Antifungal Resistant in Non-Albicans Candida Species are Emerging as a Threat to Antenatal Women with Vulvovaginal Candidiasis

Abstract

Vulvovaginal candidiasis (VVC) is caused by Candida species. It has been associated with impact on economic cost. Currently, Non-albicans Candida species are more resistant to azoles and get converted from harmless to pathogenic state due to several virulence factors. Monitoring of the antifungal susceptibility pattern is important to know the resistant pattern of Candida species. Thus the objective of this research was to the identification of Candida in species level and to evaluate the antifungal resistance pattern in Candida species isolated from the vaginal discharge of antenatal women with vulvovaginal candidiasis. This prospective study was done in SRM MCH & RC, Chennai, India, from March 2017 and December 2018. An aggregate of 342 vaginal swabs were gathered from antenatal women of symptomatic and asymptomatic VVC. Antifungal susceptibility test was done by the disk diffusion method as per the CLSI guidelines. A total of 112 Candida species were isolated from 342 high vaginal swabs. Out of 112 Candida isolates, 65 (58%) were Non-albicans Candida (NAC) and 47 (42%) were C. albicans. In this study, 103/112(91.6%) of Candida isolates had the highest sensitivity to voriconazole and 26/112(23.2%) of Candida isolates had the highest resistance to miconazole. NAC species are emerging as potential threats to cause infection and posing a therapeutic challenge. Early empirical antifungal therapy and further research to improve diagnostic, prevention and therapeutic strategies are necessary to reduce the considerable morbidity and mortality.

Is there a need to review the syndromic case management of vaginal discharge due to candida in the Indian scenario?

“…Similar findings were reported in studies from India and Iran. 18,21 Our findings have shown that there is a need to change the content of the recommended Kit-2 in SCM of patients of vaginal discharge. We found voriconazole effective.…”

“…17 Investigators from Tamil Nadu have reported 22% resistance to ketoconazole in C. albicans and 30% in C. krusei, whereas, all the isolates of Candida species showed 22.3% resistance to ketoconazole from Tamil Nadu. 18 The U.S. Food and Drug Administration (FDA) in its communication of July 2013 has limited the usages of ketoconazole oral tablets as they can cause severe liver injuries, adrenal gland problems and harmful drug interactions with other medications and therefore it should not be a first-line treatment for any fungal infection. However, the topical formulations of the drug have not been associated with such side effects.…”

Screening of C. auris among Candida isolates from various tertiary care institutions in Lahore by VITEK 2 and real time PCR based molecular technique

“…The modified Kirby-Bauer disc diffusion method was used to test antifungal susceptibility. Mueller-Hinton Agar with 2% Glucose and 0.5 g/mL Methylene Blue Dye (GMB) Medium agar culture plate was uniformly seeded with the organism to be tested in this method [ 17 , 18 ]. All of the Candida species tested against commercially available antimicrobial disks (purchased and imported from Liofilchem, Italy) were used in this study.…”