Recurrent Candida Vaginitis Research Articles

Fungal disease incidence and prevalence in Iraq – Preliminary estimates

BackgroundThe surveillance of serious and superficial skin fungal infections in Iraq has not been conducted. Limited information exists on their incidence and prevalence. ObjectivesThis study aimed to analyze, compute and estimate the prevalence and burden of fungal infections, as no previous data is available and no studies has been attempted in Iraq. MethodsIn the present study the data were collected and reviewed from published data on epidemiology of fungal infections nationally, internationally, from unpublished postgraduate master and PhD theses, hospital records and private clinic records. External sources of data from other countries were used for diseases which lacked sufficient local data. ResultsWe estimated 985,628 annual serious infections comprising of 2.26 % of the total population. When including superficial fungal infections group of the skin, this rises to 2,075,113 infections at 4.76 % of the total population. The most common serious and skin infections were recurrent Candida vaginitis, fungal rhinosinusitis and tinea capitis comprising 61.5 %, 21.8 %, and 22.4 % of all infections although the total incidence of superficial fungal infections was also high at 1,071,485. Respiratory fungal disease is also common comprising 14.0 % of infections. We predicted the following annual burden per 100,000; oral candidiasis at 247.9, esophageal candidiasis at 6.04, candidemia at 5.0, Candida peritonitis at 0.75, recurrent Candida vaginitis at 5461, allergic bronchopulmonary aspergillosis at 35, severe asthma with fungal sensitisation at 46, invasive aspergillosis at 7.9, chronic pulmonary aspergillosis at 11.7, chronic fungal rhinosinusitis at 496, mucormycosis at 0.99, fungal keratitis at 14.0, and total dermatophytosis at 1631, the most severe being tinea capitis at 366. Many of these estimates were made with data sourced from other nations, so additional data from Iraq is required to validate or modify these estimates. ConclusionRecurrent Candida vaginitis, fungal rhinosinusitis, and tinea capitis are considered to be the most frequent fungal diseases present in Iraq.

Estimated burden of fungal infections in Panama

Data published on Panamanian fungal disease are scarce, mostly case reports. To date, there is no paper that compiles the burden of fungal disease Here we estimate for the first time the incidence and prevalence of fungal diseases in Panama. Data on fungal disease were obtained from different search engines: PubMed, Google Scholar, Scielo and Lilacs. For population and at risk diseases, we used statistics from worldometer, UNAIDS, and WHO. Incidence, prevalence, and absolute numbers were calculated based on the population at risk. Panamanian population in 2022 was 4,429,739. We estimated that 85,530 (1.93 %) people suffer from fungal diseases. The most frequent fungal infection was recurrent Candida vaginitis (3285/100,000). There are 31,000 HIV-infected people in Panama and based on the number of cases not receiving anti-retroviral therapy (14,570), and previous reports of prevalence of opportunistic infections, we estimated annual incidences of 4.0/100,000 for cryptococcal meningitis, 29.5/100,000 for oral candidiasis, 23.1/100,000 for esophageal candidiasis, 29.5/100,000 for Pneumocystis pneumonia, 15.1/100,000, and for histoplasmosis. For chronic pulmonary aspergillosis (CPA) and fungal asthma we used data from Guatemala and Colombia to estimate COPD and asthma prevalence and WHO report for tuberculosis. We estimated annual incidences of 6.1/100,000 for invasive aspergillosis and prevalence of 31.5/100,000 for CPA, 60.2/100,000 for allergic bronchopulmonary aspergillosis, and 79.5/100,000 for severe asthma with fungal sensitisation. Other incidence estimates were 5.0/100,000 for candidaemia, 0.20/100,000 for mucormycosis, and 4.97/100,000 for fungal keratitis. Even though this report on burden of fungal disease is a forward step, more epidemiological studies to validate these estimates are needed.

Re-estimation of the burden of serious fungal diseases in Uganda.

