Azole Resistance and Detection of the ERG11 Gene in Clinical Candida albicans Isolated from Pregnant Women with Vulvovaginitis Attending Federal Medical Centre, Yenagoa, Nigeria

Abstract

Introduction: Candida albicans is one of the most important aetiological agents causing vaginal candidiasis in pregnant women. Most women will experience at least one episode during their reproductive years. Antifungal resistance is a particular problem with Candida infections. Some types of Candida are increasingly resistant to the first-line and second-line antifungal medications.
 Objective: To investigate the azole susceptibility of Candida albicans (C. albicans) from pregnant vulvovaginal candidiasis patients and to detect ERG11 gene in these azole resistance isolates.
 Methods: Forty-one clinical isolates of C. albicans were collected. Azole susceptibility was tested in vitro using microdilution techniques. The ERG11 genes of 27 isolates of C. albicans (All resistant to azoles) were amplified using PCR method.
 Results: Of the 67 isolates recovered, 41(61.19%) were C. albicans, of which 27 (65.85%) each, and 25(60.98%) were resistant to Fluconazole, Voriconazole, and Nystatin respectively. In total, ERG11 genes were detected among 24(88.89%) of 27 C. albicans azole resistant isolates.
 Conclusions: Twenty four ERG11 genes were detected among 27 azole resistant C. albicans isolates, which indicates a possible relation with the increase in resistance to azole drugs and the recurrence of vulvovaginal candidiasis.

First detection of mutated ERG11 gene in vulvovaginal Candida albicans isolates at Ouagadougou/Burkina Faso

“…In [29]. In China, studies on ERG11 gene mutations in C. albicans isolated in vulvovaginitis (p < 0.05) showed a prevalence of the detected gene of 8.4% [17] and 12.2% [30]; which is similar to ours.…”

“…In our study, the ERG11 gene was detected in C. albicans isolates resistant to azoles. In Nigeria, similar studies were carried out showing the presence of the ERG11 gene at 11.18% in strains of Candida resistant to Fluconazole isolated from vulvovaginitis (p > 0.05) and 88.89% in C. albicans strains all resistant to the azoles Fluconazole and Voriconazole isolated only in pregnant women [ 29 ]. In China, studies on ERG11 gene mutations in C. albicans isolated in vulvovaginitis (p < 0.05) showed a prevalence of the detected gene of 8.4% [ 17 ] and 12.2% [ 30 ]; which is similar to ours.…”

Using Single Multiplex PCR Reaction to Identify Candida Species in Vaginal isolates: Comparison between Phenotypic and Molecular Methods

“…in the female genital tract, which has been known as a challenge for gynecologists and infected patients for decades. Although C. albicans is known as the most common cause of VVC infection, other Candida species with high drug resistance, such as C. glabrata, have recently been replaced [7,12,29,30] . Studies have suggested that the diagnosis of vulvovaginitis caused by other Candida species may be very effective in selecting a successful treatment protocol [26,31] .…”

“…Nowadays, due to frequent treatment failures and recurrences, this infection has challenged the life quality of infected women as well as physicians [9] . Although C. albicans is known as the most common cause of VVC, there is a significant trend towards the emergence of other species such as C. glabrata, C. parapsilosis, and C. krusei, which show more resistance to the first-line antifungal treatments [10][11][12] . Hence, laboratory diagnosis seems necessary to identify Candida species involved in VVC.…”