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Microbial Pathogenesis May 2022Vulvovaginal candidiasis (VVC), a major gynecological disease with high recurrence rate, increases the risk of abortion, intrauterine infection, premature rupture of...
Vulvovaginal candidiasis (VVC), a major gynecological disease with high recurrence rate, increases the risk of abortion, intrauterine infection, premature rupture of membranes, and premature birth in pregnancy. However, the exact pathogenesis of this disease has yet to be elucidated. To facilitate understanding of the pathogenesis of VVC in pregnancy, this study sought to establish an animal model of vaginal infection with Candida albicans in pregnant mice. Female mice were mated with male mice, and female mice were infected with C. albicans at E4.5 (embryonic day 4.5). The weight and abortion rate of pregnant mice at E0.5, E4.5, E8.5, E11.5, and E18.5 were recorded, respectively, as well as the weights of fetus and placenta on E18.5. Fetal weight at E18.5 and the weight growth rate in the experimental mice was lower than those in the control mice, but the placenta weight at E18.5 and the abortion rate in the experimental mice were increased with those of the control mice. Hematoxylin-eosin (H&E) staining, Gomori-Grocott staining and vaginal lavage culturing were conducted to verify that the experimental mice were infected with C. albicans. Differentially expressed gene IL-15 was screened out by polymerase chain reaction (PCR) array between the two groups. Enzyme-linked immunosorbent assay (ELISA) showed that IL-15 expression in plasma of the mice was decreased in the experimental group compared with the control group. RT-qPCR confirmed that IL-15 mRNA expression was increased in placental tissues, while mRNA expression of IL-15R/JAK1-JAK3/PI3K/PDK1/AKT/P70S6K-mTOR was decreased in placental tissues. In conclusion, this study demonstrated that VVC in BALB/c pregnant mice led to a series of adverse pregnancy outcomes that were related to changes in IL-15 and its downstream signaling pathways, which may indicate a potential therapy for VVC during pregnancy in humans.
Topics: Animals; Candida albicans; Candidiasis, Vulvovaginal; Female; Humans; Interleukin-15; Male; Mice; Mice, Inbred BALB C; Placenta; Pregnancy; Pregnancy Outcome; RNA, Messenger
PubMed: 35487480
DOI: 10.1016/j.micpath.2022.105555 -
Journal of Investigative Medicine High... 2022Recurrent vulvovaginal candidiasis is a common disorder which causes significant morbidity among women worldwide, and treatment options are limited. Ibrexafungerp is a...
Recurrent vulvovaginal candidiasis is a common disorder which causes significant morbidity among women worldwide, and treatment options are limited. Ibrexafungerp is a novel antifungal agent which was approved in 2021 for treatment of vulvovaginal candidiasis. We present a case of recurrent vulvovaginal candidiasis successfully treated with ibrexafungerp.
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Female; Fluconazole; Glycosides; Humans; Triterpenes
PubMed: 36059275
DOI: 10.1177/23247096221123144 -
Antimicrobial Agents and Chemotherapy Jan 2024Vulvovaginal candidiasis (VVC) is a common condition among women. Fluconazole remains the dominant treatment option for VVC. Oteseconazole is a highly selective... (Randomized Controlled Trial)
Randomized Controlled Trial
Vulvovaginal candidiasis (VVC) is a common condition among women. Fluconazole remains the dominant treatment option for VVC. Oteseconazole is a highly selective inhibitor of fungal CYP51. This randomized, double-blinded, phase 3 trial was conducted to evaluate the efficacy and safety of oteseconazole compared with fluconazole in treating severe VVC. Female subjects presenting with vulvovaginal signs and symptoms score of ≥7 and positive infection determined by potassium hydroxide test or Gram staining were randomly assigned to receive oteseconazole (600 mg on D1 and 450 mg on D2) or fluconazole (150 mg on D1 and D4) in a 1:1 ratio. The primary endpoint was the proportion of subjects achieving therapeutic cure [defined as achieving both clinical cure (absence of signs and symptoms of VVC) and mycological cure (negative culture of species)] at D28. A total of 322 subjects were randomized and 321 subjects were treated. At D28, a statistically significantly higher proportion of subjects achieved therapeutic cure in the oteseconazole group than in the fluconazole group (66.88% vs 45.91%; = 0.0002). Oteseconazole treatment resulted in an increased proportion of subjects achieving mycological cure (82.50% vs 59.12%; < 0.0001) and clinical cure (71.25% vs 55.97%; = 0.0046) compared with fluconazole. The incidence of treatment-emergent adverse events was similar between the two groups. No subjects discontinued study treatment or withdrew study due to adverse events. Oteseconazole showed statistically significant and clinically meaningful superiority over fluconazole for the treatment of severe VVC and was generally tolerated.