It is of utmost importance to monitor any change in the epidemiology of fungal diseases that may arise from a change in the number of the at-risk population or the availability of local data. We sought to update the 2015 publication on the incidence and prevalence of serious fungal diseases in Uganda. Using the Leading International Fungal Education methodology, we reviewed published data on fungal diseases and drivers of fungal diseases in Uganda. Regional or global data were used where there were no Ugandan data. With a population of ~45 million, we estimate the annual burden of serious fungal diseases at 4,099,357 cases (about 9%). We estimated the burden of candidiasis as follows: recurrent Candida vaginitis (656,340 cases), oral candidiasis (29,057 cases), and esophageal candidiasis (74,686 cases) in HIV-infected people. Cryptococcal meningitis annual incidence is estimated at 5553 cases, Pneumocystis pneumonia at 4604 cases in adults and 2100 cases in children. For aspergillosis syndromes, invasive aspergillosis annual incidence (3607 cases), chronic pulmonary aspergillosis (26,765 annual cases and 63,574 5-year-period prevalent cases), and prevalence of allergic bronchopulmonary aspergillosis at 75,931 cases, and severe asthma with fungal sensitization at 100,228 cases. Tinea capitis is common with 3,047,989 prevalent cases. For other mycoses, we estimate the annual incidence of histoplasmosis to be 646 cases and mucormycosis at 9 cases. Serious fungal diseases affect nearly 9% of Ugandans every year. Tuberculosis and HIV remain the most important predisposition to acute fungal infection necessitating accelerated preventive, diagnostic, and therapeutic interventions for the management of these diseases.

Observation of the Effect of Giving Oral Metronidazole and Miconazole Nitrate for Treatment in Patients with Recurrent Candidal Vaginitis

Observation of the Effect of Giving Oral Metronidazole and Miconazole Nitrate for Treatment in Patients with Recurrent Candidal Vaginitis

Effect Evaluation of Holistic Nursing of Traditional Chinese Medicine for Recurrent Candidal Vaginitis

Effect Evaluation of Holistic Nursing of Traditional Chinese Medicine for Recurrent Candidal Vaginitis

Estimated burden of serious fungal infections in Togo.

Over the years, the focus of infectious diseases in many African countries has been mainly on viral, bacterial and parasitic infections. Serious fungal infections (SFIs) with comparable morbidity rate in these countries remain neglected. To estimate the burden of SFI in Togo and to stimulate efforts for improved attention. Literature was thoroughly searched for epidemiological data on SFI in Togo. Incidence and/or prevalence of SFI was estimated using socio-demographics, health system's information, risk-groups data and SFI rates obtained from national and international studies. About 5.29% of the 7,265,286 Togolese population is estimated to suffer from SFI annually. Among HIV patients, 1,342, 1,650 and 330 may develop cryptococcal meningitis, Pneumocystis pneumonia and disseminated histoplasmosis respectively per year. Oral and oesophageal candidiasis may annually affect 19,800 and 7,535 persons, respectively, living with HIV. Estimated incidence of invasive aspergillosis (IA) was 283 cases. Prevalence of chronic pulmonary aspergillosis (CPA) was estimated at 191 cases. The annual incidence of allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) was 4,577 and 6,042 cases, respectively. Tinea capitis and recurrent Candida vaginitis presumably affect 232,271 children and 108,979 women respectively. Candidaemia incidence is estimated at 5 cases per 100, 000 inhabitants and fungal keratitis may affect 981 persons annually. SFIs in Togo are probably more significant than expected. These findings underscore the need to increase awareness among healthcare professionals, enhance diagnostic and therapeutic capacities and intensify epidemiological studies for effective management of fungal infections in Togo.

Human Fungal Infections in Kuwait-Burden and Diagnostic Gaps.

Fungal infections are an increasingly important public health issue, yet accurate statistics on fungal burden worldwide and in Kuwait are scarce. Here we estimate the incidence and prevalence of fungal infections in Kuwait. Population statistics from 2018 collected by the Public Authority for Civil Information were used, as well as data from the Ministry of Health. A literature search for Kuwait data on mycotic diseases and population at risk (chronic obstructive pulmonary disease, HIV infection/AIDS, cancer, and transplant patients) was conducted. The population in 2018 was estimated at 4,226,920 million people: 1,303,246 million Kuwaitis and 2,923,674 million expatriates. We determined the annual burden of serious fungal infections number (per 100,000) from high to low based on earlier reported fungal rates for populations at risk: recurrent Candida vaginitis 54,842 (2595); severe asthma with fungal sensitisation 10,411 (246); allergic bronchopulmonary aspergillosis, 7887 (187); chronic pulmonary aspergillosis 995 (21.3); invasive aspergillosis 704 (16.7); fungal keratitis 654 (15.5); candidaemia 288 (6.8); Candida peritonitis 63 (3.5) and oesophageal candidiasis in HIV 33 (0.8). Besides identifying rising new risk groups and expanding reports on antifungal resistance, surveillance programs and further epidemiological studies are needed to achieve more precise assessments of fungal disease epidemiology and correlated morbidity and mortality.

