Recurrent Vaginal Candidiasis Research Articles

Cryptococcal disease and the burden of other fungal diseases in Uganda; Where are the knowledge gaps and how can we fill them?

The HIV epidemic in Uganda has highlighted Cryptococcus and Candida infections as important opportunistic fungal infections. However, the burden of other fungal diseases is not well described. We aimed to estimate the burden of fungal infections in Uganda. All epidemiological papers of fungal diseases in Uganda were reviewed. Where there is no Ugandan data, global or East African data were used. Recurrent vaginal candidiasis is estimated to occur in 375 540 Uganda women per year; Candida in pregnant women affects up to 651,600 women per year. There are around 45,000 HIV-related oral and oesophageal candidosis cases per year. There are up to 3000 cases per year of post-TB chronic pulmonary aspergillosis. There are an estimated 40,392 people with asthma-related fungal conditions. An estimated 1,300,000 cases of tinea capitis occur in school children yearly in Uganda. There are approximately 800 HIV-positive adults with Pneumocystis jirovecii pneumonia (PJP) annually and up to 42 000 children with PJP per year. There are an estimated 4000 cryptococcal cases annually. There are an estimated 2.5 million fungal infections per year in Uganda. Cryptococcus and PJP cause around 28,000 deaths in adults and children per year. We propose replicating the model of research around cryptococcal disease to investigate and development management strategies for other fungal diseases in Uganda.

Estimating the burden of fungal disease in Vietnam.

SummaryData regarding the prevalence of fungal infections in Vietnam are limited yet they are likely to occur more frequently as increasingly sophisticated healthcare creates more iatrogenic risk factors. In this study, we sought to estimate baseline incidence and prevalence of selected serious fungal infections for the year 2012. We made estimates with a previously described actuarial method, using reports on the incidence and prevalence of various established risk factors for fungal infections from Vietnam, or similar environments, supplemented by personal communications. Global data were used if local data were unavailable. We estimated 2 352 748 episodes of serious fungal infection occurred in Vietnam in 2012. Frequent conditions included recurrent vaginal candidiasis (3893/100 000 women annually), tinea capitis (457/100 000 annually) and chronic pulmonary aspergillosis (61/100 000/5 year period). We estimated 140 cases of cryptococcal meningitis, 206 of penicilliosis and 608 of Pneumocystis jirovecii pneumonia. This is the first summary of Vietnamese fungal infections. The majority of severe disease is due to Aspergillus species, driven by the high prevalence of pulmonary tuberculosis. The AIDS epidemic highlights opportunistic infections, such as penicilliosis and cryptococcosis, which may complicate immunosuppressive treatments. These estimates provide a useful indication of disease prevalence to inform future research and resource allocation but should be verified by further epidemiological approaches.

In Vitro Activity of Tea Tree Oil Vaginal Suppositories against Candida spp. and Probiotic Vaginal Microbiota.

The aim of this work is to evaluate the in vitro microbicidal activity of vaginal suppositories (VS) containing tea tree oil (TTO-VS) towards Candida spp. and vaginal probiotics. A total of 20 Candida spp. strains, taken from patients with vaginitis and from an established type collection, including reference strains, were analysed by using the CLSI microdilution method. To study the action of VS towards the beneficial vaginal microbiota, the sensitivity of Bifidobacterium animalis subsp. lactis (DSM 10140) and Lactobacillus spp. (Lactobacillus casei R-215 and Lactobacillus acidophilus R-52) was tested. Both TTO-VS and TTO showed fungicidal activity against all strains of Candida spp. whereas placebo-VS or the Aloe gel used as controls were ineffective. The study of fractional fungicidal concentrations (FFC) showed synergistic interaction with the association between Amphotericin B and TTO (0.25 to 0.08 µg/ml, respectively) against Candida albicans. Instead, the probiotics were only affected by TTO concentration ≥ 4% v/v, while, at concentrations < 2% v/v, they remained viable. TTO-VS exhibits, in vitro, a selective fungicidal action, slightly affecting only the Bifidobacteriun animalis strain growth belonging to the vaginal microbiota. In vivo studies are needed to confirm the efficacy to prevent acute or recurrent vaginal candidiasis.