Topics: Female; Humans; Fluconazole; Candidiasis, Vulvovaginal; Antifungal Agents; Candida; Administration, Oral; Candida albicans
PubMed: 38095426
DOI: 10.1128/aac.00778-23 -
Journal of Medicine and Life 2021This was a clinical trial study that aimed to investigate the efficacy of vaginal chlorhexidine gel in the treatment of vulvovaginal candidiasis, bacterial vaginosis,... (Clinical Trial)
Clinical Trial
This was a clinical trial study that aimed to investigate the efficacy of vaginal chlorhexidine gel in the treatment of vulvovaginal candidiasis, bacterial vaginosis, and nonspecific vaginitis. The study population included patients who complained of vaginal discharge and presented to our University Gynecology Clinic. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software. The student t-test and Mann-Whitney U test were used to analyze the quantitative and ordinal data, respectively. In order to analyze the qualitative data, the Chi-square or Fischer's exact tests were used. The mean satisfaction score in the vulvovaginal candidiasis patients who received chlorhexiine vaginal gel was 9.06 and 8.29 in the patients who received clotrimazole vaginal cream. The Mann-Whitney test did not show a statistically significant difference between mean scores of VAS in these two groups with vulvovaginal candidiasis (P=0.027). Among the patients with bacterial vaginosis, the mean satisfaction score was 8.91 in the chlorhexidine vaginal gel group and 8.72 in the metronidazole tablet group (P=0.607). In the nonspecific vaginitis group, the mean satisfaction score was 8.83 in the chlorhexidine vaginal gel group and 9.17 in the combination group (metronidazole + clotrimazole vaginal cream)(P=0.401). The highest mean visual analog scale score (VAS) score was documented in the combination therapy group. We found that chlorhexidine vaginal gel is a more effective method for the treatment and improvement of vaginal infections. The benefits of chlorhexidine gel have a positive therapeutic effect as a single drug in nonspecific vaginitis, rather than simultaneous administration of two agents.
Topics: Adult; Candidiasis, Vulvovaginal; Chlorhexidine; Clotrimazole; Drug Therapy, Combination; Female; Humans; Metronidazole; Patient Satisfaction; Vaginosis, Bacterial; Visual Analog Scale; Vulvovaginitis
PubMed: 34104249
DOI: 10.25122/jml-2019-0160 -
The Cochrane Database of Systematic... Feb 2015Genital tract infection is associated with preterm birth (before 37 weeks' gestation). Screening for infections during pregnancy may therefore reduce the numbers of... (Review)
Review
BACKGROUND
Genital tract infection is associated with preterm birth (before 37 weeks' gestation). Screening for infections during pregnancy may therefore reduce the numbers of babies being born prematurely. However, screening for infections may have some adverse effects, such as increased antibiotic drug resistance and increased cost of treatment.
OBJECTIVES
To assess the effectiveness of antenatal lower genital tract infection screening and treatment programs for reducing preterm birth and subsequent morbidity.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2014, Issue 7) and reference lists of retrieved reports.
SELECTION CRITERIA
We included all published and unpublished randomised controlled trials in any language that evaluated any described methods of antenatal lower genital tract infection screening compared with no screening.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked for accuracy.
MAIN RESULTS
One study (4155 women at less than 20 weeks' gestation) met the inclusion criteria. The intervention group (2058 women) received infection screening and treatment for bacterial vaginosis, trichomonas vaginalis and candidiasis; the control group (2097 women) also received screening, but the results of the screening program were not revealed and women received routine antenatal care. The rate of preterm birth before 37 weeks' gestation was significantly lower in the intervention group (3% versus 5% in the control group) with a risk ratio (RR) of 0.55 (95% confidence interval (CI) 0.41 to 0.75; the evidence for this outcome was graded as of moderate quality). The incidence of preterm birth for infants with a weight equal to or below 2500 g (low birthweight) and infants with a weight equal to or below 1500 g (very low birthweight) were significantly lower in the intervention group than in the control group (RR 0.48, 95% CI 0.34 to 0.66 and RR 0.34; 95% CI 0.15 to 0.75, respectively; both graded as moderate quality evidence). Based on a subset of costs for preterm births of < 1900 g, the authors reported that for each of those preterm births averted, EUR 60,262 would be saved.
AUTHORS' CONCLUSIONS
There is evidence from one trial that infection screening and treatment programs for pregnant women before 20 weeks' gestation reduce preterm birth and preterm low birthweight. Infection screening and treatment programs are associated with cost savings when used for the prevention of preterm birth. Future trials should evaluate the effects of different types of infection screening programs.
Topics: Candidiasis, Vulvovaginal; Female; Humans; Pregnancy; Premature Birth; Trichomonas Vaginitis; Vaginosis, Bacterial
PubMed: 25922860
DOI: 10.1002/14651858.CD006178.pub3 -
Infectious Diseases in Obstetrics and... 2019species colonize the vagina in at least 20% of women, with rates rising to 30% during pregnancy. This study aimed at determining the prevalence and risk factors of...