Risk-Based Estimate of Human Fungal Disease Burden, China.

We conducted a systematic literature review to obtain risk population–based fungal disease incidence or prevalence data from China. Data were categorized by risk factors and extrapolated by using most recent demographic figures. A total of 71,316,101 cases (5.0% of the population) were attributed to 12 risk factors and 17 fungal diseases. Excluding recurrent Candida vaginitis (4,057/100,000 women) and onychomycosis (2,600/100,000 persons), aspergillosis (317/100,000 persons) was the most common problem; prevalence exceeded that in most other countries. Cryptococcal meningitis, an opportunistic infection, occurs in immunocompetent persons almost twice as often as AIDS. The pattern of fungal infections also varies geographically; Talaromyces marneffei is distributed mainly in the Pearl River Basin, and the Yangtze River bears the greatest histoplasmosis burden. New host populations, new endemic patterns, and high fungal burdens in China, which caused a huge impact on public health, underscore the urgent need for building diagnostic and therapeutic capacity.

The Burden of Fungal Infections in Ethiopia.

The burden of severe fungal infections (FIs) is not well addressed in Ethiopia. We have estimated the burden of FIs from multiple demographic sources and by searching articles from PubMed. Opportunistic FIs were estimated using modelling and 2017 national HIV data. The burdens of chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA) were estimated by using the prevalence of asthma, chronic obstructive pulmonary disease, and annual the incidence of tuberculosis. Of the 105,000,000 estimated Ethiopian population, 610,000 are thought to have HIV infection. Our estimation of HIV-related FIs were: 9900 cryptococcal meningitis (CM), 12,700 Pneumocystis jirovecii pneumonia (PCP), 76,300 oral and 56,000 oesophageal candidiasis cases. A remarkable 7,051,700 4–14-year-olds probably have tinea capitis and 1,469,000 women probably have recurrent Candida vaginitis. There were 15,200 estimated CPA cases (prevalence) and 11,500 invasive aspergillosis (IA) cases (incidence). Data are scant, but we estimated 5300 candidaemia and 800 Candida peritonitis cases. In conclusion, approximately 8% of Ethiopians suffer from FIs annually, mostly schoolchildren with tinea capitis. IA, CM and PCP are the major causes of fungal deaths. The absence of CD4 count is challenging the identification of HIV patients at risk of opportunistic FIs. There is a pressing need to improve FI diagnosis, probably including national surveillance.

Estimated Burden of Serious Fungal Diseases in Serbia.

For the first time, we aimed to estimate the burden of serious fungal infections or diseases (SFD) and highlight national epidemiological features in Serbia. Data on population and underlining conditions were extracted from the Statistical Office of the Republic of Serbia, World Bank, the Institute of Public Health of Serbia, the World Health Organization, National reference laboratory for medical mycology, the national registries of Serbian professional societies, and relevant publications. The population structure/inhabitants in 2016 (not including the autonomous region Kosovo & Metohija) was 7,058,322; with 6,041,743 adults (85.6%). The populations at risk (total cases per year) were: HIV infected 2441; acute myeloid leukemia 212; stem cell transplantation 151; solid organ transplants 59; chronic obstructive pulmonary disease 250,302; adult asthmatics 311,806; adult cystic fibrosis 65; pulmonary tuberculosis 898; lung cancer 7260; intensive care unit admissions 19,821; and renal support 520. Annual fungal disease cases estimated are: candidemia 518; invasive aspergillosis 619; Candida peritonitis 187; Pneumocystis jirovecii pneumonia 62; cryptococcosis 5; mucormycosis or fusariosis 23; severe asthma with fungal sensitization 10,393; allergic bronchopulmonary aspergillosis 9094; chronic pulmonary aspergillosis 448, recurrent Candida vaginitis 135,303; oral candidiasis 208,489; esophageal candidiasis 173, fungal keratitis 70; tinea capitis 300; and onychomycosis 342,721. We expect that 156,825 people suffer from serious SFD each year (2221/100,000), and 409 dies annually. Additionally, the prevalence of superficial infections exceeds 1,008,995 cases (14,295/100,000). The first Rhinosporidium outbreak in Europe was associated with Serbian Silver Lake. The plant pathogen Fusarium seems to be emerging in Serbian pediatric haematooncology settings. Candida auris and endemic mycoses have not been observed to date. These general estimates provide a primer for further efforts to study fungal epidemiology in Serbia.

