Symptomatic Vulvovaginal Candidiasis Research Articles

Efficacy and safety of oral ibrexafungerp in Chinese patients with vulvovaginal candidiasis: a phase III, randomized, double-blind study.

To evaluate the efficacy and safety of oral ibrexafungerp (HS-10366) versus placebo in Chinese patients with vulvovaginal candidiasis (VVC). A double-blind, placebo-controlled, randomized, multicenter phase III study was conducted in symptomatic VVC patients. Patients received (2:1) twice-daily oral ibrexafungerp 300mg or matching placebo for 1day. The primary endpoint was clinical cure (vulvovaginal signs and symptoms [VSS] score = 0) at test-of-cure (TOC) on day 11 ± 3. The secondary endpoints included mycological eradication, overall response, and clinical improvement (VSS score ≤ 1) at TOC, and vulvovaginal symptom resolution at follow-up on day 25 ± 4. In total, 360 patients were included in the modified intention-to-treat set (defined as positive Candida cultured and receiving at least one study drug; 239 for ibrexafungerp, 121 for placebo). Compared with placebo, patients receiving ibrexafungerp had a significantly higher proportion of clinical cure (51.0% vs. 25.6%), mycological eradication (55.6% vs. 18.2%), overall response (33.9%, vs. 8.3%) at TOC and complete symptom resolution (74.5% vs. 39.7%, all P < 0.001) at follow-up. Subgroup analysis of clinical cure indicated that patients with C. albicans could benefit from ibrexafungerp over placebo. A similar benefit trend was also observed in those with non-albicans Candida by post-hoc analysis. Further analyses revealed similar efficacy of ibrexafungerp between patients with fluconazole non-susceptible C. albicans and fluconazole susceptible C. albicans regarding clinical cure and mycological eradication. Ibrexafungerp was generally well tolerated. Adverse events were primarily gastrointestinal and were mainly mild in severity. As a first-in-class antifungal agent, ibrexafungerp demonstrated promising efficacy and favorable safety for VVC treatment in Chinese patients. CHINADRUGTRIALS.ORG. CTR20220918.

Molecular identification of Candida spp. isolated from women withvulvovaginal candidiasis in Koya District, Iraq

Vulvovaginal candidiasis (VVC) is the second most common vaginal infection among women of reproductive age. It is an opportunistic mucosal infection. Candida species causes VVC, which affects millions of women annually. The objective of this study was to isolate and identify the species of Candida from married women who had VVC attending Shahid Doctor Khalid Hospital &amp; Haji Qader Health Centre in Koya, Iraq using traditional and molecular methods. This research was carried out, from December 2021 to May 2022; 150 vaginal swabs from married patients with symptoms of VVC were collected. Swabs were microscopically examined, grown on Sabouraud Dextrose Agar (SDA), and HiCrome™ Candida Differential agar and Germ Tube Test were used to identify Candida isolates. Next, the results were validated using the molecular method called polymerase chain reaction (PCR) to amplify and detect the ITS region in this study. The chitin synthase gene (CHS1) confirmed all C. albicans isolates. Out of the150 vaginal swabs gathered, 84 (56%) cases were positive for vaginal candidiasis. Ages26-30 were found to have the most significant proportion of positive patients, and Women who were pregnant had a more positive culture than women who were not. Identifying six different species of Candida was accomplished through the application of both traditional and molecular techniques in the study; they are C. albicans (88.1%), C. glabrata (4.8%), C. kefyr (2.4%), C. krusei (2.4%), C. parapsilosis (1.2%), and C. tropicalis (1.2%). Finally, we concluded that VVC was shown to be prevalent in Koya city, with the predominant species as C. albicans among all other species.

Zinc prevents vaginal candidiasis by inhibiting expression of an inflammatory fungal protein.

Candida causes an estimated half-billion cases of vulvovaginal candidiasis (VVC) every year. VVC is most commonly caused by Candida albicans, which, in this setting, triggers nonprotective neutrophil infiltration, aggressive local inflammation, and symptomatic disease. Despite its prevalence, little is known about the molecular mechanisms underpinning the immunopathology of this fungal infection. In this study, we describe the molecular determinant of VVC immunopathology and a potentially straightforward way to prevent disease. In response to zinc limitation, C. albicans releases a trace mineral binding molecule called Pra1 (pH-regulated antigen). Here, we show that the PRA1 gene is strongly up-regulated during vaginal infections and that its expression positively correlated with proinflammatory cytokine concentrations in women. Genetic deletion of PRA1 prevented vaginal inflammation in mice, and application of a zinc solution down-regulated expression of the gene and also blocked immunopathology. We also show that treatment of women suffering from recurrent VVC with a zinc gel prevented reinfections. We have therefore identified a key mediator of symptomatic VVC, giving us an opportunity to develop a range of preventative measures for combatting this disease.