TRATAMIENTO DE CANDIASIS VAGINAL CRONICA RECURRENTE CON CREMA VAGINAL DE TIOCONAZOL AL 2%

27 pacientes con candiasis vaginal de tipo crónica recurrente fueron tratadas intravaginalmente durante 3 días con Tioconazol en crema vaginal al 2%. En este grupo se logró la negativización microbiológica en 74.1 % de los casos en la evaluación a corto plazo y en 63% de los casos en la de largo plazo; ninguna paciente se perdió al seguimiento hasta los 35 días post tratamiento. De las 17 pacientes con cultivos negativos hasta los 35 días de seguimiento post- tratamiento, que fueron re-evaluadas entre los 60 a 80 días después de completado el tratamiento, dos pacientes se perdieron y 12/15 (80%) continuaron. siendo microbiológicamente negativas. En consecuencia, es nuestra impresión que los tres casos que se positivaron deben ser considerados como reinfecciones. Desde el punto de vista clínico y de las pacientes, los síntomas y signos revirtieron rápidamente, principalmente durante los primeros 5 días después de iniciado el tratamiento. Cuando los síntomas reaparecen, lo más probable es que la infección esté recurriendo o las pacientes se hayan reinfectado. La tolerancia deberá ser considerada como notablemente buena, no se detectaron efectos indeseables.

Estradiol Inhibits Th17 Cell Differentiation through Inhibition of RORγT Transcription by Recruiting the ERα/REA Complex to Estrogen Response Elements of the RORγT Promoter

The symptoms of vaginal candidiasis exacerbate in the second half of the menstrual cycle in premenopausal women when the serum estradiol level is elevated. Estradiol has been shown to inhibit Th17 differentiation and production of antifungal IL-17 cytokines. However, little is known about the mechanisms. In the present study, we used mouse splenocytes and found that estradiol inhibited Th17 differentiation through downregulation of Rorγt mRNA and protein expression. Estradiol activated estrogen receptor (ER)α to recruit repressor of estrogen receptor activity (REA) and form the ERα/REA complex. This complex bound to three estrogen response element (ERE) half-sites on the Rorγt promoter region to suppress Rorγt expression. Estradiol induced Rea mRNA and protein expression in mouse splenocytes. Using Rea small interfering RNA to knock down Rea expression enhanced Rorγt expression and Th17 differentiation. Alternatively, histone deacetylase 1 and 2 bound to the three ERE half-sites, independent of estradiol. Histone deacetylase inhibitor MS-275 dose- and time-dependently increased Rorγt expression and subsequently enhanced Th17 differentiation. In 15 healthy premenopausal women, high serum estradiol levels are correlated with low RORγT mRNA levels and high REA mRNA levels in the vaginal lavage. These results demonstrate that estradiol upregulates REA expression and recruits REA via ERα to the EREs on the RORγT promoter region, thus inhibiting RORγT expression and Th17 differentiation. This study suggests that the estradiol/ERα/REA axis may be a feasible target in the management of recurrent vaginal candidiasis.

Resistance to Antibiotics and Antifungal Medicinal Products: Can Complementary and Alternative Medicine Help Solve the Problem in Common Infection Diseases? The Introduction of a Dutch Research Consortium

The increase of antibiotic resistance worldwide, rising numbers of deaths and costs associated with this, and the fact that hardly any new antimicrobial drugs have been developed during the last decade have increased the interest in Complementary and Alternative Medicine (CAM) therapeutic interventions, if proven safe and effective. Observational studies on clinical CAM practices demonstrate positive effects of treatment of infections with CAM therapies (clinical effects, patient satisfaction) in combination with small percentages of antibiotics prescription. However, Cochrane reviews and other studies demonstrate that in most instances the quality of clinical trials on CAM treatment of infections is currently too low to provide sufficient evidence. Therefore a Dutch consortium on (in vitro and clinical) scientific research on CAM and antibiotic resistance has been formed. The aim and objective of the consortium is to establish an enduring partnership and to develop expertise to further develop and investigate safe and effective CAM treatments for infectious diseases of humans (and animals). A first ongoing project on the development of safe and effective biobased CAM antimycotics in women with (recurrent) vaginal candidiasis infection is introduced.

