Value of <i>Candida</i> Polymerase Chain Reaction andVaginal Cytokine Analysis for the DifferentialDiagnosis of Women with Recurrent Vulvovaginitis

Weissenbacher, Stephanie; Tolbert, V.; Giraldo, Paulo César; Linhares, Iara Moreno; Haas, A. R. C.; Weissenbacher, E. R.; Ledger, William

doi:10.1155/s1064744900000363

Cited by 6 publications

(9 citation statements)

References 12 publications

(8 reference statements)

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“…Concerning the cases of misdiagnosed fungal infections, which occurred more frequently than cases of misdiagnosed BV, our results are in accordance with the literature [ 2 , 22 ]. Because microscopic evaluation requires special diagnostic skills not available to all practitioners, misjudgement is common, therapy is frequently empirical and the relapse rate is high [ 20 ].…”

Section: Discussionsupporting

confidence: 92%

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Throwing the dice for the diagnosis of vaginal complaints?

Schwiertz¹,

Taras

Rusch³

et al. 2006

Ann Clin Microbiol Antimicrob

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BackroundVaginitis is among the most common conditions women are seeking medical care for. Although these infections can easily be treated, the relapse rate is high. This may be due to inadequate use of the diagnostic potential.MethodsWe evaluated the misjudgement rate of the aetiology of vaginal complaints. A total of 220 vaginal samples from women with a vaginal complaint were obtained and analysed for numbers of total lactobacilli, H2O2-producing lactobacilli, total aerobic cell counts and total anaerobic cell counts including bifidobacteria, Bacteroides spp., Prevotella spp. Additionally, the presence of Atopobium vaginae, Gardnerella vaginalis, Candida spp. and Trichomonas vaginalis was evaluated by DNA-hybridisation using the PCR and Affirm VPIII Microbial Identification Test, respectively.ResultsThe participating physicians diagnosed Bacterial vaginosis (BV) as origin of discomfort in 80 cases, candidiasis in 109 cases and mixed infections in 8 cases. However, a present BV, defined as lack of H2O2-lactobacilli, presence of marker organisms, such as G. vaginalis, Bacteroides spp. or Atopobium vaginae, and an elevated pH were identified in only 45 cases of the women examined. Candida spp. were detected in 46 cases. Interestingly, an elevated pH corresponded solely to the presence of Atopobium vaginae, which was detected in 11 cases.ConclusionErrors in the diagnosis of BV and candida vulvovaginitis (CV) were high. Interestingly, the cases of misjudgement of CV (77%) were more numerous than that of BV (61%). The use of Amsel criteria or microscopy did not reduce the number of misinterpretations. The study reveals that the misdiagnosis of vaginal complaints is rather high.

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Section: Discussionsupporting

confidence: 92%

“…A current CV should be diagnosed by performing saline microscopy in order to look for candidal buds or hyphae. Additionally, the diagnostic panel can comprise culturing, PCR or antibody detection [ 20 - 22 ].…”

Section: Backroundmentioning

confidence: 99%

Throwing the dice for the diagnosis of vaginal complaints?

Schwiertz¹,

Taras

Rusch³

et al. 2006

Ann Clin Microbiol Antimicrob

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“…[18][19][20] Polymerase chain reaction is currently of use only as a research tool. [21][22][23] Antifungal sensitivities There is no proved utility of antifungal sensitivity testing for complicated VVC 24 (evidence level III, recommendation grade B). It is possibly indicated for women with a chronic immunological abnormality 25 (evidence level III, recommendation grade B); or repeated isolation of a non-albicans yeast 26 27 (evidence level IV, recommendation grade C).…”

Section: Processing Of Samplesmentioning

confidence: 99%

Vulvovaginal candidiasis

White

Vanthuyne

2006

Sexually Transmitted Infections

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“…The presence of candida organisms in genital samples can only be demonstrated in up to half of symptomatic cases with a presumed current episode of RVVC 1± 8 . The introduction of polymerase chain reaction (PCR) tests, using candida-speci® c primers 5,9,10 has led to the detection of some candida-positive cases among women believed to suffer from RVVC, but who have been negative for such fungi in other types of diagnostic tests, e.g. cultures and microscopic investigations of wet and stained smears.…”

Section: Introductionmentioning

confidence: 99%

Detection of candida by polymerase chain reaction vs microscopy and culture in women diagnosed as recurrent vulvovaginal cases

et al. 2003

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The objectives were to compare the outcome of polymerase chain reaction (PCR), culture and microscopy of introital and vaginal samples for detection of candida in women with a history of recurrent vulvovaginal candidosis (RVVC). One hundred and three women with a history of RVVC, i.e. with at least four episodes of the condition in the previous year and who consulted with complaints consistent with a new episode, were studied. Introital and vaginal swabs were cultured on Sabouraud and CHROMagar. Isolated strains were identified on the chromogenic agar and by API 32C kits and by Vitek automatized identification system (BioMérieux, France). PCR for detection of Candida spp. was performed on vaginal lavage fluid. There was a complete agreement in the recovery rate when using the two agar media. However, complete concordance was not obtained between culture and PCR. In 32 (43.8%) of 73 women both PCR and culture were positive, and in 17 (23.3%) both were negative. In 15 (20.5%), only cultures proved positive, while in another 13 (17.8%) patients only the PCR was positive. Four of the PCR-negative became PCR-positive on retesting after dilution of the sample to try to reduce any potential putative PCR inhibitors. In the 47 PCR-positive women, 26 (55.3%) of the introital smears and 31 (65.9%) posterior vaginal smears showed candida morphotypes. In the 25 PCR-negative women, the corresponding figures were 9 (36.0%) and 17 (68.0%), respectively. The PCR test identified Candida albicans in 21 (87.5%) instances, but failed to do so in three (12.5%) cases in which the metabolic/assimilation tests were positive for this species. The corresponding figures for non-albicans Candida spp. were four (57%) and three (43%), respectively. The study of women with RVVC did not show any uniform agreement between the different diagnostic methods used to identify candida in genital samples or for speciation of yeast isolates. Thus reliance only on microscopy, culture or PCR may lead to inaccurate results.

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Value of Candida Polymerase Chain Reaction andVaginal Cytokine Analysis for the DifferentialDiagnosis of Women with Recurrent Vulvovaginitis

Abstract: Many women with recurrent vulvovaginitis are not infected with Candida. Testing for Candida should be required in this population. Treatment with only anti-Candida medication will clearly be inadequate for the majority of women with this condition.

Cited by 6 publications

References 12 publications

Throwing the dice for the diagnosis of vaginal complaints?

Throwing the dice for the diagnosis of vaginal complaints?

Vulvovaginal candidiasis

Detection of candida by polymerase chain reaction vs microscopy and culture in women diagnosed as recurrent vulvovaginal cases

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