Abstract
Background: Pregnant women are susceptible to vaginal candidiasis and maternal vulvovaginal candidiasis is a major risk factor for colonization and/or infection of the infant. The purpose of this study was to determine the prevalence and antifungal patterns of albicans and non-albicans Candida among pregnant women attending a tertiary referral hospital.
 Methods: Vaginal discharge- cotton swabs were self-collected from pregnant women clinically proven to have vulvovaginal candidiasis at the antenatal clinic of a tertiary referral hospital between January and July 2018. Microscopy and culture on Sabouraud's Dextrose Agar with chloramphenicol was done on the vaginal discharge-cotton swabs. Confirmatory fungal identification was done using CHROM agarTM Candida. Antifungal susceptibility testing was carried out using the standardized Kirby Bauer method.
 Results: Candida were isolated from 50.81% (126/249) of the swabs and included C. albicans (80.16%, 101/126), C. glabrata (19.05% (24/126) and C. krusei (0.79%, 1/126). Candida albicans showed resistance to amphotericin B (70.63%, 89/126), clotrimazole (11.9%, 15/126), nystatin (3.17%, 4/126), fluconazole (23.02%, 29/126), and itraconazole (17.46%, 22/126). Among the non-albican Candida species, C. glabrata showed resistance to fluconazole (100% ,24/24), amphotericin B (100% ,24/24), clotrimazole (14.29%, 18/24), nystatin (1.59%, 2/24), and itraconazole (18.25%, 23/24). C. krusei showed resistance to fluconazole (100%, 1/1), amphotericin B (100%,1/1), and itraconazole (100%, 1/1).
 Conclusion: The candida species commonly associated with VVC in Eastern Uganda are C. albicans C. glabrata and C. krusei. Antifungal resistance was highly prevalent among the candida isolated. The use of CHROMagarTMCandida media for identification of clinically relevant Candida should be adopted instead of conventional methods that are tedious and time consuming such that treatment is based on laboratory evidence.
Highlights
Pregnant women are susceptible to vaginal candidiasis and maternal vulvovaginal candidiasis is a major risk factor for colonization and/or infection of the infant
Vaginal discharge- cotton swabs were self-collected from pregnant women clinically proven to have vulvovaginal candidiasis at the antenatal clinic of a tertiary referral hospital between January and July 2018
Candida were isolated from 50.81% (126/249) of the swabs and included C. albicans (80.16%, 101/126), C. glabrata (19.05% (24/126) and C. krusei (0.79%, 1/126)
Summary
Pregnant women are susceptible to vaginal candidiasis and maternal vulvovaginal candidiasis is a major risk factor for colonization and/or infection of the infant. The formation of a germ tube is necessary for successful colonization of the vaginal mucosa [4] This phenotype switching phenomenon is associated with alterations in antifungal susceptibility patterns [5] and yet pregnant women have a limited spectrum of drugs that they can use especially in the later stages of pregnancy [6]. Due to resistance to antifungals, non- albicans Candida have emerged as clinically relevant causes of Candidiasis [7]. Most prevalent among these is C. glabrata [2,3,8,9,10] which is highly resistant to the commonly used azole antifungals [7]. C. krusei infections are commonest among patients with hematologic malignancies [11] and those of advanced age [12]
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