Estimating the Burden of Serious Fungal Infections in Uruguay.

We aimed to estimate for the first time the burden of fungal infections in Uruguay. Data on population characteristics and underlying conditions were extracted from the National Statistics Institute, the World Bank, national registries, and published articles. When no data existed, risk populations were used to estimate frequencies extrapolating from the literature. Population structure (inhabitants): total 3,444,006; 73% adults; 35% women younger than 50 years. Size of populations at risk (total cases per year): HIV infected 12,000; acute myeloid leukemia 126; hematopoietic stem cell transplantation 30; solid organ transplants 134; COPD 272,006; asthma in adults 223,431; cystic fibrosis in adults 48; tuberculosis 613; lung cancer 1400. Annual incidence estimations per 100,000: invasive aspergillosis, 22.4; candidemia, 16.4; Candida peritonitis, 3.7; Pneumocystis jirovecii pneumonia, 1.62; cryptococcosis, 0.75; severe asthma with fungal sensitization, 217; allergic bronchopulmonary aspergillosis, 165; recurrent Candida vaginitis, 6323; oral candidiasis, 74.5; and esophageal candidiasis, 25.7. Although some under and overestimations could have been made, we expect that at least 127,525 people suffer from serious fungal infections each year. Sporothrichosis, histoplasmosis, paracoccidioidomycosis, and dermatophytosis are known to be frequent but no data are available to make accurate estimations. Given the magnitude of the burden of fungal infections in Uruguay, efforts should be made to improve surveillance, strengthen laboratory diagnosis, and warrant access to first line antifungals.

Serious fungal infections in Ecuador.

There is a dearth of data from Ecuador on the burden of life-threatening fungal disease entities; therefore, we estimated the burden of serious fungal infections in Ecuador based on the populations at risk and available epidemiological databases and publications. A full literature search was done to identify all epidemiology papers reporting fungal infection rates. WHO, ONU-AIDS, Index Mundi, Global Asthma Report, Globocan, and national data [Instituto Nacional de Estadística y Censos (INEC), Ministerio de Salud Pública (MSP), Sociedad de Lucha Contra el Cáncer (SOLCA), Instituto Nacional de Donación y Trasplante de Órganos, Tejidos y Células (INDOT)] were reviewed. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology by LIFE. Ecuador has a variety of climates from the cold of the Andes through temperate to humid hot weather at the coast and in the Amazon basin. Ecuador has a population of 15,223,680 people and an average life expectancy of 76years. The median estimate of the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) population at risk for fungal disease (<200 CD4 cell counts) is ∼10,000, with a rate of 11.1% (1100) of histoplasma, 7% (700) of cryptococcal meningitis, and 11% (1070) of Pneumocystis pneumonia. The burden of candidemia is 1037. Recurrent Candida vaginitis (≥4 episodes per year) affects 307,593 women aged 15-50years. Chronic pulmonary aspergillosis probably affects ∼476 patients following tuberculosis (TB). Invasive aspergillosis is estimated to affect 748 patients (∼5.5/100,000). In addition, allergic bronchopulmonary aspergillosis (ABPA) in asthma and severe asthma with fungal sensitization (SAFS) were estimated to affect 26,642 and 45,013 people, respectively. Our estimates indicate that 433,856 (3%) of the population in Ecuador is affected by serious fungal infection.

The efficacy of itraconazole and miconazole nitrate for recurrent monilial vaginitis

Objective To study the treatment effect of joint nitric acid imidazole and itraconazole on recurrent candida vaginitis. Methods 200 confirmed cases of patients with recurrent candida vaginitis in our hospital during October 2014 to June 2015 were selected and divided into research group and the control group with random indicator method, with 100 cases in each group.The control group were treated by nitric acid imidazole vaginal soft capsule, with vaginal drug delivery, which shoud put suppository in vaginal depths after washing, for one times a night and one soft capsule every time, and a week was a period of treatment.The patients in the research group received basis treatment of the control group adding itraconazole capsules(200mg per day, oral).8 weeks after treatment, the patients in this process were reviewed to analyzed clinical efficacy and adverse reactions occured. Results The total effective rate of the research group was 98%, which of the control group was 73%, the difference was statistically significant(χ2=25.21, P 0.05). Conclusion The curative effect of itraconazole joint miconazole nitratet to recurrent monilial vaginitis is superior to the use of miconazole nitrate alone, with less adverse reaction, and is easy to use.It is worth clinical application. Key words: Cardidiasis vulvovaginal; Itraconazole; Miconazole nitrate

Burden of serious fungal infections in Belgium.

