Molecular Epidemiology and In Vitro Antifungal Susceptibility of Candida Isolates from Women with Vulvovaginal Candidiasis in Northern Cities of Khuzestan Province, Iran

Abstract

Background: Vulvovaginal candidiasis (VVC) is a common infection, affecting up to 75% of women at least once during their lifetime. In addition, approximately 5% of patients may experience recurrent VVC. Candida albicans is the most common causative agent of VVC. Overall, precise identification of the causative agents of VVC is necessary for effective treatment. Objectives: The purpose of this study was to identify the molecular characteristics and antifungal susceptibility of Candida species, isolated from women with VVC in cities of Shoush, Dezful, and Andimeshk, Khuzestan Province, Iran. Methods: In this descriptive cross sectional study, vaginal samples were collected from 173 women with VVC, referred to gynecologists. The samples were cultured on Sabouraud dextrose agar, containing chloramphenicol. The ITS1-ITS4 region was amplified via polymerase chain reaction (PCR) assay and digested by MspI restriction enzyme. Antifungal susceptibility test was performed for 4 antifungal drugs (fluconazole, nystatin, itraconazole, and clotrimazole) via disk diffusion method. Results: Out of 173 patients, 95 (54.9%) showed VVC and 26 (27.4%) had recurrent VVC. The most common Candida species were C. albicans (70.5%), C. glabrata (20%), C. tropicalis (7.4%), and C. parapsilosis (2.1%), respectively. The antifungal susceptibility test showed resistance to fluconazole in 1 C. tropicalis, 2 C. albicans, and 3 C. glabrata isolates, while resistance to clotrimazole was detected in 1 C. albicans and 1 C. glabrata isolate. Conclusions: According to the results of this study, approximately 30% of VVC infections were caused by non-C. albicans species, which should be considered by gynecologists due to their azole resistance.