6067721 DOI: 10.1371/journal.pone.0201436] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/16/2018] [Indexed: 11/29/2022] Open
Abstract
Vaginal candidiasis is a common disorder in women of childbearing age, caused primarily by the dimorphic fungus Candida albicans. Since C. albicans is a normal commensal of the vaginal mucosa, a long-standing question is how the fungus switches from being a harmless commensal to a virulent pathogen. Work with human subjects and in mouse disease models suggests that host inflammatory processes drive the onset of symptomatic infection. Fungal cell wall molecules can induce inflammation through activation of epithelial and immune receptors that trigger pro-inflammatory cytokines and chemokines, but pathogenic fungi can evade recognition by masking these molecules. Knowledge about which cell wall epitopes are available for immune recognition during human infection could implicate specific ligands and receptors in the symptoms of vaginal candidiasis. To address this important gap, we directly probed the surface of fungi present in fresh vaginal samples obtained both from women with symptomatic Candida vaginitis and from women that are colonized but asymptomatic. We find that the pro-inflammatory cell wall polysaccharide β-glucan is largely masked from immune recognition, especially on yeast. It is only exposed on a small percentage of hyphal cells, where it tends to co-localize with enhanced levels of chitin. Enhanced β-glucan availability is only found in symptomatic patients with strong neutrophil infiltration, implicating neutrophils as a possible driver of these cell wall changes. This is especially interesting because neutrophils were recently shown to be necessary and sufficient to provoke enhanced β-glucan exposure in C. albicans, accompanied by elevated immune responses. Taken together, our data suggest that the architecture of C. albicans cell wall can be altered by environmental stress during vaginal candidiasis.
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Affiliation(s)
- Eva Pericolini
- Department of Medicine, University of Perugia, Perugia, Italy
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Perito
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Anna Castagnoli
- School of Specialization in Microbiology and Virology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Gabrielli
- Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Elisabetta Blasi
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Robert T. Wheeler
- Department of Medicine, University of Perugia, Perugia, Italy
- Department of Molecular and Biomedical Sciences, University of Maine, Orono, Maine, United States of America
- Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, Maine, United States of America
- * E-mail:
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10
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Abstract
For over 3 decades, investigators have studied the pathogenesis of vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC) through clinical studies and animal models. While there was considerable consensus that susceptibility was not associated with any apparent deficiencies in adaptive immunity, protective immune mechanisms and the role of innate immunity remained elusive. It was not until an innovative live-challenge design was conducted in women that a fuller understanding of the natural history of infection/disease was achieved. These studies revealed that symptomatic infection is associated with recruitment of polymorphonuclear neutrophils (PMNs) into the vaginal lumen. Subsequent studies in the established mouse model demonstrated that infiltrating PMNs were incapable of reducing the fungal burden, which supported the hypothesis that VVC/RVVC was an immunopathology, whereby Candida and the host response drive symptomatic disease. Further studies in mice revealed the requirement for C. albicans hyphae and identified pattern recognition receptors (PRRs) and proinflammatory mediators responsible for the PMN response, all of which are critical pieces of the immunopathogenesis. However, a mechanism explaining PMN dysfunction at the vaginal mucosa remained an enigma. Ultimately, by employing mouse strains resistant or susceptible to chronic VVC, it was determined that heparan sulfate (HS) in the vaginal environment of susceptible mice serves as a competitive ligand for Mac-1 on PMNs, which effectively renders the PMNs incapable of binding to Candida to initiate killing. Hence, the outcome of symptomatic VVC/RVVC is postulated to be dependent on a PMN-mediated immunopathogenic response involving HS that effectively places the neutrophils in a state of functional anergy.
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Affiliation(s)
- Junko Yano
- Center of Excellence in Oral and Craniofacial Biology, Louisiana State University Health Sciences Center School of Dentistry, New Orleans, Louisiana, USA
| | - Brian M Peters
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Mairi C Noverr
- Center of Excellence in Oral and Craniofacial Biology, Louisiana State University Health Sciences Center School of Dentistry, New Orleans, Louisiana, USA
| | - Paul L Fidel
- Center of Excellence in Oral and Craniofacial Biology, Louisiana State University Health Sciences Center School of Dentistry, New Orleans, Louisiana, USA
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11
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Gomes de Oliveira G, Eleutério RMN, Silveira Gonçalves AK, Giraldo PC, Eleutério J. Atypical Squamous Cells in Liquid-Based Cervical Cytology: Microbiology, Inflammatory Infiltrate, and Human Papillomavirus-DNA Testing. Acta Cytol 2017; 62:28-33. [PMID: 29130974 DOI: 10.1159/000481654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the correlation between atypical squamous cells (ASC) and inflammatory infiltrate and vaginal microbiota using cervical liquid-based cytological (SurePath®) and high-risk human papillomavirus (HR-HPV) tests. STUDY DESIGN A cross-sectional study was conducted using a 6-year database from a laboratory in Fortaleza (Brazil). Files from 1,346 ASC cases were divided into subgroups and results concerning inflammation and vaginal microorganisms diagnosed by cytology were compared with HR-HPV test results. RESULTS An absence of specific microorganisms (ASM) was the most frequent finding (ASC of undetermined significance, ASC-US = 74%; ASC - cannot exclude high-grade squamous intraepithelial lesion, ASC-H = 68%), followed by bacterial vaginosis (ASC-US = 20%; ASC- H = 25%) and Candida spp. (ASC-US = 6%; ASC-H = 5%). Leukocyte infiltrate was present in 71% of ASC-US and 85% of ASC-H (p = 0.0040), and in these specific cases HR-HPV tests were positive for 65 and 64%, respectively. A positive HR-HPV test was relatively more frequent when a specific microorganism was present, and Candida spp. was associated with HR-HPV-positive results (p = 0.0156), while an ASM was associated with negative HR-HPV results (p = 0.0370). CONCLUSION ASC-US is associated with an absence of inflammation or vaginosis, while ASC-H smears are associated with Trichomonas vaginalis and inflammatory infiltrate. A positive HR-HPV is associated with Candida spp. in ASC cytology.
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Cauchie M, Desmet S, Lagrou K. Candida and its dual lifestyle as a commensal and a pathogen. Res Microbiol 2017; 168:802-810. [PMID: 28263903 DOI: 10.1016/j.resmic.2017.02.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/19/2022]
Abstract
Candida spp. are part of the normal vaginal microflora in 20-30% of healthy women. However, if the balance between these yeasts and the host is disturbed, Candida spp. can cause vulvovaginal candidiasis (VVC), with Candida albicans being the major causative agent. Different studies have been performed in order to better understand Candida's dual lifestyle in the vagina. The potential of C. albicans to switch from the yeast cell morphology to its hyphal form is considered a key element in VVC pathogenesis. Candida spp. also express other virulence factors, such as hydrolytic extracellular enzymes and heat shock proteins and can form biofilms.