Microbicidal activity of neutrophils is inhibited by isolates from recurrent vaginal candidiasis (RVVC) caused by Candida albicans through fungal thioredoxin reductase

Vulvovaginal candidiasis (VVC) is characterized by an infection of the vulva and vagina, mainly caused by Candida albicans, a commensal microorganism that inhabits the vaginal, digestive, and respiratory mucosae. Vulvovaginal candidiasis affects approximately 75% of women, and 5% develop the recurrent form (RVVC). The aim of the present study was to evaluate whether neutrophils microbicidal response is triggered when activated with RVVC isolates caused by C. albicans. Our results showed that RVVC isolates induced neutrophil migration but significantly decrease the microbicidal activity of neutrophils, compared with VVC and ASS isolates. The microbicidal activity of neutrophils is highly dependent on the production of reactive oxygen species/reactive nitrogen species (ROS/RNS). However, this isolate induced detoxification of ROS/RNS produced by neutrophils, reflected by the high level of thiol groups and by the oxygen consumption. Therefore, RVVC isolates induced biochemical changes in the inflammatory response triggered by neutrophils, and these effects were mainly related to the detoxification of ROS/RNS through the thioredoxin reductase (TR), a key antioxidant enzyme in fungi. This might be one of the resistance mechanisms triggered by RVVC caused by C. albicans.

Fixed Drug Eruption due to Fluconazole: Not so uncommon Now-a-days.

Sir, Fixed drug eruptions (FDEs) represent the most common cutaneous adverse drug reaction which is seen in the Indian scenario [1]. FDE is a distinctive drug-induced dermatosis with a characteristic recurrence at the same sites of the skin or mucous membrane, which occurs after repeated administrations of the causative drug [2]. It was first described by Bourns in1889; five years later, it was termed by Brocq as “eruption erythemato-pigmentee fixee” [3]. The most common drugs which cause FDE are antibiotics, followed by nonsteroidal anti-inflammatory drugs (diclofenac, aspirin, naproxen, and ibuprofen) [2]. Fluconazole is one of the most common drugs which is used in dermatology practice. We are reporting an FDE which occurred secondary to fluconazole intake. A 22-year-old woman received five doses of fluconazole (150 mg) orally, once a month, for recurrent vaginal candidiasis. A red erythematous macule which measured approximately 2 (two) centimetres in diameter, with well-defined and raised margins, appeared on the medial side of her right popliteal fossa, that was associated with burning and itching, four hours after she had taken her second dose of fluconazole. It faded, but a violet pigmentation developed after a week. A month later, she again developed two macules of similar dimensions within four hours of intake of another fluconazole dose. One of the lesions developed on exactly the same site where another had developed in the earlier episode and the other developed in the left popliteal fossa. After one week, the patches faded and hyperpigmented areas developed on the affected areas. Our differential diagnosis included fixed drug eruption and erythema multiforme. Although fixed drug eruption is primarily a clinical diagnosis, we conducted an oral challenge test. An oral challenge test with fluconazole (150 mg) was conducted 4 weeks later and it showed similar signs, three hours after intake of the drug. A local provocation test was performed with 10% fluconazole in petrolatum on the left pigmented area and with 10% fluconazole in ethanol on the right pigmented area. For comparison, the same compounds were tested on normal skin of her back. After 15 hours, two red patches developed on both sides of her legs and none developed on her back. A skin biopsy specimen taken from the left popliteal area revealed a lichenoid infiltrate, a basal cell vacuolization, dermal melanophages and a superficial perivascular lymphocytic infiltrate, which were consistent with features of FDE. The drug was dechallenged and the patient was treated antihistaminics and steroids. Contrary to this case, most of the previous studies done on FDEs caused by drugs had demonstrated higher occurrences in men as compared to those seen in women [4]. In the previous studies, all female patients were prescribed fluconazole for vaginal candidiasis, while male patients were prescribed fluconazole for Candida balanitis [5]. Cross-reactions may occur with structurally related agents such as itraconazole [6]. In almost all the cases, eruptions had occurred after a couple of drug administrations [7,8]. The only common medication which was used by the patients was fluconazole. The sites which were most affected for eruptions were limbs, palmar and plantar areas, as well as the oral cavity and lips [5–8]. Fluconazole is a commonly used antifungal agent, and a fixed drug eruption should be considered as a possible adverse effect of its use. This case highlights the importance of taking a comprehensive history of medication use and construction of a medication diary by the patient, to ascertain the occurrence of the eruptions after self-administering doses of fluconazole, when cutaneous adverse reactions are being examined.

