Abstract
Pregnancy represents a risk factor in the occurrence of vulvovaginal candidiasis. To investigate the prevalence rate of vaginal carriage of Candida species in Saudi pregnant and non-pregnant women, high vaginal swab (HVS) specimens (707) were examined by direct microscopy (10% KOH and Giemsa staining) and parallel cultured on Sabouraud Dextrose Agar (SDA) as well as on “CHROM agar Candida” medium. As expected,Candida-positive cultures were frequently observed in pregnant-test group (24%) than in non-pregnant group (17%). The frequency of culture positive was correlated to pregnancy (P=0.047), parity (P=0.001), use of contraceptive (P=0.146), or antibiotics (P=0.128), and diabetic-patients (P<0.0001). Out of 707 HVS examined specimens, 157 specimens were yeast-positive culture (22%) on Sabouraud Dextrose Agar or “CHROM agar Candida”. In comparison, the sensitivities of the direct 10% KOH and the Giemsa stain microscopic examination methods were 84% (132/157) and 95% (149/157) respectively but both with 100% specificity. As for the identity of recovered 157 yeast isolates, based on API 20C biotype carbohydrate assimilation, germ tube and chlamydospore formation, C. albicansand C. glabrata constitute 80.3 and 12.7% respectively. Whereas rates of C. tropicalis, C. kefyr, C. famata or C. utilis were 2.6, 1.3, and 0.6% respectively. Sachromyces cerevisiae and Rhodotorula mucilaginosa yeasts were also encountered at a frequency of 1.3 and 0.6% respectively. Finally, among all recovered 157 yeast-isolates, strains resistant to ketoconazole were not detected, whereas 5% of the C. albicans and as high as 55% of the non-albicans yeast isolates (majority C. glabrata) showed resistance to fluconazole. Our findings may prove helpful for continuous determination of the existing vaginal candidiasis causative species during pregnancy, its lab-diagnosis and/or control and possible measures to minimize the incidence of the disease-associated pre-term delivery. Key words: Vaginal candidiasis, Candida spp., pregnancy, risk factors, API 20C-yeast biotypes, Giemsa stain, antifungal agents.
Highlights
The rate of colonization with Candida spp. and symptomatic vaginitis is higher during pregnancy (CDC, 2010)
The subjects women age varied from 18 years to 54 years. In both test and control groups, women of the 26-30 age group had the highest frequency of Candidapositive cultures followed by the 31-35 age group, whereas the women aged above 46 years showed the lowest frequency of Candida-positive samples
Out of 495 test group and of 212 control group specimens, Candida positive culture was detected in 120 and in 37 specimens respectively (Table 2). These findings indicate as expected that Candida spp. positive culture is frequently encountered among pregnant women as compared to those detected among non-pregnant patients, and this difference is statistically significant (P=0.047)
Summary
The rate of colonization with Candida spp. and symptomatic vaginitis is higher during pregnancy (CDC, 2010). Among the Candida species causing infections, C. albicans, C. glabrata, C. parapsilosis, and C. tropicalis account for 80 to 90% of fungal isolates encountered worldwide. The increased incidence of Candida other than C. albicans species (non-albicans spp.) in VVC cases is not yet well established (Esmaeilzadeh et al, 2009) and it has been correlated to the extensive use of azole antifungal drugs that leads to the selection of more naturally resistant species, such as C. glabrata (Snydman, 2003). There is accumulated evidence that mere Candida spp.vaginal colonization may predispose for preterm birth, and clotrimazole prophylactic-treatment during pregnancy significantly reduces the disease-incidence (Czeizel et al, 2004)
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