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Affiliation(s)
- Mathieu Cauchie
- Department of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Stefanie Desmet
- Department of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven - University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Katrien Lagrou
- Department of Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven - University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
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13
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Affiliation(s)
- A Sommer
- Klinik für Dermatologie und Allergologie, Ruhr-Universität, Bochum
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14
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Nash EE, Peters BM, Lilly EA, Noverr MC, Fidel PL. A Murine Model of Candida glabrata Vaginitis Shows No Evidence of an Inflammatory Immunopathogenic Response. PLoS One 2016; 11:e0147969. [PMID: 26807975 PMCID: PMC4726552 DOI: 10.1371/journal.pone.0147969] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/11/2016] [Indexed: 01/11/2023] Open
Abstract
Candida glabrata is the second most common organism isolated from women with vulvovaginal candidiasis (VVC), particularly in women with uncontrolled diabetes mellitus. However, mechanisms involved in the pathogenesis of C. glabrata-associated VVC are unknown and have not been studied at any depth in animal models. The objective of this study was to evaluate host responses to infection following efforts to optimize a murine model of C. glabrata VVC. For this, various designs were evaluated for consistent experimental vaginal colonization (i.e., type 1 and type 2 diabetic mice, exogenous estrogen, varying inocula, and co-infection with C. albicans). Upon model optimization, vaginal fungal burden and polymorphonuclear neutrophil (PMN) recruitment were assessed longitudinally over 21 days post-inoculation, together with vaginal concentrations of IL-1β, S100A8 alarmin, lactate dehydrogenase (LDH), and in vivo biofilm formation. Consistent and sustained vaginal colonization with C. glabrata was achieved in estrogenized streptozotocin-induced type 1 diabetic mice. Vaginal PMN infiltration was consistently low, with IL-1β, S100A8, and LDH concentrations similar to uninoculated mice. Biofilm formation was not detected in vivo, and co-infection with C. albicans did not induce synergistic immunopathogenic effects. This data suggests that experimental vaginal colonization of C. glabrata is not associated with an inflammatory immunopathogenic response or biofilm formation.
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Affiliation(s)
- Evelyn E. Nash
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Brian M. Peters
- Department of Oral and Craniofacial Biology, Dental School, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Elizabeth A. Lilly
- Department of Oral and Craniofacial Biology, Dental School, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Mairi C. Noverr
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Oral and Craniofacial Biology, Dental School, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
- Prosthodontics, Dental School, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Paul L. Fidel
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Oral and Craniofacial Biology, Dental School, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
- * E-mail:
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15
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Nersesyan A, Parsadanyan G, Zalinyan G, Chobanyan N. Comment on the Paper by Safi Oz et al. Entitled 'Evaluation of Micronuclei, Nuclear Anomalies and the Nuclear/Cytoplasmic Ratio of Exfoliated Cervical Epithelial Cells in Genital Candidiasis'. Acta Cytol 2015; 59:429-30. [PMID: 26658725 DOI: 10.1159/000439423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Armen Nersesyan
- Institute of Cancer Research, Internal Medicine I, Medical University of Vienna, Vienna, Austria
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16
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Safi Oz Z, Doğan Gun B, Ozdamar SO. Why an Experienced Eye May Not Detect Micronucleated Cells Using Papanicolaou's Stain. Acta Cytol 2015; 59:431-3. [PMID: 26658559 DOI: 10.1159/000440934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 09/07/2015] [Indexed: 11/19/2022]
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17
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Safi Oz Z, Dogan Gun B, Ozdamar SO. Evaluation of Micronuclei, Nuclear Anomalies and the Nuclear/Cytoplasmic Ratio of Exfoliated Cervical Epithelial Cells in Genital Candidiasis. Acta Cytol 2015; 59:180-6. [PMID: 25998009 DOI: 10.1159/000381615] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/09/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Candida is the most common cause of fungal infections. The aim of this study was to fill the gaps in the current knowledge on the frequencies of micronuclei and nuclear anomalies, and the nucleus/cytoplasmic ratio in genital candidiasis. STUDY DESIGN A total of 88 Papanicolaou- stained cervical smears, which comprised Candida spp. (n = 44) and control cases with no infectious agent (n = 44), were studied. In each smear, cells with micronuclei and nuclear anomalies were counted in 1,000 epithelial cells and also nuclear and cellular areas were evaluated using image analysis software at a magnification of ×400. RESULTS The frequencies of micronucleated and binucleated cells and cells with perinuclear halos, and the nucleus/cytoplasmic ratio of epithelial cells were higher in the Candida-infected group compared with the control group (p < 0.05). CONCLUSIONS Genital candidiasis is able to induce changes in the size and shape of epithelial cells. The nuclear/cytoplasmic ratio and the frequency of micronuclei may reflect the DNA damage in the cervical epithelium. Micronucleus scoring could be used to screen the genomic damage profile of epithelial cells in candidiasis.
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Affiliation(s)
- Zehra Safi Oz
- Department of Medical Biology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
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18
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Boon ME, Holloway PA, Breijer H, Bontekoe TR. Gardnerella, Trichomonas and Candida in cervical smears of 58,904 immigrants participating in the Dutch national cervical screening program. Acta Cytol 2012; 56:242-6. [PMID: 22555524 DOI: 10.1159/000336992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 01/31/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report the prevalence of Gardnerella, Trichomonas and Candida in the cervical smears of 9 immigrant groups participating in the Dutch national cervical screening program. STUDY DESIGN Cervical smears were taken from 58,904 immigrant participants and 498,405 Dutch participants. As part of the routine screening process, all smears were screened for the overgrowth of Gardnerella (i.e. smears with an abundance of clue cells) and for the presence of Trichomonas and Candida. The smears were screened by 6 laboratories, all of which use the Dutch KOPAC coding system. The odds ratio and confidence interval were calculated for the 9 immigrant groups and compared to Dutch participants. RESULTS Immigrants from Suriname, Turkey and the Dutch Antilles have a 2-5 times higher prevalence of Gardnerella and Trichomonas when compared to native Dutch women. Interestingly, the prevalence of Trichomonas in cervical smears of Moroccan immigrants is twice as high, yet the prevalence of Gardnerella is 3 times lower than in native Dutch women. CONCLUSIONS Immigrants with a high prevalence of Gardnerella also have a high prevalence of Trichomonas. In the context of the increased risk of squamous abnormalities in smears with Gardnerella, such slides should be screened with extra care.
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Affiliation(s)
- Mathilde E Boon
- Leiden Cytology and Pathology Laboratory, Leiden, The Netherlands.
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19
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Abstract
Investigations into the complex interaction between the fungal pathogen Candida albicans and its human host require the use of animals as in vivo models. A major advance is the creation of a low-oestrogen murine model of concurrent oral and vaginal C. albicans colonisation that resembles human candidal carriage at both mucosal sites. Weekly intramuscular (5 μg) and subcutaneous (5 μg) oestrogen administration was determined as optimal, enhancing oral colonisation but essential for vaginal colonisation. Using a clinical C. albicans oral isolate, persistent colonisation for up to 6 weeks can be achieved at both sites in two strains of mice (BALB/c and C57BL/6). This concurrent model of mucosal colonisation reduces the numbers of experimental mice by half, and opens up new avenues of research in assessing potential mucosal vaccine candidates and in studying delicate host-pathogen interactions during the most natural state of C. albicans epithelial colonisation.
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MESH Headings
- Animals
- Candida albicans/growth & development
- Candida albicans/pathogenicity
- Candidiasis, Oral/complications
- Candidiasis, Oral/microbiology
- Candidiasis, Oral/pathology
- Candidiasis, Vulvovaginal/complications
- Candidiasis, Vulvovaginal/microbiology
- Candidiasis, Vulvovaginal/pathology
- Disease Models, Animal
- Female
- Host-Pathogen Interactions
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Inbred DBA
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Affiliation(s)
- Durdana Rahman
- Department of Oral Immunology, King's College London Dental Institute, London, UK
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20
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Guzel AB, Ilkit M, Burgut R, Urunsak IF, Ozgunen FT. An evaluation of risk factors in pregnant women with Candida vaginitis and the diagnostic value of simultaneous vaginal and rectal sampling. Mycopathologia 2011; 172:25-36. [PMID: 21293929 DOI: 10.1007/s11046-011-9392-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 01/17/2011] [Indexed: 01/07/2023]
Abstract
In this study, we investigated the epidemiological characteristics of VVC among pregnant women. We conducted a prospective survey among 372 pregnant women to investigate the prevalence, clinical forms, etiological agents, and predisposing factors of VVC. In addition, we determined the relationship between vaginal and rectal flora by simultaneously obtaining one high vaginal swab and one rectal swab from each patient using sterile cotton-tipped swabs. Furthermore, we compared the recovery and identification performances of chromID Candida agar to Sabouraud dextrose agar with gentamicin and chloramphenicol. Clinically and mycologically confirmed cases of VVC were detected in 139 (37.4%) and vaginal colonization described in 42 (11.3%) of 372 pregnant women. Rectal cultures were also positive in 98 of the 139 (70.5%) VVC cases. Candida albicans and C. glabrata were identified in vaginal samples in 58.0 versus 19.0% and from rectal samples in 49.0 versus 13.5%, respectively. Increases in gestational week and gravidae were identified to be statistically significant in patients with acute VVC (AVVC) and symptomatic recurrent VVC (RVVC), and asymptomatic RVVC (P = 0.04 and P = 0.03, respectively). In the laboratory diagnosis of VVC, specifically tailored chromogenic media are reliable tools for both the recovery and rapid identification of common Candida spp., particularly C. albicans, as well as for the detection of polyfungal populations in vaginal samples (P > 0.05). In addition, rectal colonization is a common finding in cases of AVVC and symptomatic-RVVC cases and corresponds well with the presence of the same yeast species in the vagina.
