Prevalence of <i>Candida glabrata</i> and Its Response to Boric Acid Vaginal Suppositories in Comparison With Oral Fluconazole in Patients With Diabetes and Vulvovaginal Candidiasis

Ray, Debarti; Goswami, Ravinder; Banerjee, Uma; Dadhwal, Vatsla; Goswami, Deepti; Mandal, Piyali; Sreenivas, Vishnubhatla; Kochupillai, N.

doi:10.2337/dc06-1469

Cited by 92 publications

(75 citation statements)

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“…This increase in non-albicans species, specifically C. glabrata, is an important observation that was reported in smaller studies of the elderly (4). Similar increases in nonalbicans species have been reported for diabetic patients, in which C. glabrata was the primary species isolated (2,6,11). Understanding the changes that occur in patient populations which exhibit higher prevalences of non-albicans species is warranted (i.e., menopausal and postmenopausal women and diabetic patients).…”

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confidence: 67%

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Survey of Vaginal-Flora Candida Species Isolates from Women of Different Age Groups by Use of Species-Specific PCR Detection

et al. 2008

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A retrospective survey of 93,775 samples testing positive in Candida species-specific PCR tests performed on cervicovaginal swabs over a 4-year period demonstrated consistent yearly distributions of Candida albicans (89%), C. glabrata (7.9%), C. parapsilosis (1.7%), and C. tropicalis (1.4%). However, the species distributions among different age groups revealed increases in the percentages of non-albicans species with increases in age.Vulvovaginal candidiasis (VVC) is a common fungal infection that affects healthy women of all ages. At least 75% of women will develop one or more infections once during their lifetime, with 5 to 8% of those individuals developing recurrent infections (5, 7). Current literature examining the species distribution of Candida isolates involved in VVC is limited; however, several important observations have been made. For example, one study shows that Candida albicans accounts for 70 to 90% of all VVC cases, with a recent emergence of nonalbicans species (10). The rise in VVC infections, more specifically in those caused by non-albicans species, could be due to several factors, ranging from an increase in over-the-counter antifungal use to an increase in high-risk patient populations (i.e., diabetics and menopausal women). Candida glabrata is the primary non-albicans species emerging in VVC, accounting for up to 14% of infections in immune-competent women (9, 10).In addition to an increase in non-albicans species overall, it is becoming clear that certain patient populations may experience higher risks of infection from these non-albicans species, often leading to limited treatment options. Interestingly, in a few small studies, C. glabrata was found to be the primary species isolated from diabetic (61.3%) and elderly (51.2%) patients with VVC (2, 4, 6, 11). Often, these non-albicans species are associated with elevated MIC levels for the azoles, the most commonly prescribed class of antifungal drugs. It has been well documented that C. glabrata demonstrates both intrinsically low susceptibility to the azoles and the ability to develop frank resistance (8,12,13,14,15,16). Moreover, a recent increase in the trailing phenotype, with low-level resistance to the azoles, has been observed for the Candida tropicalis isolates (1, 3). This highlights the importance of identifying Candida species within clinical samples in order to provide physicians with information concerning the proper treatment for their patients.

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confidence: 67%

“…Interestingly, in a few small studies, C. glabrata was found to be the primary species isolated from diabetic (61.3%) and elderly (51.2%) patients with VVC (2,4,6,11). Often, these non-albicans species are associated with elevated MIC levels for the azoles, the most commonly prescribed class of antifungal drugs.…”

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confidence: 99%

Survey of Vaginal-Flora Candida Species Isolates from Women of Different Age Groups by Use of Species-Specific PCR Detection

et al. 2008

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“…Fluconazole and itroconazole do not usually provide good clinical results. Boric acid capsules of 600 mg during 2-3 weeks have been used successfully [29,67,68] . Voriconazole or other non-azole therapies like amphotericin B, nystatin, mepartrcine, flucytomycin, or caspofungin may have to be tried to eradicate the microorganism.…”