We aimed to estimate the total number of serious fungal infections occurring yearly in Belgium. The number of cryptococcal infections was retrieved from the National Reference Center for Mycosis. Populations at risk and fungal infections frequencies in these populations were used to estimate incidence or prevalence of other fungal infections. The Belgian population consists of 11.10 million people. Cryptococcal meningitis is rare. In all, 15 of the 1227 newly diagnosed HIV/AIDS cases presented with Pneumocystis jirovecii pneumonia. This accounts for ±14% of total PCP cases (n = 120). The incidence of candidaemia is estimated as 5/100,000 resulting in 555 cases and 213 deaths. A total number of 675 invasive aspergillosis cases and ≥169 deaths attributed to this infection were calculated. Chronic pulmonary aspergillosis is estimated to be prevalent in 662 cases. Allergic bronchopulmonary aspergillosis cases were estimated to be 23,119 applying a 2.5% and 15% rate in adult asthma and cystic fibrosis patients respectively. Severe asthma with fungal sensitisation cases was estimated to be 30,402. There were 174,760 women with recurrent Candida vaginitis assuming a 6% rate in women aged between 15 and 50. Approximately 233,000 people of the Belgian population (2.1%) are estimated to suffer from a fungal infection on a yearly basis.

Burden of fungal disease in Ireland.

Our objective was to estimate the burden of fungal disease on the island of Ireland, as part of a coordinated project estimating the global burden. Published epidemiology data describing fungal infection in Ireland were identified. Population and underlying disease data were collected for 2010 and a structured set of assumptions were applied to estimate burden of fungal disease based on immunosuppression, chronic disease, and other demographic information indicating predisposition to fungal infection. From Ireland's population of 6.4 million, we estimate 117, 000 patients develop significant fungal disease each year. By far the most common fungal disease is recurrent Candida vaginitis, with an estimated 95, 000 episodes annually (3000 per 100 000 women). Other fungal diseases which may be less well recognized are severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis, with estimated episodes per year of 11, 700 and 9000, respectively (182 and 140 per 100, 000 population, respectively). The model also estimates 450 episodes of invasive aspergillosis, 200 of chronic pulmonary aspergillosis, 600 of oesophageal candidiasis and 450 of candidaemia per year (7, 3, 9 and 6 episodes per 100, 000 population, respectively). This is, we believe, the first attempt to estimate the burden of fungal disease in our population and provides a basis for estimating its impact on human health and resource use.

Diversity of Pathogenic Candida Species Colonizing Women with and without Candida Vaginitis in Dar es Salaam Region, Tanzania

The aim of this study was to establish phenotypic and genetic diversities of Candida species isolated from women with recurrent Candida vaginitis. A total of 3000 samples were cultured from 3000 women with and without complaints of vaginal discharges and pruritis vulvae. Growth characteristics on Sabouraud’s dextrose agar and on conidia enhancing media (Corn meal agar) resulted in isolation of 5440 distinct colonies of Candida species. They were then analyzed by germ tube test to separate C. albicans from non-albicans Candida species. For confirmation, 300 doubtful isolates were then tested on API 20C AUX and by polymerase chain reaction.The results showed Candida albicans species to be dominant 3661 (67.29%) while non-albicans Candida species presented only 1779 (32.71%) which included C. glabrata 435(8.0%), C. tropicalis 762(14.0%), C. krusei 163(3.0%), C. famata 109(2.0%), C. parapsilosis 131(2.41%), C. guilliermondii and C. lusitaniae each 27(0.5%) respectively, C. incospicua 13 (0.24%), C. norvegensis 82(1.5%), C. colliculosa 16 (0.3%) and C. magnoliae 15 (0.27%). On genotypic diversity, the principle coordinate analysis of the PCR results for the genetic relatedness and genetic distances revealed the distribution of 200 isolates tested as: C. albicans 90(36%), C. glabrata 40(20%), C. krusei 20 (10%), C. tropicalis 20 (10%), C. famata 10(5%), C. parapsilosis 5(2.5%), C. norvegensis 6(3%), C. lusitaniae 4(2%), and C. guilliermondii 5(2.5%). From this study it shows that a combination of biochemical methods and PCR technology may identify most of the isolates, including the germ tube negative isolates. Both symptomatic and asymptomatic women possessed similar species and genotypic diversities. However, in symptomatic women, a single host can be colonized with multiple species or multiple genotypes of the same species. In order to establish if the same species behave differently in symptomatic and asymptomatic individuals, this study recommend further investigation on virulent factors.