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Affiliation(s)
- Ahmet Barış Guzel
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Cukurova, Adana, Turkey
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21
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Del Pup L. [Treatment of atrophic and irritative vulvovaginal symptoms with an anhydrous lipogel and its complementary effect with vaginal estrogenic therapy: new evidences]. Minerva Ginecol 2010; 62:287-291. [PMID: 20827246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
It is sometimes difficult to treat vulvovaginal itching and dryness, which represent frustrating symptoms for both patients and doctors. In case that the etiological agent is Candida albicans, effective antimycotic therapies are available; however, itching is often caused by aspecific allergic-irritative factors, which are difficult to be defined. In these cases, patients are invited to limit local irritative factors; nevertheless, this advice is not always taken and sometimes it turns out to be insufficient. Besides behavioral suggestions, a therapeutic support would be useful; medical doctors habitually prescribe local symptomatic treatments which, however, do not target numerous causes of irritative vulvovaginal symptomatology, though they are formulated for vulvovaginal application. If there is estrogenic deficit, the best therapeutic approach is based on topical estrogenic therapy, which is sometimes ineffective on vulvar symptoms. Frequently, it is necessary to choose a complementary therapeutic tool for vaginal application in order to alleviate itching, burning, erythema, dryness. The aim of this study was to evaluate the efficacy of an innovative anhydrous lipogel containing vitamin E and boswellic acids. Results of this study, performed on 34-58-year-old patients, confirmed the efficacy of the lipogel on irritative vulvovaginal symptoms. In postmenopausal women, the lipogel is a useful synergistic complement to topical hormonal therapy.
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Affiliation(s)
- L Del Pup
- Oncologia Ginecologica, Istituto Nazionale Tumori, Centro di Riferimento Oncologico. Aviano, Pordenone, Italia
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22
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Domino SE, Hurd EA, Thomsson KA, Karnak DM, Holmén Larsson JM, Thomsson E, Bäckström M, Hansson GC. Cervical mucins carry alpha(1,2)fucosylated glycans that partly protect from experimental vaginal candidiasis. Glycoconj J 2009; 26:1125-34. [PMID: 19326211 PMCID: PMC2794911 DOI: 10.1007/s10719-009-9234-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 03/01/2009] [Accepted: 03/11/2009] [Indexed: 10/21/2022]
Abstract
Cervical mucins are glycosylated proteins that form a protective cervical mucus. To understand the role of mucin glycans in Candida albicans infection, oligosaccharides from mouse cervical mucins were analyzed by liquid chromatography-mass spectrometry. Cervical mucins carry multiple alpha(1-2)fucosylated glycans, but alpha(1,2)fucosyltransferase Fut2-null mice are devoid of these epitopes. Epithelial cells in vaginal lavages from Fut2-null mice lacked Ulex europaeus agglutinin-1 (UEA-I) staining for alpha(1-2)fucosylated glycans. Hysterectomy to remove cervical mucus eliminated UEA-I and acid mucin staining in vaginal epithelial cells from wild type mice indicating the cervix as the source of UEA-I positive epithelial cells. To assess binding of alpha(1-2) fucosylated glycans on C. albicans infection, an in vitro adhesion assay was performed with vaginal epithelial cells from wild type and Fut2-null mice. Vaginal epithelial cells from Fut2-null mice were found to bind increased numbers of C. albicans compared to vaginal epithelial cells obtained from wild type mice. Hysterectomy lessened the difference between Fut2-null and wild type mice in binding of C. ablicans in vitro and susceptibility to experimental C. albicans vaginitis in vivo. We generated a recombinant fucosylated MUC1 glycanpolymer to test whether the relative protection of wild type mice compared to Fut2-null mice could be mimicked with exogenous mucin. While a small portion of the recombinant MUC1 epitopes displayed alpha(1-2)fucosylated glycans, the predominant epitopes were sialylated due to endogenous sialyltransferases in the cultured cells. Intravaginal instillation of recombinant MUC1 glycanpolymer partially reduced experimental yeast vaginitis suggesting that a large glycanpolymer, with different glycan epitopes, may affect fungal burden.
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Affiliation(s)
- Steven E Domino
- Department of Obstetrics and Gynecology, Cellular and Molecular Biology Program, University of Michigan Medical Center, Ann Arbor, MI, 48109, USA.
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Hogewoning CJA, Ottervanger HP, Adriaanse AH, Trum JW. [The practice guideline 'Vaginal discharge' (first revision) from the Dutch College of General Practitioners; a response from the perspective of gynaecology]. Ned Tijdschr Geneeskd 2007; 151:1330-2. [PMID: 17665623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The Dutch College of General Practitioners (NHG) revised their practice guideline on vaginal discharge. From a gynaecological point of view, relocation of cervix problems from this guideline to the NHG guideline 'The STD consultation' is not practical. Moreover, the role of simple, but effective diagnosis with a microscope in the primary-care setting cannot be overemphasized. The reluctance to oral treatment is rather inopportune, because once-only ingestion has the advantage of promoting compliance. As physical examination is not always necessary in a recurrent Candida infection, treatment performed by the patient with imidazole compounds is a possibility that does not always result in abuse or increased resistance.
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Affiliation(s)
- C J A Hogewoning
- Albert Schweitzer Ziekenhuis, afd. Gynaecologie, Postbus 444, 3300 AK Dordrecht.
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Boukes FS, Boeke AJP, Dekker JH, Wiersma T, Goudswaard AN. [Summary of the practice guideline 'Vaginal discharge' (first revision) from the Dutch College of General Practitioners]. Ned Tijdschr Geneeskd 2007; 151:1339-43. [PMID: 17665625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The 1996 practice guideline of the Dutch College of General Practitioners (NHG) on vaginal discharge has been updated. Most women who visit their doctor with complaints about vaginal discharge do not have an increased risk of a sexually-transmitted disease. Investigations into vaginal discharge comprise history taking, physical examination and microscopic analysis in the laboratory of the general practitioner. Additional investigation into Chlamydia, gonorrhoea and Trichomonas infection is only necessary if the patient history reveals an increased risk of a sexually-transmitted disease. A Candida infection or bacterial vaginosis should only be treated if the patient experiences bothersome complaints. Treatment of a Candida infection consists of a vaginally applied imidazole compound. Bacterial vaginosis can be treated with oral administration of metronidazole. Patients with vaginal fluor can be examined and, if necessary, treated by their general practitioner. Referral to a gynaecologist is rarely necessary.
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Affiliation(s)
- F S Boukes
- Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Wetenschapsbeleid, Postbus 3231, 3502 GE Utrecht.