Outcomes of Natalizumab Therapy in Crohnʼs Disease: Case Studies from Clinical Practice

Purpose: We assessed the efficacy of natalizumab in adults with refractory Crohn's disease (CD) in a tertiary care center. Methods: Retrospective case analysis of CD patients treated with natalizumab from 2008-2011 at a tertiary referral center identified using an IRB-approved clinical data repository. Patients were refractory to or intolerant of conventional medical therapy, including at least one anti-TNF. Natalizumab (300 mg) was infused every 4 weeks. Treatment response was assessed by physician global assessment and the Harvey Bradshaw index. Quality of life was assessed with the Short Inflammatory Bowel Disease Questionnaire. Colonoscopy or capsule endoscopy was used at the discretion of the provider to assess for mucosal healing using the Froslie Simple Endoscopic Score. Results: Ten patients received treatment with Natalizumab. Mean age at diagnosis was 23.6±14.1 years. Eight patients were women. Median disease duration was 13 years (range, 4-20). Nine patients had ileocolonic, and one patient had colonic disease location; three had upper tract disease, and six had perianal disease. Disease phenotype was inflammatory in three, stricturing in three, and penetrating in four patients. Five patients had extraintestinal manifestations. Median duration of natalizumab therapy was 33.5 months (range, 17-48). Four patients responded, four patients did not respond, and two patients experienced severe acute infusion reactions requiring discontinuation of natalizumab. Three patients underwent follow up endoscopy; two had mucosal healing, and one had no improvement in endoscopic activity. Six patients were tested for JC virus antibody after initiating therapy. One patient was positive, but continued natalizumab because of the excellent response to therapy. Adverse events included Varicella-zoster requiring hospitalization, recurrent vaginal candidiasis, worsening of CD (n=2), nasopharyngitis, and headache (n=3). No patients developed progression multifocal leukoencephalopathy. Conclusion: In a tertiary referral center, 40% of patients experience a durable clinical response to natalizumab. Serious infusion reactions occurred in 20%, necessitating drug withdrawal, and one patient experienced a serious opportunistic infection. The lower response rate than observed in clinical trials should be interpreted with caution, given the small sample size and the treatment refractory nature of the patient population. Further research is needed to detail the experience of natalizumab in clinical practice.

Development of a novel synergistic thermosensitive gel for vaginal candidiasis: An in vitro, in vivo evaluation

The singular aim of the proposed work is the development of a synergistic thermosensitive gel for vaginal application in subjects prone to recurrent vaginal candidiasis and other microbial infections. The dual loading of Itraconazole and tea tree oil in a single formulation seems promising as it would elaborate the microbial coverage. Despite being low solubility of Itraconazole in tea tree oil, a homogeneous, transparent and stable solution of both was created by co-solvency using chloroform. Complete removal of chloroform was authenticated by GC–MS and the oil solution was used in the development of nanoemulsion which was further translated into a gel bearing thermosensitive properties. In vitro analyses (MTT assay, viscosity measurement, mucoadhesion, ex vivo permeation, etc.) and in vivo studies (bioadhesion, irritation potential and fungal clearance kinetics in rat model) of final formulation were carried out to establish its potential for further clinical evaluation.