Section: Shift Towards Less-responsive Non-albicans Candida Strainsmentioning

confidence: 99%

Management of Recurrent Vulvo-Vaginal Candidosis as a Chronic Illness

Donders

Bellen²,

Mendling

2010

Gynecol Obstet Invest

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For sporadic acute Candida vaginitis, any oral or local antifungal therapy can be used. For women with recurrent vulvo-vaginal candidosis (RVC), on the other hand, such simple approaches are insufficient, regardless of the product chosen. Instead, RVC should be managed as any other chronic disease and requires long-term, prophylactic, suppressive antifungal treatment. A regimen using individualized, decreasing doses of oral fluconazole (the ReCiDiF regimen) was proven to be highly efficient and offered great comfort to the patients. During this regimen, it is crucial that patients are carefully examined by anamnestic, clinical, microscopic and culture-proven absence of Candida. If a relapse occurs, the medication is adjusted and efforts are taken to find a possible triggering factor for the reactivation of the infection. Care has to be taken not to accumulate ‘don’t do’s’, unless the efficiency of a measure has been proven, by trying to eliminate one risk factor at a time for 2 months. Known possible triggers to be kept in mind are (1) antibiotic use, (2) use of specific contraceptives, especially combined contraceptive pills, (3) disturbed glucose metabolism, (4) the use of personal hygienic products, and (5) tight clothing or plastic panty liners. In therapy-resistant cases, non-albicans infection must be ruled out, and alternative therapies should be tried. Boric acid is proven to be efficient in most of these resistant cases, but other non-azoles like amphotericin B, flucytosine, gentian violet, and even caspofungin may have to be tried. As a final remark it has to be said that many patients feel poorly understood and inefficiently managed by many care-givers, increasing their feelings of guilt and sexual inferiority. Therefore, attention has to be given to take the disease seriously, follow strict treatment regimens, and advise precisely and based on individual evidence concerning any possible risk factors for recurrence. In case of therapy-resistant vulvo-vaginitis, reconsider your diagnosis and/or consider referral to specialized therapists.

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“…Rapid identification is important for treating infections caused by Candida species especially vaginal infections that cause unbearable itching and yellow exudation of white clots (Fidel and Sobel, 1996). Rapid diagnosis by polymerase chain reaction (PCR) and random amplification polymorphism DNA (RAPD) assays facilitate patients' treatment with vaginal antifungal antibiotics (Jordan and Durso, 1996;Ray et al, 2007). The simple PCR detects genetic variation but sometimes not clear enough for typing all Candida spp.…”

Section: Introductionmentioning

confidence: 99%

Molecular diagnosis of vaginal candidiasis by polymerase chain reaction (PCR) and random amplification polymorphism DNA (RAPD-PCR) in Babylon Province, Iraq

Zaidan¹,

Hadeel²

2014

Afr. J. Microbiol. Res.

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Most women suffer from severe vaginal candidiasis caused by Candida spp. Vaginal infections represent a second type of common disease. This infection occurs commonly in married and pregnant women and immunocompromised patients. This study aimed to survey, isolate and diagnose the vaginal Candida spp. using phenotypic and molecular assays. Candida isolates were recovered from patients attending main hospital in Babylon Province, Iraq from July 2011 to April 2012. Samples were subcultured on CHROMagar for preliminary identification of Candida isolates. Germ tube and chlamydospore formation were also performed to confirm identification. DNA of representative isolates was extracted for polymerase chain reaction (PCR) assays and analyzed using gel image patterns of bands for different isolates based on ultraviolet transilluminator band software. Results show that CHROMagar was a good tool for preliminary identification of Candida isolates. Molecular identification of PCR and random amplification polymorphism DNA (RAPD-PCR) assays were used to group the representative Candida isolates into different genetic patterns; phylogenetic tree was generated based on the information available in gel images. This study concludes that PCR and RAPD PCR assays confirmed more the diagnosis of Candida isolates than culture on CHROMagar medium and other phenotypic tests.

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Prevalence of Candida glabrata and Its Response to Boric Acid Vaginal Suppositories in Comparison With Oral Fluconazole in Patients With Diabetes and Vulvovaginal Candidiasis

Cited by 92 publications

References 28 publications

Survey of Vaginal-Flora Candida Species Isolates from Women of Different Age Groups by Use of Species-Specific PCR Detection

Survey of Vaginal-Flora Candida Species Isolates from Women of Different Age Groups by Use of Species-Specific PCR Detection

Management of Recurrent Vulvo-Vaginal Candidosis as a Chronic Illness

Molecular diagnosis of vaginal candidiasis by polymerase chain reaction (PCR) and random amplification polymorphism DNA (RAPD-PCR) in Babylon Province, Iraq

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