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25
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Eekhof JAH. [The practice guideline 'Vaginal discharge' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice]. Ned Tijdschr Geneeskd 2007; 151:1327-9. [PMID: 17665622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The revised practice guideline by the Dutch College of General Practitioners (NHG) on vaginal discharge is intended to offer general practitioners a handle for management of vaginal complaints. Most general practitioners experience uncertainties in daily practice with respect to the diagnosis of vaginal discharge. In most cases history taking and physical examination fails to provide sufficient valuable information to arrive at a definite diagnosis. No further (microscopic) investigation is only permissible in a very obvious infection with Candida albicans. A recent onset of complaints of itching accompanied by white odourless discharge means a 70% chance of an infection with C. albicans. If the general practitioner also finds vulvar or vaginal inflammation and a nonhomogeneous fluor during examination the chance of an infection with C. albicans increases to 90%. In all other cases microscopic investigation is inevitable. This does not reflect an inadequacy of the NHG guideline but is a consequence of the limited diagnostic possibilities to arrive at a precise diagnosis.
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Affiliation(s)
- J A H Eekhof
- Leids Universitair Medisch Centrum, afd. Public Health en Eerstelijnsgeneeskunde, Postbus 9600, 2300 RC Leiden.
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Abstract
The model of vaginal candidiasis in Kunming mice was constructed in order to search for the optima construction conditions and provide an economic animal model of Candida albicans (C. albicans) vaginitis. Estrogen benzoate (E2) was given to mice at different concentrations ranging from 0.0 to 0.05 mg/mouse (4 levels) beginning 72 h prior to vaginal inoculation, then mice were inoculated intravaginally with various concentrations of stationary-phase C. albicans blastoconidia (ATCC90028) (5 levels) in 20 microL of phosphate-buffered saline (PBS) in each E2 level. General state, scores of genital pathology, the hyphae and vaginal fungal burden (CFU) in vaginal lavage fluid, the hydrops rate of uterus and vaginal tissues for pathological section in mice were observed and obtained at day 2, 4, 7, 14 and 21 after inoculation. The results showed the infection rate in mice was related to the dosage of E2 and concentration of C. albicans blastoconidia. Additionally there was better cross-effect between the two treated factors. The infection rate was about 80% on the day 4, and could reach 100% on the day 7 until the end of experiment after inoculated intravaginally in groups of E2I3, E2 0.025 mg/mouse injected hypodermically and inoculated intravaginally with 5 x 10(4) C. albicans blastoconidia, and large amount of hyphae and blastoconidia could be observe in superficial layer tissue and canal of vaginal by PAS. From the results in our experiment it was concluded that E2I3 was the optima construction condition in kunming mice.
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Affiliation(s)
- Zhuo Chen
- Department of Integrated Traditional Chinese Medicine and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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27
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Rahman D, Mistry M, Thavaraj S, Challacombe SJ, Naglik JR. Murine model of concurrent oral and vaginal Candida albicans colonization to study epithelial host-pathogen interactions. Microbes Infect 2007; 9:615-22. [PMID: 17383212 PMCID: PMC3242973 DOI: 10.1016/j.micinf.2007.01.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 01/16/2007] [Indexed: 10/23/2022]
Abstract
We report the creation of a new low-estrogen murine model of concurrent oral and vaginal C. albicans colonization that resembles human candidal carriage at both mucosal sites. Weekly estrogen administration of 5 microg intramuscular and subcutaneously was optimal for enhancement of oral colonization and was essential for vaginal colonization. In BALB/c mice, a number of C. albicans clinical isolates (n=3) colonized both oral and/or vaginal sites, but only strain 529L colonized 100% of mice persistently for over 5 weeks. Laboratory strains SC5314 and NCPF 3153 did not colonize the model; however, NCPF 3156 showed vaginal colonization up to week 5. Prior passaging through mice enhanced subsequent colonization of SC5314. Intranasal immunization with a C. albicans virulence antigen (secreted aspartyl proteinase 2) significantly reduced or abolished the fungal burden orally and vaginally by week 2 and 7. Our concurrent model of mucosal colonization reduces the numbers of experimental mice by half, can be used to assess potential vaccine candidates, and permits the detailed analysis of host-fungal interactions during the natural state of Candida colonization.
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De Bernardis F, Liu H, O'Mahony R, La Valle R, Bartollino S, Sandini S, Grant S, Brewis N, Tomlinson I, Basset RC, Holton J, Roitt IM, Cassone A. Human Domain Antibodies against Virulence Traits ofCandida albicansInhibit Fungus Adherence to Vaginal Epithelium and Protect against Experimental Vaginal Candidiasis. J Infect Dis 2007; 195:149-57. [PMID: 17152019 DOI: 10.1086/509891] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 08/17/2006] [Indexed: 11/03/2022] Open
Abstract
Antibody variable domains (domain antibodies [DAbs]) are genetically engineered antibody fragments that include individual heavy-chain (VH) or kappa-chain (Vkappa) variable domains and lack the Fc region. Human DAbs against the 65-kDa mannoprotein (MP65) or the secretory aspartyl proteinase (SAP)-2 of Candida albicans (monospecific DAbs) or against both fungal antigens (heterodimeric, bispecific DAbs) were generated from phage expression libraries. Both monospecific and bispecific DAbs inhibited fungus adherence to the epithelial cells of rat vagina and accelerated the clearance of vaginal infection with the fungus. When heterodimeric DAbs were used, the clearance of infection was at least equivalent to treatment with fluconazole. The in vivo protective effects of DAbs were demonstrated by both pre- and postchallenge schedules of DAb administration and with both fluconazole-susceptible and fluconazole-resistant strains of C. albicans. This is the first demonstration that human DAbs lacking the Fc constituent can efficiently control an infection and can act largely by inhibiting adherence.
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Affiliation(s)
- Flavia De Bernardis
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 00161 Rome, Italy
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Doyle TC, Nawotka KA, Kawahara CB, Francis KP, Contag PR. Visualizing fungal infections in living mice using bioluminescent pathogenic Candida albicans strains transformed with the firefly luciferase gene. Microb Pathog 2006; 40:82-90. [PMID: 16426810 DOI: 10.1016/j.micpath.2005.11.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Revised: 11/03/2005] [Accepted: 11/07/2005] [Indexed: 11/23/2022]
Abstract
Animal studies with Candida albicans have provided models for understanding fungal virulence and antifungal drug development. To non-invasively monitor long-term Candida murine infections, clinical isolates were stably transformed with a codon-optimized luciferase gene to constitutively express luciferase. Chronic systemic infections were established in mice with engineered strains, and bioluminescent signals were apparent from kidneys by non-invasive imaging using charged-coupled device cameras. These infections were established in immune-competent mice, and bioluminescence was detectable in animals that showed no physiological consequence of infection, as well as those visually succumbing to the disease. Similarly, bioluminescence was measured from the vaginal tissue of mice infected vaginally. Fungal loads determined by plating vaginal lavages showed a similar pattern to the bioluminescent signals measured, and fungal infection could be detected in animals for over 30 days post infection by both modalities. The effect of the antifungal drug miconazole was tested in this model, and clearance in animals was apparent by both direct imaging and fungal load determination. The use of bioluminescence to monitor these and other models of Candida infections will greatly speed up the analysis of drug development studies, both in ease of visualizing infections and decreasing numbers of animals required to run such studies.
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Affiliation(s)
- Timothy C Doyle
- Xenogen Corporation, 860 Atlantic Avenue, Alameda, CA 94501, USA.
