Abstract
The aim of this study was to determine the frequency of various Candida species in cases of genitourinary candidiasis and pelvic inflammatory disease (PID) in Ghana. To achieve this, Candida isolates were recovered from high vaginal swabs of patients with vulvovaginal candidiasis (VVC), urine samples from patients with urinary tract infections (UTIs) and endocervical swabs from patients with PID, from three teaching hospitals in Ghana. The hospitals were located at Korle Bu, Komfo Anokye and Tamale. These isolates were identified to the species level on the basis of the color of the colonies that they formed on chromogenic medium. Candida albicans was the most common species in high vaginal swabs from patients present for the first time with VVC in each of the three locations, and was present in 53.4% of the total swabs. The other species that were present were Candida glabrata (21.6%), Candida parapsilosis (15.5%), Candida tropicalis (4.7%) and Candida krusei (4.7%). Only single species were found in these swabs. In patients with VVC for at least the third time, Chi square analysis indicated that the frequency of each of these species were not statistically different from those present for the first time, although 15% of the swabs from these patients contained more than one species. For all patients with VVC, no significant differences were observed in the frequencies of the species between the three locations. Similar distributions were found in swabs taken from patients with PID. Across the three locations however, there was a significant difference in the frequency of C. albicans, which was present in 68 and 69.6% of patients from Komfo Anokye and Tamale, but only 26.7% of patients from Korle Bu. Twenty one percent of swabs from patients with PID contained more than one species. Urine samples were also collected from two of the locations, Korle Bu and Tamale, in female patients with candiduria. In Korle Bu, C. glabrata was the most prominent species (37.8%) followed by C. albicans (22.4%), C. parapsilosis (21.7%), C. tropicalis (10.5%), C. krusei (7%) and Candida lusitaniae (0.7%). In Tamale, the species distribution was C. albicans (60.9%), C. glabrata (21.7%), C. parapsilosis (13%) and C. krusei (4.3%). Statistical analysis indicated a significant difference in the frequency of C. albicans between the two locations. Fourteen percent of the urine samples contained more than one species. Taken as a whole, these data highlight a relatively high prevalence of species other than C. albicans, in cases of genitourinary candidiasis and PID in Ghana. This is consistent with a trend towards the emergence of other Candida species that may be more resistant to the first line antifungal treatments. Key words: Genitourinary candidiasis, Candida albicans, Candida glabrata, Candida parapsilosis, Vulvovaginal candidiasis, Ghana.
Highlights
Candida infections of the genitourinary tract are of interest to clinicians as they can occur in both Immuno-compromisedand immunocompetent individuals
The data indicate that C. albicans is, in most instances, the most prevalent species in the cases of genitourinary candidiasis in the three locations that samples were taken from
It should be noted that other Candida species were responsible for a significant number of cases, in particular C. glabrata and C. parapsilosis
Summary
Candida infections of the genitourinary tract are of interest to clinicians as they can occur in both Immuno-compromisedand immunocompetent individuals. While C. albicans is the most frequently isolated species in VVC, it is becoming evident that other species of Candida may be important (Enwuru et al, 2008) This is troubling, given that these other species may have higher resistance levels to azole-based treatments, and as such may be more prevalent in those experiencing recurrent episodes of VVC (Achkar and Fries, 2010). C. tropicalis has been shown to be responsible for 18% of cases of VVC in Nigeria (Okungbowa et al, 2003) and C. parapsilosis for 10% of cases in India (Ahmad and Khan, 2009) These contrast with reported values of between 3 and 16% for C. glabrata, 1-2% for C. tropicalis and 1-4% for C. parapsilosis in other parts of the world (Achkar and Fries, 2010). It is thought that the prevalance of these non C. albicans species may be increasing over time (Chaim et al, 1997; Spinillo et al, 1997)
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