MALDI-TOF mass spectrometry identification and antifungal susceptibility testing of yeasts causing vulvovaginal candidiasis (VVC) in Tebessa (Northeastern Algeria).

Vulvovaginal candidiasis (VVC) alongside with antifungal resistance are becoming a major clinical problem in recent years. A prospective study aimed to evaluate the diversity of yeast strains associated with VVC in Tebessa city (northeastern Algeria) and investigate their susceptibility patterns. Over two months, yeasts were isolated on chromogenic medium from twenty-nine non-pregnant women with symptomatic VVC. The isolates were characterized with MALDI-TOF MS and antifungal susceptibility testing was performed for nine antifungal drugs using SensititreTM YeastOneTM YO10. Twenty-nine non-duplicate yeasts were recovered and the mass spectrometry profiles showed reliable scores of which four genera and five different species were identified. Candida albicans accounted for 65.5 % (n = 19) of the total number of isolates, followed by C. glabrata with 20.7% (n = 6). For the remaining non-albicans Candida (NCA) species, Kluyveromyces marxianus with 6.9% (n = 2), Pichia kudriavzevii and Saccharomyces cerevisiae with one isolate each. The antifungal susceptibilities showed wild type MICs of C. albicans to amphotericin B, azoles and echinocandins. In addition, four C. albicans isolates were resistant to flucytosine. For C. glabrata isolates, 100% non-WT phenotype was found for both posaconazole and itraconazole. For the very first time, the obtained outcomes bring out new data concerning the epidemiology of yeasts causing VVC in Algeria and their antimicrobial susceptibility profiles.

“Efficacy and safety of oteseconazole in recurrent vulvovaginal candidiasis (RVVC) – A systematic review and meta-analysis"

BackgroundRecurrent Vulvovaginal Candidiasis (RVVC) is defined as 3 or more episodes of symptomatic Vulvovaginal Candidiasis (VVC) within a year. Out of 75 % of women with VVC, this debilitating infection is experienced by 9 % of women. Although standard guidelines recommend oral and topical fluconazole as its treatment regimen, approval of another drug Oteseconazole has drawn the attention because of its better safety profile and lower recurrence rate by its use. AimThe purpose of our Meta-analysis is to evaluate the safety and efficacy of Oteseconazole (Vivjoa) (VT-1161) in the treatment of Recurrent Vulvovaginal Candidiasis (RVVC). MethodologyFour databases namely PubMed, Google Scholar, Cochrane CENTRAL and Clinical Trial.gov were used from inception till June 2023. Studies that met the predefined inclusion criteria were statistically analyzed on RevMan (Version 5.4). A random effect model was used to pool the studies. A p value of less than 0.05 was considered significant and results were presented as Odds ratio with 95 % Confidence Intervals (CIs). ResultThe pooled analysis of our selected studies showed that Oteseconazole was associated with significantly reduced incidence of Recurrent Vulvovaginal Candidiasis (OR = 0.07; 95 % CI = 0.05–0.11; p < 0.00001, I2 = 0 %) through week 48. Additionally, Vivjoa has also been shown by our analysis to reduce incidence of RVVC through week 24. (OR = 0.05; 95 % CI = 0.03–0.09; p < 0.00001, I2 = 0 %) Furthermore, Oteseconazole was non-significantly associated with developing serious adverse effects during the treatment for Recurrent Vulvovaginal Candidiasis in comparison to the placebo (OR = 0.79; 95 % CI = 0.33–1.89; p = 0.60, I2 = 0 %). ConclusionThe available evidence suggests Oteseconazole to be safer and more efficacious. However, limited patient population points towards the need of further large and dedicated trials for definitive conclusion.

Uncovering the Yeast Diversity in the Female Genital Tract: An Exploration of Spatial Distribution and Antifungal Resistance.

