Candida glabrata

Abstract

Chronic recurrent vulvovaginal candidiasis caused by Candida glabrata is still rare in comparison to C. albicans infection, but therapy remains more difficult. Standard agents as fluconazole or itraconazole often fail, as well as the newer systemic triazoles like voriconazole or posaconazole. Micafungin is a new echinocandin drug with a wide antifungal spectrum including rare Candida species. No clinical trials with micafungin in chronic recurrent vulvovaginal candidiasis have been undertaken. We present the initial results employing a new therapy regimen consisting of micafungin in combination with topical ciclopirox olamine. All 14 patients with chronic recurrent vulvovaginal candidiasis caused by C. glabrata were treated successfully.

Vulvar Pruritus—Causes, Diagnosis and Therapeutic Approach

“…Compared to C. albicans-induced VVC, the clinical signs and symptoms of C. glabrata-induced VVC are generally milder. Other characteristic features of C. glabrata-induced VVC include absence of leukocytosis and pseudomycelium formation in the wet preparation as well as production of less vaginal discharge (30). The recommended treatment for C. glabrata-induced VVC is still an oral dose of 800 mg fluconazole for 2 to 3 weeks (level of evidence II; grade of recommendation: C) (25).…”

“…Today, fluconazole-sensitive strains are only occasionally encountered in clinical practice and the remaining strains cannot be treated with the triazole derivatives voriconazole or posaconazole either, because of additional cross-resistances. For this reason, it is necessary to use echinocandins for the systemic treatment of C. glabrata, a new class of antifungal agents which includes, besides caspofungin and anidulafungin, also micafungin, the currently preferred agent (30).…”

“…For this reason, micafungin, an expensive drug which is given intravenously, has not been approved for the treatment of vaginal mycosis, even though it has been shown to be highly effective against C. glabrata (36). First promising treatment concepts favor a systemic treatment approach consisting of a 15-day treatment with 150 mg micafungin intravenously/day in combination with ciclopirox olamine cream and nystatin vaginal ovules (30). Treatment strategies commonly recommended in other countries, such as boric acid vaginal suppositories (600 mg) or flucytosine 17%, are not available in Germany.…”

Vulvovaginal Candidosis (excluding chronic mucocutaneous candidosis). Guideline of the German Society of Gynecology and Obstetrics (AWMF Registry No. 015/072, S2k Level, December 2013)

“…He did begin to observe quickly emerging resistance as well as treatment failure with that regimen, however. He then described the successful treatment of 14 patients with C. glabrata infections of the vagina at several German universities and his own institute using micafungin, an echinochandin approved for the treatment of life-threatening mycoses, for example in hematooncology [144]. Such measures are only appropriate in exceptional cases involving significant illness as this is an "off-label", non-approved use.…”

“…Such measures are only appropriate in exceptional cases involving significant illness as this is an "off-label", non-approved use. Candida krusei vaginitis is resistent to fluconazole and flucytosin, however local clotrimazole, ciclopirox olamine [83,144] and (for example, in the USA) boric acid [129] can be used. Nystatin treatment is also prone to failure.…”