Citation Information :
Mariyah S, Iyer RN, Jangam RR, Kesireddy S. Vulvovaginal candidiasis: Clinical profile, species distribution and antifungal susceptibility pattern. 2022; 24 (2):71-75.
INTRODUCTION: Vulvovaginal candidiasis (VVC) is a common problem seen in women and 70%–75% of women experience VVC at least once in their lifetime. The relative incidence of vaginitis caused by non-albicans Candida (NAC) species is increasing which poses a problem as NAC is less susceptible to fluconazole which is commonly used for the treatment of VVC. In this study, we determined the species distribution of Candida isolates causing VVC and the antifungal susceptibility pattern of these isolates to fluconazole.
MATERIALS AND METHODS: A prospective study was done in a tertiary care hospital in Hyderabad, South India (August 2019–December 2020), on 500 women with suggestive clinical features and culture-confirmed VVC. Five hundred Candida strains isolated from the vaginal swab of these women were speciated and fluconazole antifungal susceptibility testing (AFST) was done by broth microdilution technique (CLSI guidelines) for 103 isolates. The following fluconazole concentrations were tested: 0.125 μg/ml, 0.25 μg/ml, 0.5 μg/ml, 1 μg/ml, 2 μg/ml, 4 μg/ml, 8 μg/ml, 16 μg/ml, 32 μg/ml and 64 μg/ml which encompassed the clinical breakpoint concentrations and the expected results for the quality control strains.
RESULTS: The majority of the women (93%) with VVC were in the reproductive age group (21–40 years). The most common presenting symptoms were vaginal discharge (66.4%) and pruritus (26.6%). The most common predisposing factor for VVC was pregnancy (44.8%). Candida albicans (62.8%) was the most common species isolated, followed by Candida glabrata (27.2%). Overall fluconazole susceptibility was 57%. About 72.2% of C. albicans were fluconazole susceptible.
CONCLUSION: VVC has a wide clinical presentation with non-specific signs and symptoms. Diagnosis based only on signs and symptoms leads to over treatment. Thus, culture confirmation is crucial for the accurate diagnosis and to detect VVC caused by NAC which is less susceptible to fluconazole. Fluconazole AFST on these isolates would help in developing local antibiograms and to monitor resistance trends.
Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2016;214:15-21.
British Association for Sexual Health and HIV (BASHH). British Association for Sexual Health and HIV National Guideline for the Management of Vulvovaginal Candidiasis. British Association for Sexual Health and HIV; 2019. Available from: www.bashhguidelines.org/media/1223/vvc-2019.pdf. [Last accessed on 2022 Oct 09].
Ngouana TK, Toghueo RM, Kenfack IF, Lachaud L, Nana AK, Tadjou L, et al. Epidemiology and antifungal susceptibility testing of non-Albicans Candida species colonizing mucosae of HIV-infected patients in Yaoundé (Cameroon). J Mycol Med 2019;29:233-8.
Mandell GL, Bennett JE, Dolin R. Mandell, Douglas and Bennett's Principles and Practices of Infectious Disease Essentials. 7th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2009.
Chander J. Textbook of Medical Mycology. 4th ed. New Delhi, India: Jaypee Brothers Medical Publishers; 2018.
Clinical and Laboratory Standards Institute. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts. 4th ed. CLSI Standard M27. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
Clinical and Laboratory Standards Institute. Performance Standards for Antifungal Susceptibility Testing of Yeasts. 2nd ed. CLSI Standard M60. Wayne, PA: Clinical and Laboratory Standards Institute; 2020.
Clinical and Laboratory Standards Institute. Epidemiological Cutoff Values for Antifungal Susceptibility Testing. 3rd ed. CLSI Supplement M59. Wayne, PA: Clinical and Laboratory Standards Institute; 2020.
Dharmik PG, Gomashe AV, Upadhyay VG. Susceptibility pattern of various azoles against Candida species causing vulvovaginal candidiasis. J Obstet Gynaecol India 2013;63:135-7.
Rathod SD, Klausner JD, Krupp K, Reingold AL, Madhivanan P. Epidemiologic features of vulvovaginal candidiasis among reproductive-age women in India. Infect Dis Obstet Gynecol 2012;2012:859071.
Khan M, Ahmed J, Gul A, Ikram A, Lalani FK. Antifungal susceptibility testing of vulvovaginal Candida species among women attending antenatal clinic in tertiary care hospitals of Peshawar. Infect Drug Resist 2018;11:447-56.
Ragunathan L, Poongothai GK, Sinazer AR, Kannaiyan K, Gurumurthy H, Jaget N, et al. Phenotypic characterization and antifungal susceptibility pattern to fluconazole in Candida Species isolated from vulvovaginal candidiasis in a tertiary care hospital. J Clin Diagn Res 2014;8:C01-4.
Dias LB, de Souza Carvalho Melhem M, Szeszs MW, Filho JM, Hahn RC. Vulvovaginal candidiasis in Mato Grosso, Brazil: Pregnancy status, causative species and drugs tests. Braz J Microbiol 2011;42:1300-7.
Rodrigues CF, Rodrigues ME, Henriques M. Candida sp. Infections in patients with diabetes mellitus. J Clin Med 2019;8:76.
Wang FJ, Zhang D, Liu ZH, Wu WX, Bai HH, Dong HY. Species distribution and in vitro antifungal susceptibility of vulvovaginal candida isolates in china. Chin Med J (Engl) 2016;129:1161-5.
Pfaller MA, Diekema DJ. Progress in antifungal susceptibility testing of Candida spp. by use of clinical and laboratory standards institute broth microdilution methods, 2010 to 2012. J Clin Microbiol 2012;50:2846-56.