Candida albicans is the leading cause of vulvovaginal yeast infections; however, other species are becoming relevant in this niche. The spatial distribution of these fungi in the female genital tract remains poorly understood. In this study, swab samples were collected from 33 patients, first from the anterior vulva and then from the upper third and right lateral wall of the vagina: 16 were with symptoms of vulvovaginal candidiasis and 17 were without characteristic symptoms; furthermore, the genus and species of each isolate were identified. In vitro susceptibility testing for fluconazole and clotrimazole was performed for all isolates. Candida albicans was the most common species (63.6%), followed by Rhodotorula spp. (51.5%), and then Candida parapsilosis (15.2%). Rhodotorula spp. and C. parapsilosis were more commonly associated with colonization, and C. albicans with infection. Rhodotorula spp. isolates presented a low susceptibility to fluconazole, with the MIC ranging from 32 to >64 µg/mL. Differences in susceptibility to fluconazole and clotrimazole between the pairs of vaginal and vulvar isolates were found for Candida albicans, Rhodotorula spp., and Nakaseomyces glabratus. The results suggest that different niches may impact the susceptibility profiles of the isolates, as well as their different clinical behaviors.

Vulvovaginal candidiasis and vaginal microflora interaction: Microflora changes and probiotic therapy.

Vaginal microbiome is mutually beneficial to the host and has a significant impact on health and disease. Candida species, including Candida albicans, are part of the mucosal flora of most healthy women. Under suitable conditions, they can live in the vulvovaginal mucosa, resulting in symptomatic vulvovaginal candidiasis (VVC). Based on the analysis of 16S ribosomal RNA gene sequences, great progress has been made in exploring the composition and structure of vaginal bacterial community. Moreover, researchers have conducted several studies on whether vaginal microbiome will change during VVC infection. In addition, it has been reported that vaginal colonization of probiotics in vaginal microorganisms, especially Lactobacillus, can effectively reduce the risk of VVC and treat VVC. This review aims to summarize the changes of vaginal microflora during VVC infection, and further point out the possibility of using lactic acid bacteria as probiotics to treat VVC, so as to reduce the adverse consequences of VVC infection and reduce the expensive treatment cost.

Kandughna Gana Varti in Vulvo Vaginalcandidiasis - A Case Series

Vulvovaginal candidiasis is an infection caused by yeast like micro organisms called candida albicans. It is the second most common cause of vaginitis affecting women of reproductive age group. It is most distressing and irritating to women, hampers their day to day life and makes them irritable, depressed, anxious and disturbs their interpersonal relationships including marital life. In vulvovaginal candidiasis patients complain of vaginal discharge with intense vulvovaginal pruritus. The pruritus is out of proportion to the discharge. The symptoms of vulvovaginal candidiasis appear similar to the symptoms of Slaishmiki yoni vyapath mentioned in Ayurvedic classics. It is due to the vitiation of Kapha caused by usage of Abishyandi aharas and has symptoms like Pichila yonisrava, Kandu, Alpa vedhana or Avedhana in Yoni. Topical treatments have great importance in the treatment of several gynecological conditions (Yoni vyapaths). Yoni varti or vaginal pessary is used to cleanse the vaginal walls and make the local environment more healthy. It acts directly on the vaginal mucosa and enables easier and target specific action. They are also hygroscopic in property and act in accordance with the drugs they contain. Kandughna gana varti have Tiktha, Kashaya rasa, Laghu, Ruksha guna, Krimighna, Kandughna and Kaphaghna properties and all the ingredients have potent antifungal action also. This facilitates faster absorption of drugs through vaginal mucosa and relieves the symptoms more quickly. A pilot study was conducted in 5 cases to assess the effect of Kandughna gana varti in vulvovaginal candidiasis. It was found to be effective in vaginal discharge and vulvovaginal pruritus.

Prevalência de casos de candidíase vulvovaginal no Amazonas, Brasil

Vulvovaginal candidiasis (VVC) is caused by abnormal growth of yeast on the female genital mucosa. We aimed to analyze the prevalence of VVC in Manaus, its association with pre-exposure factors and antifungal resistance. Study conducted in the public healthcare, involved 1226 women aged 13-84 years. The yeasts were isolated and identified using Candifast test. Symptomatic VVC patients were grouped in symptomatic with one episode in year (SVVC) and symptomatic with recurrent VVC (RVVC), had two or more episodes in year. The total vaginal yeast isolation occurred in 231 women (18.86%). Mixed resistance was observed in 39% of patients. The RVVC group (21.6%) had a higher percentage of positive test for Candida spp. than the symptomatic non-recurrent group (13%). The prevalence of non-albicans spp. demostrated the importance of identify the Candida spp. present in infected patients.