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Pirotta M. Response to Dr Pakula (AFP September). Aust Fam Physician 2005; 34:807-8. [PMID: 16247882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Abstract
OBJECTIVE This study was undertaken to investigate whether amphotericin B vaginal suppositories would be effective in the treatment of non- albicans Candida vaginitis in women who failed conventional therapy. STUDY DESIGN Thirty-two patients were identified with non- albicans Candida vaginitis. These patients were treated with conventional antifungal agents. Ten patients had persistence of the non- albicans Candida infection after treatment. Amphotericin B 50-mg vaginal suppositories were given nightly for 14 days to this subgroup of treatment failures. RESULTS Of 10 women, 8 (80%) who were treated with amphotericin B vaginally initially showed no further infection. One of the treatment successes had 2 recurrences and responded to a second course of amphotericin B but failed a third course. If this patient is considered a treatment failure, then amphotericin B vaginal suppositories were successful in 70% of patients. The medication was well tolerated and local side effects were minimal. CONCLUSION Amphotericin B vaginal suppositories are a viable treatment option for refractory vaginitis caused by non- albicans Candida .
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Affiliation(s)
- Albert John Phillips
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, USA.
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Chami F, Chami N, Bennis S, Trouillas J, Remmal A. Evaluation of carvacrol and eugenol as prophylaxis and treatment of vaginal candidiasis in an immunosuppressed rat model. J Antimicrob Chemother 2004; 54:909-14. [PMID: 15456732 DOI: 10.1093/jac/dkh436] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Anticandidal activity of carvacrol and eugenol, the major phenolic components of oregano and clove essential oils, respectively, were tested in vivo. METHODS Efficacy evaluation of carvacrol and eugenol in the prophylaxis and treatment of experimental vaginal candidiasis was performed in immunosuppressed rats. The anticandidal activity was analysed by microbiological and histological techniques and was compared with that of nystatin. RESULTS Microbiologically, prophylactic treatment with carvacrol eradicated the vaginal fungal burden of infected rats, whereas eugenol reduced the number of colony counts of Candida albicans in vaginas of infected rats by 98.9% 10 days after inoculation. Therapeutic treatment for 7 consecutive days with carvacrol was able to eradicate the vaginal candidal burden in 7/9 of the infected rats and reduced the number of colony counts of C. albicans in vaginas of the two remaining rats by 98%. Treatment with eugenol completely cured 2/9 of the infected animals, but the 7/9 still infected showed an 84% reduction of colony counts of C. albicans in their vaginas. Histologically, in all treated rats, no Candida organisms were found in the lumina of the vagina; this was in contrast to control groups in which many yeasts, strongly stained with periodic acid-Schiff, were observed. The results obtained with nystatin used at 10-fold minimal inhibitory concentration confirm the validity of this model. CONCLUSIONS Carvacrol and eugenol could be considered as promising products in the treatment of vaginal candidiasis. This work is a preliminary contribution to the development of a new generation of efficient and natural antifungal agents for curative treatment and prophylaxis.
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Affiliation(s)
- F Chami
- Faculté des Sciences, Fès Laboratoire de Biotechnologie, BP 1796, Atlas FES, Morocco
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Malkawi SR, Abu Hazeem RM, Hajjat BM, Hajjiri FK. Evaluation of cervical smears at King Hussein Medical Centre, Jordan, over three and a half years. East Mediterr Health J 2004; 10:676-9. [PMID: 16335662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Cervical smears taken from women referred for a check-up or with vaginal itching/discharge over a period of 3.5 years were reviewed at the King Hussein Medical Centre, Jordan. All smears were fixed with 96% alcohol, stained with Papanicolaou stain and screened microscopically. Of the smears from 1176 women aged 18-70 years, 4.5% were classified as inadequate, 7.7% were normal and 79.9% showed non-specific inflammation. Abnormal vaginal flora was found in 4.8% of cases, Candida albicans in 1.2%, Trichomonas vaginalis in 0.9% and actinomycosis in 1 case. Dysphasic changes were rare: 9 cases (0.8%) were classified as atypical squamous cells of undetermined significance (ASCUS) and 2 cases (0.2%) were low-grade squamous intraepithelial lesion (LSIL). No cases of human papillomavirus infection (HPV) or cervical carcinoma were found.
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Affiliation(s)
- S R Malkawi
- Princess Iman Research and Laboratory Sciences Centre, King Hussein Medical Centre, Amman, Jordan
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Demirezen S, Beksaç MS. Relationship between the morphology of Candida cells and vaginal discharge. New Microbiol 2004; 27:173-6. [PMID: 15164628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The aim of this study was to detect whether there is a correlation between the dimorphic pattern of Candida cells and various types of vaginal discharge. For this purpose, 2861 Papanicolaoustained cervicovaginal smears were examined cytologically and 265 of 2861 (9.26%) were diagnosed as having Candida cells. The 88 of 295 (29.83%) were identified as having blastospores only, 135 of 295 (45.76%) as having "hyphae only", and 47 of 295 (15.93%) as having both blastospores and hyphae of candida cells. There was a significant correlation between the type of candida cells and vaginal discharge (p < 0.05). The white-cheesy type vaginal discharge was the most prominent symptom for the observation the "hyphae only" following "blastospores only" and both blastospores and hyphae of Candida cells. It was suggested that hyphael form of Candida cells is the most pathogenic pattern and white-cheesy vaginal discharge is a marker for the presence of hyphael form in the vaginal mucosa.
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Affiliation(s)
- S Demirezen
- Hacettepe University, Faculty of Science, Department of Biology, Beytepe, Ankara, Turkey
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Ben-Haroush A, Yogev Y, Kaplan B. The importance of diagnostic work-up in the management of candidal vulvovaginitis. A prospective study. CLIN EXP OBSTET GYN 2004; 31:113-6. [PMID: 15266763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To assess the accuracy of the diagnostic work-up in identifying vaginal candidal infection, and to determine the safety, efficacy and speed of action of clotrimazole vaginal tablets. PARTICIPANTS Two hundred and twenty-three patients with symptoms and signs of candidal infection, a presence of vaginal pH < or = 4.5 and positive 10% KOH examination. METHODS After vaginal culture was taken, the eligible patients were treated with clotrimazole 200 mg vaginal tabs (manufactured by Teva or Agis). RESULTS Cultures grew Candida albicans in 189 cases (85%), and Candida non-albicans in five (2.2%); 29 patients (13%) did not have any candidal infection. Of the 189 C. albicans-positive patients, 174 were reassessed for effects of clotrimazole treatment by self-reports and objective measures. Ninety-four percent of the patients reported improvement after treatment, rated moderate to high by 87%. The physician evaluation was similar: some improvement in 96%, and moderate or high improvement in 91%. At the second examination, 7.5% of the treated patients still had a positive culture for Candida albicans, and they remained positive on KOH microscopic examination, although vaginal pH was significantly higher. Maximal improvement was recorded three to four days after starting treatment. CONCLUSION It is important that the diagnostic work-up for suspected candidal infections consist of at least vaginal pH measurement and microscopy study with KOH. We encourage the use of vaginal cultures, especially in recurrent cases. Clotrimazole is a safe and effective treatment.
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Affiliation(s)
- A Ben-Haroush
- Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
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Abstract
MUC7 16-mer (residues 36-51 of human salivary mucin, MUC7) and histatin 5 possess potent in vitro antifungal activity. In the present study, we have evaluated the efficacy of these peptides in vivo using the experimental model of murine vulvo-vaginal candidiasis. The treatment groups included MUC7 16-mer, histatin 5, clotrimazole (all in pluronic F127 gel), and placebo (gel alone). Mice were treated intravaginally for 7 consecutive days. At the end of the treatment, anticandidal activities were assessed by colony counts and by histological examination. All groups except clotrimazole presented positive cultures; no statistically significant differences were found in fungal burden amongst placebo and any treatment group except clotrimazole. Histopathological findings confirmed the microbiological results; all groups with the exception of clotrimazole showed variable signs of infection.
