Prevalence of Candida albicans and non-albicans isolates from vaginal secretions: comparative evaluation of colonization, vaginal candidiasis and recurrent vaginal candidiasis in diabetic and non-diabetic women

Abstract

CONTEXT AND OBJECTIVE: Vulvovaginal candidiasis (VVC) is caused by abnormal growth of yeast-like fungi on the female genital tract mucosa. Patients with diabetes mellitus (DM) are more susceptible to fungal infections, including those caused by species of Candida. The present study investigated the frequency of total isolation of vaginal Candida spp., and its different clinical profiles -colonization, VVC and recurrent VVC (RVVC) -in women with DM type 2, compared with non-diabetic women. The cure rate using fluconazole treatment was also evaluated. DESIGN AND SETTING: Cross-sectional study conducted in the public healthcare system of Maringá, Paraná, Brazil. METHODS:The study involved 717 women aged 17-74 years, of whom 48 (6.7%) had DM type 2 (mean age: 53.7 years), regardless of signs and symptoms of VVC. The yeasts were isolated and identified using classical phenotypic methods. RESULTS:In the non-diabetic group (controls), total vaginal yeast isolation occurred in 79 (11.8%) women, and in the diabetic group in 9 (18.8%) (P = 0.000). The diabetic group showed more symptomatic (VVC + RVVC = 66.66%) than colonized (33.33%) women, and showed significantly more colonization, VVC and RVVC than seen among the controls. The mean cure rate using fluconazole was 75.0% in the diabetic group and 86.7% in the control group (P = 0.51). CONCLUSION: We found that DM type 2 in Brazilian women was associated with yeast colonization, VVC and RVVC, and similar isolation rates for C. albicans and non-albicans species. Good cure rates were obtained using fluconazole in both groups. RESUMO

Prevalence of Candida spp. in cervical-vaginal samples and the in vitro susceptibility of isolates

“…We detected the yeast in 27% of the study population, corresponding to a prevalence of approximately 13% both for colonization and for vulvovaginal candidiasis. Similar and lower rates of fungal isolation in women with and without vulvovaginitis have been described in other studies of the southern region: 11 and 24.7% in patients in the state of Paraná,12, 13, 14, 15 23.8% in patients in the state of Santa Catarina 12 and 18.2% in the city of Santo Ângelo-RS, 16 the latter being the only study held in Rio Grande do Sul. These differences in the isolation of Candida spp.…”

“…In this study, C. albicans was predominant, accounting for over 60% of the isolates both in colonized patients and in those with VVC. In fact, this species is the most pathogenic of the gender, being related to most cases of VVC described, and generally represents more than half of the isolates identified in other studies 7, 15, 16, 22. Ferraza and co-workers 12 described the identification of this species in Santa Catarina in 100% and 72% of isolates from the asymptomatic and symptomatic patients, respectively, and in 66.7% of patients with VVC in state of Paraná.…”

“…Among these, C. glabrata , described as the second most important species in cases of VVC due to its frequency10, 12, 15, 18, 23 and greater resistance to antifungals10, 22, 24 was found in 8.6% of symptomatic patients and in 14.3% of colonized patients in our study, which highlights the importance of laboratory tests for correct identification of the etiologic agent, although the clinical diagnosis of the disease is easily performed and commonly applied 2, 25…”

Perfil do conhecimento de mulheres quanto aos fatores predisponentes ao desenvolvimento da candidíase vulvovaginal

“…Outros estudiosos abordam o DM como fator predisponente para aquisição de CVV (GUNTHER et al, 2014). Sendo assim, se as causas e as consequências são conhecidas, a prevenção se torna eficaz e satisfatória.…”

Mutations in the Flo8 transcription factor contribute to virulence and phenotypic traits in Candida albicans strains

“…Alves et al (2014) demonstrated that progesterone might have a major influence on C. albicans pathogenicity on vaginal epithelial cells, which may partly explain the changes in susceptibility of women to vulvovaginal candidiasis (VVC) at different stages of the menstrual cycle. Gunther et al (2014) reported that diabetes mellitus type 2 was associated with yeast colonization, VVC and recurrent VVC in Brazilian women.…”