Clinical experience of treating recurrent candidal vaginitis with flueonazole capsule(diflucan capsule)

Objective To appraise two kinds of treatment plan of treating recurrent candidal vaginitis with fluconazole capsule. Methods The control group( also called the single medication) :husband and wife take flucon-azole capsule 150mg and add terbinafine hydrochloride vasinal effervescent tablets into the vagina,one time a day and one tablet a tlme,taking 7 days continually is a treatment course;the treatment group( also called taking drugs continu-onsly) :after a treatment course,at the first day of the menstrual period,husband and wife take fluconazole capsule 150mg at the same time, after the clean of menstruation, add terbinafine hydrochloride vaginal effervescent tablets into the vagina,one time a day and one tablet a time,taking 7 days continuously,three months in total. Appraise the two kinds of treatment plans from long-term,short-term curative effect and the recurrent rate. Resu/ts The curative effect of the two kinds of treatment plan about the treatment of recurrent candidal vaginitis,there is no difference between the short-term( one week) curative effect( P>0.05) ,but the long-term curative effect in the group of taking tablets con-tinuously is obviously better than the single medication( P<0.01 ) ,and the recurrent rate also obviously decreases( P<0.01 ). Conclusion The treatment pLan of taking the tablets continuously is the safey, effective treatment plan for the recurrent candidal vaginitis,no adverse reaction had been discovered. Key words: Canclidiasis, vulvovaginal; Anti-bacterial agents; Fluconazole; Terbinafine

Treatment of Complicated Candida Vaginitis: Comparison of Single and Sequential Doses of Fluconazole

Candida vaginitis is commonly described as uncomplicated, for which the recommended treatment is single-dose antimycotic therapy, and complicated, for which the recommended dose is short-course antimycotic therapy. This study was performed to evaluate the necessity of multidose therapy in women with severe or recurrent Candida vaginitis. Severity of disease was determined using a semiquantitative scale in which a score of 1 to 10 was assigned according to the severity of pruritus and the presence of vulvar or vaginal erythema, edema, and excoriation or fissure formation. Only women with scores greater than 4 were included. For the purposes of this report, disease severity was rated mild in women with a score of 4 to 6 and severe in those with a score greater than 7. Of the 309 patients who met all of the study criteria, 157 women were identified with mild Candida vaginitis, and 152 had severe disease. Patients in each group were randomly assigned to receive either a single done of 150 mg fluconazole or two sequential doses of 150 mg fluconazole given 3 days apart. Follow-up examinations were conducted on day 14 and day 35 of the trial. There were no significant differences in the demographic or clinical characteristics of the two groups, with more 90% (N = 283, 91.6%) of all cases diagnosed as C. albicans. Other strains identified included 13 cases of C. glabrata, 7 of C. parapsilosi, 3 of C. tropicalis, and 1 each of C. guiliermondii, C. krusei, C. lipolytica, and C. zeylandoides. A greater number of patients with non-albicans lesions were randomly assigned to the two-dose group (N = 21) than to the single-dose group (N = 6). Of the 13 women with C. glabrata, which is resistant to fluconazole, 12 received two sequential doses and only 1 received a single dose of fluconazole. The one woman with C. krusei, another strain resistant to fluconazole, was in the two-dose group. The C. albicans species was eradicated on the day 14 visit in 78% of the patients in the single-dose group and 86% of the women in the two-dose group. Compared with C. albicans, non-albicans species were significantly more likely to be present in both the single- and dual-dose groups on the day 14 follow-up visit (79 vs. 46%, respectively; P = .097) and on the day 35 follow-up visit (65 vs. 23%, respectively; P <.001). The patient with C. krusei had a negative culture at day 14. The cure rate achieved on both days 14 and 35 was significantly higher in the women receiving two doses of fluconazole compared with those receiving a single dose after a logistic regression analysis of the two treatment regimens (P =.049). The two-dose regimen was also more likely to be successful (improved or eradicated disease) on day 14 in patients with severe disease compared with the single-dose regimen (P =.15). By day 35, the advantage had lost its significance but remained. Logistic regression analysis of the results of patients with C. albicans compared with those with non-albicans strains showed a significant difference in the improvement/cure rate for the patients in the two-dose group at both the day 14 and day 35 visit (P =.02 and.03, respectively). For 94 patients with severe disease, this was their first diagnosis of Candida vaginitis. At day 14, these patients had significantly better results with the two-treatment regimen than with the single dose (P =.028). Patients with recurrent disease, whether severe or mild, responded to both treatment regimens equally.