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Affiliation(s)
- Giuseppe Intini
- Departments of Oral Biology and Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, The State University of New York, 109 Foster Hall, 3435 Main Street, Buffalo, NY 14214-3092, USA
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Friese K, Neumann G, Siebert J. Topical antiseptics as an alternative in the treatment of acute vulvovaginal candidosis. Arch Gynecol Obstet 2003; 268:194-7. [PMID: 12942250 DOI: 10.1007/s00404-002-0368-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2002] [Accepted: 07/09/2002] [Indexed: 11/25/2022]
Abstract
The aim of this prospective, multicenter, randomized, case-control study was to investigate the efficacy of a nonspecific mucosal antiseptic (octenidine dihydrochloride, phenoxyethanol) with proven antifungal effects, in patients with acute symptomatic vaginal candidosis, in comparison with a specific topical antifungal agent (clotrimazole), particularly in respect to non-Candida albicans yeasts. A total of 491 patients from 29 gynecological practices, who had new clinical vaginal mycosis, not treated with antifungal agents in the last 12 months, were included in the study. The diagnosis in each case was confirmed by microscopy or positive culture. The majority of the vaginal mycoses were infections with C. albicans (72%). In 28% of patients a non- Candida species (mainly C. glabrata) contributed to the infection. Except for vaginal discharge, the success of treatment was between 71% and 91% for both clinical and subjective parameters. The control preparation was significantly better than the treatment in the test group. Mycological cure rate on the basis of cultures was 78% in the test group and 87% in the control group. These results were also significantly different. The relatively high proportion of C. glabrata isolates in this study tended to be more successfully treated by the antiseptic (to 72%) than by the administration of clotrimazole (59%). Even though therapeutic success with clotrimazole was overall significantly better than with the test preparation, the success of treatment with the antiseptic used was within the range between 70% and 90% described for topical antifungal agents. Both the good efficacy of the topical antiseptic and the increased prevalence of non-Candida albicans species causing vaginal infections mean that the use of an antiseptic may be considered a suitable alternative therapeutic concept to an appropriate topical antifungal agent in the treatment of acute vaginal candidosis.
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Affiliation(s)
- K Friese
- Women's Hospital and Outpatient Department, University of Rostock, Doberanerstrasse 142, 18055 Rostock, Germany
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Schaller M, Bein M, Korting HC, Baur S, Hamm G, Monod M, Beinhauer S, Hube B. The secreted aspartyl proteinases Sap1 and Sap2 cause tissue damage in an in vitro model of vaginal candidiasis based on reconstituted human vaginal epithelium. Infect Immun 2003; 71:3227-34. [PMID: 12761103 PMCID: PMC155757 DOI: 10.1128/iai.71.6.3227-3234.2003] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Secreted aspartyl proteinases (Saps) contribute to the ability of Candida albicans to cause mucosal and disseminated infections. A model of vaginal candidiasis based on reconstituted human vaginal epithelium (RHVE) was used to study the expression and role of these C. albicans proteinases during infection and tissue damage of vaginal epithelium. Colonization of the RHVE by C. albicans SC5314 did not cause any visible epithelial damage 6 h after inoculation, although expression of SAP2, SAP9, and SAP10 was detected by reverse transcriptase PCR. However, significant epithelial damage was observed after 12 h, concomitant with the additional expression of SAP1, SAP4, and SAP5. Additional transcripts of SAP6 and SAP7 were detected at a later stage of the artificial infection (24 h). Similar SAP expression profiles were observed in three samples isolated from human patients with vaginal candidiasis. In experimental infection, secretion of antigens Sap1 to Sap6 by C. albicans was confirmed at the ultrastructural level by using polyclonal antisera raised against Sap1 to Sap6. Addition of the aspartyl proteinase inhibitors pepstatin A and the human immunodeficiency virus proteinase inhibitors ritonavir and amprenavir strongly reduced the tissue damage of the vaginal epithelia by C. albicans cells. Furthermore, SAP null mutants lacking either SAP1 or SAP2 had a drastically reduced potential to cause tissue damage even though SAP3, SAP4, and SAP7 were up-regulated in these mutants. In contrast the vaginopathic potential of mutants lacking SAP3 or SAP4 to SAP6 was not reduced compared to wild-type cells. These data provide further evidence for a crucial role of Sap1 and Sap2 in C. albicans vaginal infections.
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Affiliation(s)
- Martin Schaller
- Department of Dermatology and Allergology, University of Munich, Germany.
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Duerr A, Heilig CM, Meikle SF, Cu-Uvin S, Klein RS, Rompalo A, Sobel JD. Incident and persistent vulvovaginal candidiasis among human immunodeficiency virus-infected women: Risk factors and severity. Obstet Gynecol 2003; 101:548-56. [PMID: 12636961 DOI: 10.1016/s0029-7844(02)02729-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine risk factors for vulvovaginal candidiasis among women with or at risk for human immunodeficiency virus (HIV) infection. METHODS Data were from 856 HIV-infected women and 421 at-risk uninfected women observed semiannually at four study sites from April 1993 through February 1999. At enrollment women were 15-55 years old and had no acquired immunodeficiency syndrome-defining conditions. Three definitions for vulvovaginal candidiasis of differing severity were constructed using data from vaginal Candida culture and Gram stains scored for yeast and three signs on pelvic examination (vulvovaginal edema, erythema, or discharge): 1) culture or Gram stain positivity plus at least one clinical sign, 2) culture or Gram stain positivity plus at least two clinical signs, and 3) visible yeast on Gram stain plus at least one clinical sign. RESULTS The prevalence and cumulative incidence of each definition of vulvovaginal candidiasis were greater among HIV-infected women than among women not infected with HIV (P <.01 for all comparisons). Stratified by status at the preceding visit, vulvovaginal candidiasis was most likely among women with prior vulvovaginal candidiasis, least likely among women without earlier Candida colonization, and intermediately likely among women with preceding subclinical Candida colonization. Among HIV-infected women, lower CD4 count and higher HIV viral load were associated with vulvovaginal candidiasis. Several other factors were independently associated with vulvovaginal candidiasis, with strong associations for diabetes mellitus and pregnancy in particular. Vulvovaginal candidiasis was not more severe among HIV-infected women. CONCLUSION Vulvovaginal candidiasis occurred with higher incidence and greater persistence, but not greater severity, among HIV-infected women.
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Affiliation(s)
- Ann Duerr
- National Center for Chronic Disease Prevention & Health Promotion, Division of Reproductive Health-HIV Section, Centers for Disease Control and Prevention, Mailstop K-34, 4770 Buford Highway NE, Atlanta, GA 30341-3717, USA.
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Ashman RB, Papadimitriou JM, Fulurija A, Drysdale KE, Farah CS, Naidoo O, Gotjamanos T. Role of complement C5 and T lymphocytes in pathogenesis of disseminated and mucosal candidiasis in susceptible DBA/2 mice. Microb Pathog 2003; 34:103-13. [PMID: 12623278 DOI: 10.1016/s0882-4010(02)00211-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aims of the study were to compare the pathogenesis of Candida albicans infection in various organs and anatomical regions of C5-deficient (DBA/2) and C5-sufficient (BALB/c) mice, and to evaluate the importance of complement C5 and T lymphocytes as factors that determine host susceptibility or resistance. The kidneys of DBA/2 mice showed higher colonisation and more severe tissue damage than those of BALB/c, but infection at other sites, including oral and vaginal mucosa, was generally similar in the two strains. Passive transfer of C5-sufficient serum into DBA/2 mice decreased the fungal burden in the kidney, and prolonged survival of the reconstituted animals. Depletion of CD4(+) and/or CD8(+) cells did not exacerbate either systemic or mucosal infection when compared to controls, and passive transfer of splenocytes from infected donors caused only a small and transient reduction in numbers of yeasts recovered from the kidney of sub-lethally infected recipients. It is concluded that the acute susceptibility of the kidneys in this mouse strain is due to C5 deficiency expressed on a susceptible genetic background. T lymphocytes, however, appear to have minimal influence on recovery from systemic infection with this isolate of C. albicans.