Increased Diversity of Fungal Flora in the Vagina of Patients with Recurrent Vaginal Candidiasis and Allergic Rhinitis

Recurrent vaginal candidiasis (RVC) is considered to be a hypersensitivity disorder that is associated with allergic rhinitis (AR) in immune deficiencies; however, whether or not the composition of the vaginal fungal flora in patients with AR and RVC is altered and if such alterations in patients with AR are associated with the development of RVC remain unclear. In the present study, a cultivation-independent method with the 18S rRNA gene clone library was used to analyze the diversity and composition of the vaginal fungal flora in patients with AR and RVC and to explore the association. Three fungal phyla (Ascomycotae, 22 out of 28; Basidiomycetes, 5 out of 28; and Oomycetes, 1 out of 28) were identified from groups of healthy volunteers, patients with AR, patients with RVC, and patients with RVC complicated by AR, including 28 phylotypes of fungal flora (10, 15, 17, and 21 phylotypes for each group, respectively). The predominant genera of fungi identified in the vagina included Candida, uncultured fungi, and Dothideomycetes. An increased proportion of Candida albicans accompanied with decreased proportions of Saccharomyces cerevisiae and uncultured fungi was observed in patients with AR or RVC (P < 0.05). Candida glabrata, Eladia saccula, Trichosporon jirovecii, and Phytophthora spp. occurred simultaneously in the three patient groups. The composition of the fungal communities in the four groups was statistically different (P < 0.001). The vaginal fungal diversity in patients with AR or RVC was significantly higher compared with healthy volunteers (P < 0.05). The data revealed an increased diversity and varied composition of the vaginal fungal flora in patients with AR and RVC and indicated that disturbed vaginal fungal flora in patients with AR might be correlated with disease progression in patients with RVC.

P51 Patient-reported effects of vaginal lactose as a prebiotic for bacterial vaginosis

BackgroundBacterial vaginosis (BV) is a common, frequently recurrent condition typically treated with oral metronidazole. Using lactose as a vaginal prebiotic to support Lactobacilli growth and lactic acid production is a...

Dramatic scenario of urogenital Candida albicans in presence of Lactic acid bacteria (LAB)

Yeast infections of the vagina are more prevalence and frequently recurring problem of women. Such infections are caused primarily by Candida albicans and apparently occur when the environmental balance in the-vagina is disturbed. Lactobacillus acidopbilus restricts the growth of pathogenic microorganisms per se displayingwide inhibitory spectrum substances. Fifteen (30%) C. albicans isolates were obtained through 50 vaginal swabs from patients who visited the obstetrics and Gynecology clinic departments of hospitals in Baghdad city during the period of March to July 2010. Local isolates of L. acidophilus was evaluated as antifungal activity against vaginal isolates of C. albicans. Such activity was comprised with common four antifungal agents (Nystatine, Fluconazol, Griseofulvin and Amphotricin B). Susceptibility of C. albicans isolates to L. acidophilus bacteria were determined by means of disc diffusion assay. Results of susceptibility were showed in-vitrothat all isolates 15 (100%) sensitive to Nystatine after cultivation on ESDA agar at 37°C for 24 h. Sensitivity of C. albicans to L. acidophilus suspension was less than Nystaine but still high with 13 sensitive isolates (86.6%). Fluconazol and Griseofulvin antifungal agents were showed same susceptibility of 10 sensitive isolates (66.6%) against C. albicans growth, while Amphotricin B had relatively low sensitivity with 7 isolates (46.5%). All results of susceptibility are being detected by the importance of L. acidophilus bacteria in re equilibrium normal flora of vagina that prevent or reduce the chances of vaginal infection especially recurrent vaginal candidiasis (RVC) cases. Also the findings of the study suggest that using of yoghurt as local application can be an important role to reduce or prevent RVC cases, and this can be verify by continuous efforts to make sure of probiotic effects of lactobacilli species. Key words: Lactobacillus acidophilus, Candida albicans, vaginitis.

Efficiency of Lyticase (Bacterial Enzyme) in Experimental Candidal Vaginitis in Mice

Lyticase (a bacterial enzyme) was tested as a new antimycotic drug. Of all objects studied, Cellulomonas cellulans AC-870 strain proved to be most productive for this enzyme. A technology for lyticase isolation and purification was proposed. An experimental model of recurrent vaginal candidiasis was created. The model includes combined antibiotic and estradiol therapy. Antimycotic effect of lyticase on the model of recurrent vaginal candidiasis in mice was demonstrated.