Treatment of complicated Candida vaginitis: Comparison of single and sequential doses of fluconazole

Objective: An attempt was made to validate recent recommendations that women with complicated Candida vaginitis (severe or recurrent, non-albicans Candida spp or abnormal host) require longer-duration antifungal therapy to achieve clinical cure and mycologic eradication. Study Design: A prospective, multicenter, randomized, double-blind study was performed comparing a single dose of 150 mg of fluconazole with 2 sequential 150-mg doses of fluconazole given 3 days apart. Results: Five hundred fifty-six women with severe or recurrent Candida vaginitis were enrolled, and 398 had at least one postbaseline evaluation (intent to treat) and of these 309 were fully evaluable (efficacy-valid). At baseline, 92% of vaginal isolates were Candida albicans. The 2-dose fluconazole regimen achieved significantly higher clinical cure rates in women with severe vaginitis when evaluated on day 14 (P =.015) and higher clinical and mycologic responses persisted at day 35. Women with recurrent but not severe vaginitis did not benefit clinically short term by the additional fluconazole dose. Multivariate logistic regression analysis showed that being infected with non-albicans Candida predicted significantly reduced clinical and mycologic response regardless of duration of therapy. Fluconazole therapy was well tolerated and free of serious adverse effects. Conclusion: Treatment of Candida vaginitis requires individualization, and women with severe Candida vaginitis achieve superior clinical and mycologic eradication with a 2-dose fluconazole regimen. (Am J Obstet Gynecol 2001;185:363-69.)

Most frequent scenario for recurrent Candida vaginitis is strain maintenance with "substrain shuffling": demonstration by sequential DNA fingerprinting with probes Ca3, C1, and CARE2.

The following three basic scenarios have emerged for the genetic relatedness of strains in recurrent vaginal candidiasis: strain maintenance without genetic variation, strain maintenance with minor genetic variation, and strain replacement. To test the frequency of each of the three scenarios, the genetic relatedness of Candida albicans isolates from each of 18 patients with recurrent infections was assessed by sequential DNA fingerprinting with the following three probes: the Ca3 probe; the C1 probe, a subfragment of the Ca3 probe which hybridizes to hypervariable genomic fragments; and the unrelated CARE2 probe. In each of the 18 patients with recurrent infections, the same strain was responsible for sequential infections, suggesting that the predominant scenario is strain maintenance. However, in 56% of these patients, the strain exhibited minor genetic variations in sequential infections. These changes were not found to be progressive. Rather, the changes suggest that substrains of an established infecting strain are shuffled in sequential infections. Results are also presented that in 45% of patients with recurrent infections, oral and vulvovaginal isolates were identical, in 35% they were highly related but not identical, and in 20% they were unrelated. These results differ markedly from those for commensal isolates simultaneously cultured from the oral cavity and vulvovaginal region of healthy individuals. Finally, it is demonstrated that in all eight cases in which C. albicans was isolated from both the male sexual partner of the patient with a recurrent infection and the patient, an isolate from the male partner was identical or highly related to the vulvovaginal strain. These results demonstrate that in patients with recurrent vulvovaginitis, a single strain usually dominates both in the different body locations of the patient and in the male partner and that it is maintained through sequential infections. However, in patients with recurrent infections, different substrains of the established clone dominate in an apparently random fashion, a process that we refer to as "substrain shuffling".