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Affiliation(s)
- Robert B Ashman
- School of Dentistry, Oral Biology and Pathology, University of Queensland, Brisbane, Qld 4072, Australia.
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Abstract
This article examines the ecology and epidemiology of gastrointestinal candidiasis, esophageal candidiasis, chronic mucocutaneous candidiasis, urinary tract candidiasis, and vulvovaginal candidiasis. Such issues as pathogenesis and host defenses, clinical manifestations, diagnosis, and treatment are discussed.
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Affiliation(s)
- Jose A Vazquez
- Division of Infectious Diseases, School of Medicine, Wayne State University, 3990 John R, 4 Brush Center, Detroit, MI 48201, USA
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Novikova N, Mårdh PA. Characterization of women with a history of recurrent vulvovaginal candidosis. Acta Obstet Gynecol Scand 2002; 81:1047-52. [PMID: 12421173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
BACKGROUND To characterize history, signs, and symptoms in women with a history of recurrent vulvovaginal candidosis (RVVC) and who had consulted with symptoms generally associated with the condition. METHODS Eighty-three women with a history consistent with RVVC were interviewed regarding 32 parameters and 10 signs found at the clinical examination were noted. Candida cultures were made from the introitus and the posterior vaginal fornix. RESULTS Only in a few of the 43 women with and the 40 without a positive yeast culture could any of the many etiological factors that have been associated with RVVC be traced. Only two factors differed between the groups, namely yogurt intake, which was reported by 28 (68%) and 38 (95%) women in these groups, respectively. Vaginal douching was performed by 10 (23%) women in the Candida-positive group and by 17 (42%) women in the Candida-negative group. Pruritus and burning occurred in 31 (72%) and 22 (51%) of culture-positive patients, which was less frequent than in the culture-negative group, i.e. reported by 19 (47%) and 9 (22%) patients, respectively (p = 0.022 and p = 0.007). Edema (p = 0.026) of the vulva as well as erythema (p = 0.019) and edema (p = 0.008) of the vaginal mucosa, caseous discharge (p = 0.016), were found more often in the Candida culture-positive cases. CONCLUSIONS History and results of clinical examination of patients with RVVC are not enough to distinguish those who are culture-positive from those who are culture-negative for Candida from the genital tract.
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Affiliation(s)
- Natalia Novikova
- Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden
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Abstract
OBJECTIVE The purpose of this study was to determine whether nondiabetic women with recurrent vaginal candidiasis have an impaired glucose metabolism. STUDY DESIGN A case-control study of 62 otherwise healthy women who were attending a vaginitis clinic > or =3 times a year for symptoms of Candida vaginitis, positive microscopy, and at least one positive Candida culture and of 32 Candida-negative control subjects, all of whom were undergoing standardized oral glucose tolerance testing. RESULTS Women with recurrent bacterial vaginal infections did not differ from women without infections, so both groups comprised the control group. Women with recurrent vaginal candidiasis had a greater mean body mass index than the control subjects (23.5 vs 21.4, P =.001). They had no more incidences of overt or preclinical diabetes mellitus than the control subjects (6/62 vs 0/32 incidents), but a greater proportion of them had at least one glucose concentration above the 95th percentile (36% vs 12%, P =.016). Glucose concentrations were higher in recurrent vaginal candidiasis cases than in control subjects at 0 (89 vs 85 mg/dL,P =.049), 30 (139 vs 126 mg/dL, P =.05), and 60 minutes (123 vs 102 mg/dL, P =.009) after the intake of 75 g of glucose. Fasting concentration of glycosylated hemoglobin was 25% higher in women with recurrent vaginal candidiasis (5 vs 4 g/dL, P =.0006), even after correction for body mass index. Compared with control subjects, ingestion of 75 g of glucose led to a 15% increase of serum glucose levels in women with recurrent vaginal candidiasis (P =.01). As expected, most of these differences were largely mediated by an increased body mass index. CONCLUSION The tolerance to glucose in nondiabetic women with recurrent vaginal candidiasis is discretely impaired. Glucose tolerance testing is of value in women with recurrent vaginal candidiasis, but the interpretation of the obtained values should not be limited to the diagnosis of preclinical diabetes mellitus.
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Affiliation(s)
- Gilbert G G Donders
- Department of Obstetrics and Gynecology, General Hospital Heilig Hart Tienen, Tienen, Belgium.
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Abstract
Clinical and microbiologic examinations are not always sufficient for a correct and specific diagnosis of diseases of the vulva. In the case of an unusual clinical presentation or an unusual course of the disease, a histopathologic examination is warranted. Importance, technique, and limitations of biopsies of the vulva are illustrated on the basis of three case reports.
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Affiliation(s)
- W Weyers
- Zentrum für Dermatopathologie, Freiburg.
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Santoni G, Boccanera M, Adriani D, Lucciarini R, Amantini C, Morrone S, Cassone A, De Bernardis F. Immune cell-mediated protection against vaginal candidiasis: evidence for a major role of vaginal CD4(+) T cells and possible participation of other local lymphocyte effectors. Infect Immun 2002; 70:4791-7. [PMID: 12183521 PMCID: PMC128254 DOI: 10.1128/iai.70.9.4791-4797.2002] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The protective roles of different lymphocyte subsets were investigated in a rat vaginal candidiasis model by adoptive transfer of vaginal lymphocytes (VL) or sorted, purified CD3(+) T cells, CD4(+) or CD8(+) T cells, or CD3(-) CD5(+) B cells from the vaginas of naïve or immune rats following three rounds of Candida albicans infection. The adoptive transfer of total VL from nonimmune animals did not alter the course of vaginal candidiasis of the recipient rats. In contrast, the animals receiving total VL or CD3(+) T cells from immune rats showed a highly significant acceleration of fungus clearance compared with animals which received nonimmune VL. The animals with vaginal CD3(-) CD5(+) B cells transferred from immune rats also had fewer Candida CFU than the controls, but fungal clearance was significantly retarded with respect to the animals administered immune T cells. Sorted, purified CD4(+) and CD8(+) vaginal T cells from immune rats were also adoptively transferred to naïve animals. Although both populations were seen to accelerate the clearance of the fungus from the vagina, CD4(+) T cells were much more effective than CD8(+) T cells. Overall, there was no difference between the antifungal effects of immune vaginal CD4(+) T cells and those achievable with the transfer of whole, immune VL. Histological observations of the vaginal tissues of rats with adoptively transferred immune T cells demonstrated a remarkable accumulation of lymphocytes in the subepithelial lamina propria and also infiltrating the mucosal epithelium. These results strongly suggest that distinct vaginal lymphocyte subsets participate in the adaptive anti-Candida immunity at the vaginal level, with the vaginal CD4(+) T cells probably playing a major role.
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Affiliation(s)
- Giorgio Santoni
- Department of Pharmacological Sciences and Experimental Medicine, University of Camerino, Italy
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Mårdh PA, Rodrigues AG, Genç M, Novikova N, Martinez-de-Oliveira J, Guaschino S. Facts and myths on recurrent vulvovaginal candidosis--a review on epidemiology, clinical manifestations, diagnosis, pathogenesis and therapy. Int J STD AIDS 2002; 13:522-39. [PMID: 12194734 DOI: 10.1258/095646202760159639] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Approximately three-quarters of all women will experience an episode of vulvovaginal candidosis at least once in their life and 5-10% of them will have more than one attack. Women suffering from three to four attacks within 12 months will be diagnosed with recurrent vulvovaginal candidosis (RVVC). This review covers the large number of proposed aetiological factors for RVVC. The diagnosis of the condition made by conventional means by health providers is often false and is also often misdiagnosed by the affected woman herself. The review covers various methods of diagnosing RVVC and the current knowledge on potential pathogenetic mechanisms proposed for genital candida infections. Treatment of RVVC, including local and systemic antimicrobial therapy and behaviour modification to decrease the risk of recurrences, are discussed. Recent knowledge on drug resistance in candida is also included.