Comparison of various regimens of itraconazole in treatment of acute vulvovaginal candidiasis

One of the most striking change in the current scenario is the increasing occurrence of non-albicans vulvovaginal candidiasis (VVC), which is considered as the major cause of recurrence, relapse and chronic VVC in India. In the present study we evaluated the effectiveness of three different regimens of itraconazole in the treatment of acute VVC.The present randomised, three arm comparative clinical study involved 123 women aged 18 years or above with symptomatic acute VVC. These patients were randomised (41 patients in each group) to receive either itraconazole 200 mg twice daily for 1 day (group I), 200 mg twice daily for 2 days (group II) or 100 mg twice daily for 3 days (group III). Effectiveness was evaluated on the basis of clinical cure (total symptom score), mycological cure (negative KOH test). All the groups were effective in relieving signs and symptoms (p&amp;#60;0.05), but on comparison between all groups, there was statistical difference between Group II and Group I &amp; III (p&amp;#60;0.05) and Group III &amp; I (p&amp;#60;0.05). Complete cure i.e. disappearance of signs and symptoms and negative KOH test was maximum in group II (44%) as compared to groups I (12%) and III (17% of the patients). Relapse was least in seen in 11 patients (27%) in Group I, 3 patients (7%) in Group II and 7 patients (17%) in Group III. All the 3 regimens were well tolerated.In the present study, 2 day high dose itraconazole therapy was found to have better effectiveness compared to conventional regimens. Longer duration of therapy might be required to attain even better cure rates, especially when the incidence of Non Albicans vulvovaginal candidiasis is rising in all parts of the country.

ASSOCIATION BETWEEN PESARIUM INSTALLATION AND VULVOVAGINAL CANDIDIASIS INCIDENT

AbstractBackground: Vulvovaginal candidiasis (VVC) is one of the lower female genital tract infections caused by Candida sp. The Symptoms of VVC are more production of yellowish-white secretions, irritation, odor, itching in the genitals to swelling. One of the risk factors triggering CVV is the use pessaries in patients with uterine prolapse. This study aims to determine the relationship between pessary installation and Vulvovaginal Candidiasis (VVC) incident. Methods: this research uses a cross sectional study with a sampling technique that is purposive sampling. The sample used was POP patients with pessaries who visited Dr. Hospital. Soetomo in 2018 as many as 68 patients. The primary data in this study is a research form that has been prepared by the researcher, while the secondary data is patient medical records. Data analysis used the Chi-Square test with a Prevalence Ratio (PR) of 95% CI. Results: This study showed that the incidence of CVV was most commonly found in women aged &gt;45 years with most of them being in primary education, using a pessary for more than 3 months and being a housewife, meanwhile the incidence of CVV was more common in POP women with pessaries than without a pessary. The results of the Chi-Square test showed that have a significant relationship between pessarium installation and the incidence of CVV (p=0.041). Conclusion: there is a relationship between pessary installation in POP patient and vulvovaginal candidiasis incident.

Prevalence and Antifungal Susceptibility Profile of Clinically Relevant Candida Species in Postmenopausal Women with Diabetes.

The incidence of diabetes mellitus has increased in Saudi Arabia, which has raised the risk of vulvovaginal candidiasis (VVC). This study highlights the prevalence and antifungal susceptibility of Candida species among postmenopausal women with diabetes with symptoms of VVC in Taif, a city in Saudi Arabia. Several diagnostic tools were used to differentiate the yeast isolates, including microscopic examination, culture morphology on CHROM agar, further confirmation with the VITEK 2 system, and ITS1 and ITS4 region sequencing. Antifungal susceptibility of the selected Candida species was determined using the VITEK 2 system (bioMérieux Inc., USA). Out of the 550 high vaginal swabs investigated, 86 specimens were Candida species positive (15.6%) with a significant difference according to age; the positivity in the 45–50 years' age group (12%) was higher than that in the 51–55 years' age group (3.6%). Candida albicans was the most common causative agent in 51 samples (59.3%), followed by C. glabrata in 21 samples (24.41%) and C. krusei in 14 samples (16.27%), with no significant differences between the age groups. Three isolates, including two C. albicans and one C. krusei, exhibited resistance against all the tested antifungal agents. CHROM agar and VITEK 2 were accurate phenotypic tools to identify Candida species with 100% sensitivity and specificity and were consistent with the phylogenetic characterization. The data emphasized the importance of identifying Candida species and their antifungal susceptibility among postmenopausal women with diabetes, highlighting the potential risk posed by diabetes in this age group.

