Vulvovaginal candidiasis and current perspectives: new risk factors and laboratory diagnosis by using MALDI TOF for identifying species in primary infection and recurrence

Abstract

Vulvovaginal candidiasis (VVC), considered the second cause of genital infection among women, has pathogenic mechanisms still to be elucidated and unknown risk factors. Prevalence studies with laboratory diagnosis (at first diagnosis and recurrence) are uncommon, especially using MALDI TOF, used in this clinical, epidemiological, and laboratory study for evaluating candidiasis, and identifying unknown risk factors. To obtain clinical and epidemiological data, patients were questioned, and there was material collection. Samples collected were identified by using phenotypic and presumptive methods and confirmed by MALDI TOF. This study analyzed 278 patients, divided into symptomatic (n = 173) and asymptomatic (n = 105) groups. Regarding the main candidiasis symptoms (discharge, itching, and burning), only 50.3% of patients described these concomitant symptoms, showing a positive predictive value of 67.8%. Regarding the risk factors investigated, there was a statistical correlation between candidiasis and dairy products, gut transit, contraceptive use, respiratory allergy, and panty liners, describing new risk factors related to intestinal and vaginal dysbiosis. After Candida species analysis and confirmation, the primary prevalence was 80.9% (Candida albicans), 15.2% (non-albicans), 1% (Rhodotorula mucilaginosa), and 1.9% (unidentified species). In recurrence, the prevalence was 66.7% (C. albicans) and 33.3% (non-albicans). The presence of symptoms has low positive predictive value for the diagnosis of candidiasis, even when considering the classic triad of symptoms. Laboratory identification of yeast species is essential for correct treatment, preventing the resistance to antifungals and the high recurrence. In addition, dairy products and bowel habits, both related to intestinal and vaginal dysbiosis, may be associated with VVC.

Increased vulvovaginal candidiasis incidence risk in various gestational ages at a private midwifery practice in Surabaya, Indonesia

“…Pereira et al found that 62.2% of women with candidiasis were symptomatic while 37.8% were asymptomatic. 10 Vaginal smear examination revealed that the most candida infections (13 patients or 52%) were experienced by pregnant women in the 3rd trimester of pregnancy. Among those in 2nd trimester of pregnancy, seven patients (28%) were positive for candidiasis, and the lowest candida infection was experienced by pregnant women during the first trimester of pregnancy (five patients or 20%).…”

Gebelerde Candida Vajinitinin Epidemiyolojisi

“…(33) benzer bir çalışmada, kromojenik agar ve MALDI-TOF MS yöntemi ile doğruladıkları vajina kökenli 79 C. albicans izolatından 75'inde germ-tüp oluşumu bildirmişlerdir. Çalışmamızda, referans yöntem olarak kullanılan MALDI-TOF MS, maya türlerinin identifikasyonu için yaygınlaşmaya başlayan bir yöntemdir ve %90'ın üzerinde özgüllüğe sahiptir (33) . Ayrıca, Erdem ve ark.…”

Infecciones De Transmisión Sexual

“…Generalmente las infecciones genitales trasmitidas por hongos no se consideran enfermedades de trasmisión sexual, sin embargo, pueden ocurrir con menor frecuencia, además, son condiciones que pueden aumentar morbilidad en personas con inapropiadas prácticas sexuales (50), dentro de las enfermedades producidas por hongos se incluyen la vulvovaginitis y la balanitis, que son causadas por el hongo cándida albicans, que forma parte de la microbiota vaginal normal en la mujer por lo que generalmente no se le considera como de trasmisión sexual en la mujer, mientras que, en los hombres sí se considera como una infección de transmisión sexual frecuente (50,51).…”