T cells specific for Candida albicans antigens and producing type 2 cytokines in lesional mucosa of untreated HIV-infected patients with pseudomembranous oropharyngeal candidiasis

Factors influencing the susceptibility to mucosal candidiasis in HIV-infected patients are not clearly understood. Since in animal models of candidiasis the T helper (Th)1- or Th2-responses are protective or non-protective, respectively, this study was aimed to evaluate the cytokine profile of T-cell response to Candida albicans in the blood and lesional tissues of human immunodeficiency virus (HIV)-infected individuals, suffering, or not, from pseudomembranous oropharyngeal candidiasis (POPC), of HIV-negative women suffering from recurrent vaginal candidiasis (RVC) and of healthy controls. Peripheral blood mononuclear cells from HIV-infected and RVC patients proliferated to C. albicans antigen more than controls. Upon antigen activation, T cells from HIV-infected patients produced low interferon (IFN)-γ, while only T cells from patients with POPC displayed high interleukin (IL)-4 and IL-5 production. POPC-positive patients also showed higher serum IgE levels than POPC-negative patients. T-cell clones generated from the oral mucosa of one HIV-infected patient with POPC produced IL-4, but not IFN-γ (Th2 phenotype), whereas clones obtained from vaginal mucosa from one RVC patient or one healthy donor showed a Th1 profile. These findings, showing a non-protective Th0/Th2 response to C. albicans antigen in the blood and lesional mucosa of HIV-infected patients with POPC, may explain the high susceptibility of candidiasis in these subjects.

REINVESTIGATION OF PATIENTS WITH A DIAGNOSIS OF INTERSTITIAL CYSTITIS: COMMON THINGS ARE SOMETIMES COMMON

We tested the accuracy of the diagnosis and the value of each step of the diagnostic process in a group of patients undergoing reinvestigation of interstitial cystitis (IC). A total of 61 patients with a provisional diagnosis of IC underwent systematic reinvestigation by a pathway involving a thorough history and physical examination, a rigorous search for urinary infection, frequency volume records, urodynamics and cystoscopy under general anesthesia. Abnormalities detected in the course of this pathway were treated before proceeding with further investigation. The diagnosis of IC was confirmed or considered possible in only 34 cases (55%). Common alternative diagnoses included recurrent urinary tract infections, detrusor overactivity and vaginal candidiasis. Of 5 male patients only 1 was confirmed to have IC. The original diagnosis was overturned by history and physical examination (including urine cultures) in 11 cases, by urodynamic investigation in 11 and by cystoscopy in 5. While IC remains a diagnosis of exclusion, active exclusion of all possible causes of similar symptoms using a thorough investigative algorithm is imperative. Urodynamic investigation, together with a thorough history and physical examination, remains an important component of the diagnostic pathway.

Association between atopy and recurrent vaginal candidiasis.

To determine whether there is an association between atopy and recurrent vaginal candidiasis (RVC) and to evaluate the type-2 immune response in patients with RVC. Evaluation of immediate hypersensitivity skin tests to aeroallergens, measurement of total IgE and Candida albicans specific IgE and levels of IL-5 in 44 women with RVC and 26 with sporadic vaginal candidiasis (SVC). Statistical analyses were performed by Mann-Whitney test and chi(2) test with Yates correction. History of atopy (68%) and positive skin test (42%) were higher (P < 0.05) in RVC than in patients with SVC. No significant difference was found in total IgE, C. albicans specific IgE and IL-5 levels. There was a strong association between atopy and RVC, but type-2 immune response to C. albicans antigen was absent or similar in the two groups of patients.