Epidemiology, risk factors and antimicrobial profile of Vulvovaginal Candidiasis (VVC): A study among women in the central region of Saudi Arabia

BackgroundCandida spp. is a fungal resident of the normal microbiota of gastrointestinal tract, reproductive mucosa and oral cavity. Hence, a majority of the healthy population may be prone to the most common fungal infection such as candidiasis that can be caused by any species of Candida. In women, vaginitis or vulvovaginal candidiasis (VVC) forms a significant part of urogenital infections with a high recurrence rate thus posing a public health issue worldwide. ObjectivesThe aim of this study was to determine the prevalence of VVC, its possible risk factors and the antifungal susceptibility of the species isolated from women attending a hospital in the central region of Saudi Arabia. MethodsSamples of high vaginal swabs (HVS) were obtained from 208 women aged 15–64 years with signs and symptoms of VVC. The samples were cultured on Sabouraud agar plates (SDA) and incubated at 30°C for 10 days. Candida spp. were initially identified using morphologic characteristics, wet mount, germ tube test and finally confirmed with Vitek 2. ResultsAmong the samples, 34% were culture positive. Out of the positive samples, 68% were Candida albicans, followed by C. tropicalis (27%) and C. glabrata (2.7%). Majority of the C. albicans (16%) were observed in women between ages of 21–30 years. All the isolates were sensitive to the antifungals tested. Also, the presence of Candida spp. did not correlate to risk factors such as pregnancy, diabetes and use of antibiotics. ConclusionsPrevalence of vulvovaginal candidiasis was observed in the central region of Saudi Arabia with the predominant organism as Candida albicans.

Vulvovaginitis Caused by Candida Species Following Antibiotic Exposure.

Goal was to review epidemiology, pathophysiology, and prevention of post-antibiotic Candida vulvovaginitis (VVC). Antibacterial therapy, whether systemic or locally applied to the vagina, represents the single most frequent and predictable cause or triggering mechanism of symptomatic vulvovaginal candidiasis (VVC). Such initiating mechanisms may precipitate sporadic or recurrent episodes of VVC. In spite of this widely recognized association, the exact mechanism whereby antibiotics of all classes cause acute exacerbation of symptomatic vaginal disease remains largely unstudied and therefore largely unknown. Pathophysiology is hypothesized to be reduction or alteration of vaginal microbiome restraints of yeast colonization, proliferation, and expression of virulence characteristics. The predictable link between antibiotic use and post-antibiotic VVC affords practitioners an opportunity for timely intervention using selective, convenient antimycotics usually drugs but possibly probiotic measures. Indications and limitation of these steps are discussed.

Antifungal Resistant in Non-Albicans Candida Species are Emerging as a Threat to Antenatal Women with Vulvovaginal Candidiasis

Vulvovaginal candidiasis (VVC) is caused by Candida species. It has been associated with impact on economic cost. Currently, Non-albicans Candida species are more resistant to azoles and get converted from harmless to pathogenic state due to several virulence factors. Monitoring of the antifungal susceptibility pattern is important to know the resistant pattern of Candida species. Thus the objective of this research was to the identification of Candida in species level and to evaluate the antifungal resistance pattern in Candida species isolated from the vaginal discharge of antenatal women with vulvovaginal candidiasis. This prospective study was done in SRM MCH &amp; RC, Chennai, India, from March 2017 and December 2018. An aggregate of 342 vaginal swabs were gathered from antenatal women of symptomatic and asymptomatic VVC. Antifungal susceptibility test was done by the disk diffusion method as per the CLSI guidelines. A total of 112 Candida species were isolated from 342 high vaginal swabs. Out of 112 Candida isolates, 65 (58%) were Non-albicans Candida (NAC) and 47 (42%) were C. albicans. In this study, 103/112(91.6%) of Candida isolates had the highest sensitivity to voriconazole and 26/112(23.2%) of Candida isolates had the highest resistance to miconazole. NAC species are emerging as potential threats to cause infection and posing a therapeutic challenge. Early empirical antifungal therapy and further research to improve diagnostic, prevention and therapeutic strategies are necessary to reduce the considerable morbidity and mortality.