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Abstract
This study was undertaken to determine the value of stained smears from the vaginal introitus and the posterior vaginal fornix for detection of candida morphotypes in the diagnosis of recurrent vulvovaginal candidosis (RVVC) in cases with an assumed novel attack of the condition, and to compare the value of microscopy of such smears in relation to candida culture, vaginal pH-determinations and leucocyte esterase tests (LE). One hundred and thirteen women with a history and a current assumed attack of RVVC were studied by means of culture of samples from the vaginal introitus and posterior vaginal fornix on Sabouraud and CHROMagar. Microscopy of methylene blue- and Gram-stained smears from these sites was performed. The pH of vaginal secretion and the LE activity in vaginal flushing fluid was measured. Candida morphotypes were found significantly more often in the smears from candida culture-positive than culture-negative women. There was no difference in this respect between the findings in the methylene blue- and Gram-stained smears. Differences were found in candida morphotypes among Candida albicans and non-albicans-positive cases, as blastoconidia were detected only in the latter cases. The leukocyte esterase activity score was higher in the candida-positive than in candida-negative cases. The study showed that microscopy of fixed, stained genital smears can play a role in attempts to distinguish cases infected and not infected by candida among patients consulting with an assumed novel attack of RVVC. Study of methylene blue-stained smears is recommended as they represent an easier means than Gram-stained smears to diagnose genital candida infections in assumed RVVC cases.
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Affiliation(s)
- Natalia Novikova
- Department of Obstetrics and Gynecology, National Medical University, Kiev, Ukraine
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Hamad M, Abu-Elteen KH, Ghaleb M. Persistent colonization and transient suppression of DTH responses in an estrogen-dependent vaginal candidosis murine model. New Microbiol 2002; 25:65-73. [PMID: 11837393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Recurrence of vaginal candidosis in women of childbearing age has been attributed to several predisposing factors including the presence of significant amounts of estrogen in the reproductive tract. In this study, the effect of estrogen on the level of C. albicans colonization, persistence of infection and suppression of DTH responses was investigated in an estrogen-dependent vaginal candidosis murine model. Mice were first injected subcutaneously with 0.5 mg of estradiol valerate 72 hours prior to C. albicans intravaginal inoculation and at weekly intervals thereafter for a period of up to 4 weeks; the inoculum consisted of 2 x 10(7) stationary-phase C. albicans blastoconidia in a volume of 20 microl. C. albicans colonization was evaluated in the spleen, liver, kidney, small intestine and reproductive tract of estrogen-treated and control mice 72 hours following inoculation, DTH responses were evaluated 2 and 5 weeks following primary inoculation and persistence of infection was evaluated at days 2, 3, 4, 8, 12, 19 and 26 post inoculation. Estrogen-treated mice exhibited higher levels of C. albicans colonization compared with control mice; this was most evident in the small intestine and reproductive tract. Estrogen treatment resulted in pronounced suppression of C. albicans-specific DTH responses; in that average footpad swelling was 4.7 mm in untreated mice compared with 2.3 mm in estrogen-treated mice. Long-term estrogen treatment resulted in the persistence of infection; in contrast, C. albicans infection resolved by day 8 post inoculation in untreated mice. DTH responses assayed 5 weeks post primary inoculation in treated mice were on average 4.1 mm, this was similar to that observed in untreated mice tested for DTH response 2 and 5 weeks post primary inoculation. These results suggest that, on the one hand, estrogen has an enhancing effect on C. albicans colonization and persistence of infection. On the other, estrogen seems to suppress DTH responses within the first 2 weeks post infection; persistence of infection under the influence of estrogen, however, seems to coexist with detectable systemic cell-mediated immunity.
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Affiliation(s)
- M Hamad
- Department of Biological Sciences, Hashemite University, Jordan
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Martinez A, Ferrer S, Santos I, Jimenez E, Sparrowe J, Regadera J, De Las Heras FG, Gargallo-Viola D. Antifungal activities of two new azasordarins, GW471552 and GW471558, in experimental models of oral and vulvovaginal candidiasis in immunosuppressed rats. Antimicrob Agents Chemother 2001; 45:3304-9. [PMID: 11709301 PMCID: PMC90830 DOI: 10.1128/aac.45.12.3304-3309.2001] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sordarins constitute a new class of antifungal agents with a novel mechanism of action involving the selective inhibition of fungal protein synthesis. A further evolution of this class of antifungals has led to a new family of sordarin derivatives called azasordarins. The therapeutic efficacies of two new azasordarins, GW471552 and GW471558, were studied in experimental models of oral and vulvovaginal candidiasis in immunosuppressed rats. In all cases rats were immunosuppressed with dexamethasone in the drinking water. Oral candidiasis was established by inoculating 0.1 ml of a yeast suspension containing 5 x 10(8) cells of Candida albicans 4711E with a cotton swab on three alternate days. Vulvovaginal candidiasis was established in ovariectomized and estrus-induced rats by intravaginal inoculation of 10(7) CFU of C. albicans 4711E in 0.1 ml of saline. GW471552 and GW471558 were administered at 1, 5, and 10 mg/kg of body weight via the subcutaneous route. In oral candidiasis, azasordarins were administered each 8 h for 7 consecutive days, while in vaginal candidiasis the compounds were given each 4 h for 3 consecutive days. Antifungal activity of azasordarins was assessed by colony counts and by histological examination 1 day after treatment. In the oral infection model, GW471552 and GW471558 administered at 5 mg/kg significantly reduced (P < 0.05) the number of CFU of C. albicans compared with untreated controls. In addition, GW471552 and GW471558 given at 10 mg/kg eradicated C. albicans from the oral cavities of 100% of infected animals. Against vulvovaginal infection, both compounds showed significant therapeutic efficacy. GW471552 was able to eradicate the vaginal fungal burden at a dose of 10 mg/kg, and it significantly reduced the number of CFU of C. albicans in vaginas of rats treated with a dose of 5 mg/kg (P < 0.05). GW471558 showed greater efficacy, eradicating the fungal burden of 100% of infected rats at a dose of 5 mg/kg and significantly reducing (P < 0.05) the C. albicans vaginal counts even at a dose of 1 mg/kg. In both therapeutic efficacy studies, the histological findings confirmed the microbiological results. The experimental results presented show that the tested azasordarins are effective against oral and vulvovaginal candidiasis in immunosuppressed rats and could be promising antifungal agents for use in humans.
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Abstract
Our aim was to relate vaginal candidiasis to vaginal oestrogenisation. First, the incidence was determined (subjected to chi-square analysis) of vaginal Candida albicans infection in 339 consecutive dermogynaecology clinic patients aged 55 years and over, of whom 142 were using and 197 were not using oestrogen. Second, the ability of Candida species to utilise glycogen as a sole nutrient source was studied by performing assimilation tests using yeast nitrogen broth as a basal medium. infection on initial presentation compared with 4% in the cohort not using oestrogen (p < 0.001). All 34 isolates of C. albicans assimilated glycogen. Twenty-six non-albicans species of Candida tested did not assimilate glycogen. In this study of postmenopausal women, there was a highly significant relationship between the usage of oestrogen and the occurrence of C. albicans infection. The production of glycogen by oestrogen stimulated epithelial maturation provides an attractive substrate for C. albicans.
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Affiliation(s)
- G J Dennerstein
- Dermogynaecology Clinic, Mercy Hospitalfor Women, East Melbourne, Victoria, Australia
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