Recurrent Vulvovaginal Candidiasis: The Causative Agents, Clinical Signs and Susceptibility to Fluconazole in Gonabad City, Northeast Iran

Abstract

Background: Recurrent vulvovaginal candidiasis (RVVC) is the second most common cause of genital tract infection in females. Excessive use of fluconazole and other azoles is likely to cause the emergence of the resistant species of Candida. Objective : The purpose of this research was to identify Candida isolates from RVVC and the antifungal effect of fluconazole against them. Methods : In this study, 152 patients with vulvovaginal candidiasis were evaluated for the RVVC form. The Candida isolates were purified using CHROMagar Candida and identified based on the nuclear ribosomal internal transcribed spacer (ITS1-ITS2 rDNA) sequence analysis by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The antifungal susceptibility of C. albicans isolates against fluconazole was determined according to document M27-A3. Results: Out of 152 patients, 20 cases (13.2%) were identified as recurrent form. The frequencies of the Candida species among the patients with RVVC were C. albicans (n = 16, 80%), C. parapsilosis (n = 3, 15%) and C. tropicalis (n = 1, 5%). The most common clinical sign was vaginal discharge (60%). The mean minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of fluconazole against Candida isolates were 32 µg/mL and 64 µg/mL, respectively. Conclusion: C. albicans was the dominant cause of RVVC. The Candida isolates showed relatively high resistance to fluconazole in vitro. Vaginal discharge was the most common clinical sign among patients with RVVC.

Molecular Characterization and Antifungal Susceptibility of Candida Species Isolated From Vulvovaginitis in Jahrom City, South of Iran

“…Predisposing factors of the vulvovaginal candidiasis (VVC) consist of pregnancy, uncontrolled diabetes mellitus, antimicrobial therapy, the use of anti-estrogen pills, contraceptives, the use of corticosteroids, organ transplantation, cancer chemotherapy, tight clothing, higher sexual activity, and vaginal douching (3,4). Generally, Candida albicans (85% -95%) is the popular causative agent of VVC across the world (5)(6)(7). Other species that cause infections, including C. tropicalis, C. glabrata, C. krusei, C. parapsilosis, C. kefyr, and C. lusitaniae, have also been announced (8,9).…”

Green synthesis of selenium nanoparticles and evaluate their effect on the expression of ERG3, ERG11 and FKS1 antifungal resistance genes in Candida albicans and Candida glabrata

“…Candida spp. resulting in more than 3Á6 million U.S. healthcare visits each year and $3 billion estimated direct medical costs with increasing rate, are a widespread cause of lifethreatening systemic diseases and bloodstream infections in hospital patients and can be drug-resistant and challenging to treat (Lockhart et al 2017;Arastehfar et al 2019Arastehfar et al , 2021Minooeianhaghighi et al 2020). Antifungal resistance is a significant problem with alarming growth for treating Candida species (Hashemi et al 2019).…”

“…2019, 2021; Minooeianhaghighi et al . 2020). Antifungal resistance is a significant problem with alarming growth for treating Candida species (Hashemi et al .…”

Distinct host immune responses in recurrent vulvovaginal candidiasis and vulvovaginal candidiasis

“…Vulvovaginal candidiasis (VVC) is one of the most prevalent manifestations of superficial fungal infections, commonly presented by vaginal and vulvar pruritus, burning and irritation, dyspareunia, and abnormal vaginal discharges ( 1 – 3 ). VVC affects up to 75% of women of childbearing age at least once during their lifetime ( 4 , 5 ).…”