Randomised clinical trial in women with Recurrent Vulvovaginal Candidiasis: Efficacy of probiotics and lactoferrin as maintenance treatment.

Vulvovaginal candidiasis (VVC) is a recurrent vaginal condition in childbearing women. The aim of this study was to assess the efficacy of an oral formulation containing Lactobacillus acidophilus GLA-14, Lactobacillus rhamnosus HN001 and bovine lactoferrin on symptoms and recurrence of VVC as adjuvant therapy to topical clotrimazole. Forty-eight women positive for C. albicans, symptoms of VVC and documented history of recurrences were randomised into 2 groups receiving verum or placebo (2 capsules/day for 5days followed by 1 capsule/day for additional 10days) as adjuvant treatment to clotrimazole (induction phase) followed by a maintenance cycle of 6months (1 capsule/day verum or placebo for 10 consecutive days each month). Symptoms, overall cure rate and recurrence rate were assessed. After clotrimazole therapy, a significant improvement of symptoms was shown in both groups. However, only women treated with probiotics and lactoferrin showed a significant improvement of itching and discharge at 3 and 6months. During the six-month follow-up, recurrences were significantly less in the intervention group vs placebo (33.3% vs 91.7% after 3months and 29.2% vs 100% after 6months). The results show that the investigated lactobacilli mixture in combination with lactoferrin represents a safe and effective adjuvant approach for reducing symptoms and recurrences of RVVC.

Biofilms and vulvovaginal candidiasis.

Candida species, including C. albicans, are part of the mucosal flora of most healthy women, and inhabit the gastrointestinal and genitourinary tracts. Under favourable conditions, they can colonize the vulvovaginal mucosa, giving rise to symptomatic vulvovaginal candidiasis (VVC). The mechanism by which Candida spp. produces inflammation is unknown. Both, the blastoconidia and the pseudohyphae are capable of destroying the vaginal epithelium by direct invasion. Although the symptoms are not always related to the fungal burden, in general, VVC is associated with a greater number of yeasts and pseudohyphae. Some years ago, C. albicans was the species most frequently involved in the different forms of VVC. However, infections by different species have emerged during the last two decades producing an increase in causative species of VVC such as C. glabrata, C. parapsilosis, C. krusei and C. tropicalis. Candida species are pathogenic organisms that have two forms of development: planktonic and biofilm. A biofilm is defined as a community of microorganisms attached to a surface and encompassed by an extracellular matrix. This form of presentation gives microorganisms greater resistance to antifungal agents. This review, about Candia spp. with a special emphasis on Candida albicans discusses specific areas such as biofilm structure and development, cell morphology and biofilm formation, biofilm-associated gene expression, the cell surface and adherence, the extracellular matrix, biofilm metabolism, and biofilm drug resistance in vulvovaginitis biofilms as an important virulence factor in fungi.

Evaluación de los efectos de croton lechleri en la candidiasis vulvovaginal

Introducción. El objetivo del presente estudio fue determinar y comparar los efectos benéficos de Croton Lechleri y clotrimazol en crema en el tratamiento de la candidiasis vulvovaginal, en pacientes del centro de salud del distrito de Pillcomarka, Huánuco. Métodos. Fueron elegidas para el estudio mujeres en edad fértil, con síntomas de candidiasis vulvovaginal y observación de pseudomicelos en la microscopía. Asignamos a las pacientes de forma no aleatoria en 2 grupos de tratamiento tópico; un grupo recibió croton y el otro recibió clotrimazol. Se extrajo una muestra de sangre y orina antes de iniciar y al finalizar el tratamiento. Resultados. Incluimos 30 pacientes en el presente estudio. Del total de remisiones de leucorrea el 44,4% perteneció al grupo experimental (croton) y el 55,6% al grupo control (clotrimazol) [OR=8,68 (IC95% 0,41; 184,28) p &lt; 0,22)], y de las remisiones del prurito el 44,4% perteneció al grupo experimental y el 55,6% al grupo control [OR=8,68 (IC95% 0,41; 184,28) p &lt; 0,22)]. Con respecto a los exámenes microscópico no patológicos el 44,4% perteneció al grupo experimental y el 55,6% al grupo control [OR=0,20 (IC95% 0,02; 2,05) p &lt; 0,22)] y de todos los cultivos no patológicos el 46,4% perteneció al grupo experimental y el 53,6% al grupo control [OR=0,24 (IC95% 0,03; 3,13) p &lt; 0,41)]. Los resultados post tratamiento de la analítica sanguínea y examen orina, no mostraron diferencias significativas en el grupo experimental frente al grupo control. Conclusiones. No hubo diferencias significativas en los resultados post tratamiento del uso de croton frente al uso del clotrimazol.