Successful Treatment of Refractory Recurrent Vaginal Candidiasis with Cetirizine Plus Fluconazole

To determine the prevalence of allergy in patients with recurrent vaginal candidiasis (RVC) and the efficacy of fluconazole in combination with an antihistamine drug in RVC patients who do not respond to fluconazole alone. Participants in the study included 24 women with RVC. All subjects filled out an International Study of Asthma and Allergies in Childhood questionnaire and 23 performed skin prick tests for immediate type 1 hypersensitivity as part of atopy assessment. All subjects were treated with fluconazole 150 mg weekly and were followed every 2 months for 6 months. Those who did not respond to fluconazole alone received cetirizine 10 mg daily in addition to the antifungal medication and were followed up for 6 months. The majority of women had a history of allergy (60%) and 10 of them (43%) had at least 1 positive result of a skin prick test to aeroallergens. Nineteen patients (79%) responded to fluconazole alone. The 5 patients who remained with symptoms had a medical history of allergy and obtained remission when cetirizine was associated with fluconazole. Patients with RVC refractory to standard antifungal therapy and a history of allergy may respond to the combination of antihistamine and antifungal therapy.

Post-menopausal recurrent vaginal candidiasis: effect of hysterectomy on response to treatment, type of colonization and recurrence rates post-treatment

Introduction: Post-menopausal patients are still susceptible to be colonized by fungal organisms despite being estrogen-deprived. Symptomatic vulvovaginal candidiasis, although a rare occurrence in post-menopausal patients, can be diagnosed in about one third of the patients. The purpose of our study was to investigate in post-menopausal patients with recurrent vulvovaginal candidiasis the effect of hysterectomy on response to treatment, the type of colonization and the recurrence rates after treatment. Materials: Forty-seven menopausal patients with symptomatic recurrent vulvovaginal colonization were evaluated between January 1995 and August 2002. The study was a retrospective cohort chart review and included complete history and physical examination, basic metabolic blood panel, colposcopy, wet mount, bacterial and fungal cultures. Twenty-three patients had hysterectomy and 24 were not hysterectomized. All the patients received daily fluconazole therapy for 30 days. They were then re-evaluated at 1, 3 and 6 months and retreated if symptomatic and culture positive. Results: The 2 groups of patients were comparable regarding age, number of years of recurrent colonization, number of previous antifungal treatments and previous, current use of hormone replacement therapy. None used vaginal douching. The 2 groups of patients showed statistical differences regarding: colonization by Candida albicans ( P < 0.01), colonization by Candida glabrata ( P < 0.05), colonization by Candida stelloidea ( P < 0.01), recurrence after 3 months ( P < 0.05) and 6 months ( P < 0.05), response to one course of therapy ( P < 0.02) and need for multiple treatments ( P < 0.03). Conclusions: Hysterectomized post-menopausal patients with recurrent vulvovaginal fungal colonization seems to be more propense to harbor more aggressive and resistant fungi. Post-menopausal recurrent vaginal candidiasis: effect of hysterectomy on response to treatment, type of colonization and recurrence rates post-treatment.

Glucose tolerance in pregnant women with vaginal candidiasis

BackgroundThe use of traditional historic risk factors to identify gestational diabetes mellitus (GDM) will miss half of women with gestational diabetes mellitus. Our aim was to evaluate whether impaired glucose tolerance is a risk factor for vaginal candidiasis in pregnant women.Patients and MethodsIn a cross-sectional study, we compared the prevalence of impaired glucose tolerance in 64 pregnant women with vaginal candidiasis (positive microscopy) and 59 Candida-negative control subjects. Subjects underwent standardized 75-gram oral glucose tolerance testing between the 24th and 28th weeks of their pregnancies. Patients were included only if they had no known diabetes mellitus or historic risk factors for gestational diabetes mellitus, and had not been receiving antibiotic or steroid therapy. We compared glucose levels at fasting, 30 minutes, 60 minutes and 120 minutes, and perinatal and neonatal outcomes in the two groups.ResultsThere were no statistical differences between cases and controls in demographic characteristics. Glucose concentrations were higher in pregnant women with vaginal candidiasis than in control subjects at fasting (89 vs. 84 mg/dL, P=0.021), 30 minutes (139 vs. 126 mg/dL, P=0.050), and 60 minutes (124 vs. 106 mg/dL, P=0.018) after intake of 75 gram of glucose. The two groups did not differ in glucose level at 120 minutes after glucose administration. Gestational diabetes prevalence was 3.1% and 3.4% in the study and control group, respectively (P=0.274).ConclusionThe tolerance to glucose in pregnant women with vaginal candidiasis seems discretely impaired.