Abstract
BackgroundVulvovaginal candidiasis (VVC) represents a universal health hazard that contributes to significant morbidity in women. Resistance of Candida to antifungal therapy has been reported as a public health problem. So, the objective of our current study is to detect resistance profile of different candidal strains.MethodsIn this study, isolated Candida strains were identified by conventional methods, confirmed by internal transcribed spacer (ITS) sequencing, and phylogenetically analyzed with reference strains in GenBank. Also, sensitivity of different Candida strains to common antifungal agents was evaluated by disc diffusion method.ResultsCandida albicans was identified as the most frequent strain (63%) followed by non-albicans strains, such as C. glabrata (20%), C. tropicalis (13%), and C. krusei (4%). Sensitivity of Candida strains (C. albicans, C. tropicalis and C. glabrata) to commonly used antifungal agents was evaluated through the disc diffusion method. C. glabrata was the most resistant strain and considered to be a multidrug-resistant pathogen, while both, C. albicans and C. tropicalis showed high susceptibility to terbinafine. In contrast, C. albicans showed resistance to fluconazole, clotrimazole, and nystatin, while C. tropicalis, considered as the most sensitive strain, was susceptible to all the antifungal agents tested except nystatin. Terbinafine was the most effective antifungal agent against both C. tropicalis and C. albicans, and hence its minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) for C. albicans and C. tropicalis were evaluated. MICs of terbinafine against C. albicans and C. tropicalis were 5 μg/ml and 2.5 μg/ml, while their MFCs were 10 μg/ml and 5 μg/ml, respectively.ConclusionThe emergence of resistant Candida strains necessitates conduction of the antifungal susceptibility test prior to deciding the medication regime.
Highlights
Vulvovaginal candidiasis (VVC) represents a universal health hazard that contributes to significant mor‐ bidity in women
This result is in accordance with that of Kamath et al [21] who recorded 47.7% of pregnant women to be infected with vulvovaginal candidiasis and the disease incidence in non-pregnant woman to be 20.3%
The present study identified C. albicans to be the predominant causative agent of vulvovaginal candidiasis disease (63%) followed by non-albicans strains C. glabrata (20%) and C. tropicalis (13%)
Summary
Vulvovaginal candidiasis (VVC) represents a universal health hazard that contributes to significant mor‐ bidity in women. Is mediated through virulence factors like transition between yeast and hyphal forms, formation of biofilms, secretion of hydrolytic enzymes and expression of invasion and adhesion proteins [5] Hydrolytic enzymes such as hemolytic enzymes, lipases and phospholipases produced by the Candida sp. Significant morbidity in women worldwide due to recurrent vulvovaginal candidiasis (RVVC) caused by C. albicans has been reported [11]. Many of these infections may cause high mortality rates due to the development of resistance against antifungal agents [12]. A study conducted by Salehei et al [18] showed isolated vaginal Candida strains to be highly susceptible to terbinafine, clotrimazole and miconazole, but resistant to fluconazole and econazole. Susceptibility of different strains to antifungal agents commonly used in treatment of vulvovaginal candidiasis was evaluated
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