Prevalence of Vulvovaginal Candidiasis and Treatment with Isoconazol Nitrate

Background : Vulvovaginal candidiasis (VVC) was an infection caused by Candida species that affects millions of women every year. Candida albicans was the main cause of VVC. The development of VVC was usually attributed to the disturbance of the balance between Candida vaginal colonization and host environment by physiological or non-physiological changes. Several host-related and behavioral risk factors have been proposed as predisposing factors for VVC. Host-related factors include pregnancy, hormone replacement, uncontrolled diabetes, immunosuppression, antibiotics, glucocorticoids use and genetic predispositions. Behavioral risk factors include use of oral contraceptives, intrauterine device, spermicides and condoms and some habits of hygiene, clothing and sexual practices. Materials and Methods: A total of 448 women with vaginal infection were studied retrospectively. Yeasts were isolated from the samples of 140 patients with vulvovaginal candidiasis. Routine diagnostic methods were used. A total of 113 patients were included to our treatment protocol. Results and Conclusions: This study provides information about the current state of epidemiology and microbiology of VVC, as well as quite effective treatment of symptomatic and uncomplicated VVC with confirmed by laboratory results with isoconazole nitrate (a single dose of topical creams or vaginal ovules). We believe that all of them, as well as partner co-treatment and perineal hygiene increase the our success.

Comparison of enzymatic activities in different Candida species isolated from women with vulvovaginitis

Comparing the activities of secreted enzymes in different fungal species can improve our understanding of their pathogenic role. Secretion of various enzymes by Candida species has been considered for determination of their virulence in different Candida infections including vulvovaginitis. The aim of this study was to determine and compare the activity of secreted enzymes in Candidia strains isolated from women suspected to vulvovaginal candidiasis (VVC) and referred to some health centers in Khuzestan, Southwestern Iran. The vaginal secretion samples were taken by swap from 250 suspected women with symptoms of vulvovaginal candidiasis and cultured on CHROMagar Candida medium. Identification of the isolated Candida from culture positive samples performed by the color of colonies and some standard mycological procedures. Activities of phospholipase, hemolysin-α, hemolysin-β, esterase and proteinase were measured in vitro by standard laboratory protocols. The enzymatic activity index (EAI) was calculated for each enzyme in accordance to relevant protocols. Totally in eighty cases (32%), a Candida strain was isolated which found to be as 52 (65%) Candida albicans; 12 (15%) C.glabrata; 10 (12.5%) C.dubliniensis; 4 (5%) C.krusei, C.tropicalis and C.parapsilosis species (each=1; 1.3%). Among C.albicans strains, 89.1% produced all studied enzymes, while 86% of C.glabrata strains failed to produce proteinase and phospholipase. The EAIs in decreasing order were as hemolysin-β=0.2895, hemolysin-α=0.5420, esterase=0.5753, proteinase=0.7413, and phospholipase=0.7446, respectively. Activity of phospholipase, esterase and proteinase secreted by C.albicans and C.dubliniensis were significantly more than those released by C.glabrata and C.krusei, while 86% of C.glabrata strains did not show esterase activity. On the other hand, the activity rates of hemolysin α and β among all studied isolates were almost similar. In the present study, the prevalence of VVC among investigated women was higher than the previous report from Khuzestan but C.albicans has yet remained the predominant agent of VVC in this area. Given to the EAI, the virulence of C.albicans in VVC can be mediated by phospholipase, esterase and proteinases.