OBJECTIVE
species colonize the vagina in at least 20% of women, with rates rising to 30% during pregnancy. This study aimed at determining the prevalence and risk factors of vulvovaginal candidiasis (VVC) in pregnant women at 35-37 weeks of gestation. It also aims at finding possible correlations between VVC and vaginal colonization by other agents, such as Group B (GBS) and bacterial vaginosis.
METHODOLOGY
Over a one-year period, high vaginal swabs were collected from pregnant women during their regular antenatal checkup in different polyclinics in Beirut and South Lebanon. Swabs were examined microscopically, cultured on Sabouraud Dextrose Agar, and isolates were identified using Chromatic medium and Germ Tube Test.
RESULTS
VVC was detected in 44.8% of samples, with (44.4%) and (43.4%) being the most isolated species. Approximately, half of pregnant women (57.7%) were coinfected with and bacterial vaginosis, while 26% of them carried simultaneously spp. and GBS. No significant correlation was found between the occurrence of VVC and demographic, clinical, medical, and reproductive health characteristics of pregnant women. In contrast, participants with previous miscarriages and those being hospitalized during the past 12 months were more susceptible to develop vaginal infection in comparison to other species (p=0.0316 and p=0.0042, respectively).
CONCLUSION
The prevalence of VVC in pregnant women is an increasing trend in our community. Therefore, routine medical examination and regular screening for candidiasis in the antenatal care program is highly recommended to manage the disease and its complications.
Topics: Adult; Candida; Candidiasis, Vulvovaginal; Female; Humans; Lebanon; Pregnancy; Pregnancy Complications, Infectious; Prevalence; Risk Factors; Vagina; Young Adult
PubMed: 31467477
DOI: 10.1155/2019/5016810 -
Microorganisms Oct 2022spp. generally dominate the vaginal microbiota and prevent pathogen adhesion and overgrowth, including spp., by various mechanisms. Although spp. can be commensal, in...
spp. generally dominate the vaginal microbiota and prevent pathogen adhesion and overgrowth, including spp., by various mechanisms. Although spp. can be commensal, in certain conditions they can become pathogenic, causing vulvovaginal candidiasis. The insurgence of candidiasis is related to the expression of virulence factors, including morphologic switching and biofilm formation. Germ tubes, pseudohyphae, and hyphae promote tissue invasion, biofilms increase persistence and are often resistant to antifungals and host immune response. Here, we explored the inhibitory activity of vaginal strains belonging to , , , and species towards virulence factors. With the aim to investigate the interrelation between mode of growth and functionality, supernatants were collected from lactobacilli planktonic cultures and, for the first time, from adherent ones, and were evaluated towards dimorphic switching and biofilm. biofilms were analyzed by multiple methodologies, i.e., crystal violet staining, MTT assay, and confocal microscopy. supernatants reduce switching and biofilm formation. Importantly, supernatants showed the best profile of virulence suppression, especially when grown in adherence. These results highlight the role of such species as a hallmark of vaginal eubiosis and prompt its employment in new probiotics for women's health.
PubMed: 36296367
DOI: 10.3390/microorganisms10102091 -
PloS One 2018To characterize the lipid profile in vaginal discharge of women with vulvovaginal candidiasis, cytolytic vaginosis, or no vaginal infection or dysbiosis. (Clinical Trial)
Clinical Trial
OBJECTIVE
To characterize the lipid profile in vaginal discharge of women with vulvovaginal candidiasis, cytolytic vaginosis, or no vaginal infection or dysbiosis.
DESIGN
Cross-sectional study.
SETTING
Genital Infections Ambulatory, Department of Tocogynecology, University of Campinas, Campinas, São Paulo-Brazil.
SAMPLE
Twenty-four women were included in this study: eight with vulvovaginal candidiasis, eight with cytolytic vaginosis and eight with no vaginal infections or dysbiosis (control group).
METHODS
The lipid profile in vaginal discharge of the different study groups was determined by liquid chromatography-mass spectrometry and further analyzed with MetaboAnalyst 3.0 platform.
MAIN OUTCOME MEASURES
Vaginal lipids concentration and its correlation with vulvovaginal candidiasis and cytolytic vaginosis.
RESULTS
PCA, PLS-DA and hierarchical clustering analyses indicated 38 potential lipid biomarkers for the different groups, correlating with oxidative stress, inflammation, apoptosis and integrity of the vaginal epithelial tissue. Among these, greater concentrations were found for Glycochenodeoxycholic acid-7-sulfate, O-adipoylcarnitine, 1-eicosyl-2-heptadecanoyl-glycero-3-phosphoserine, undecanoic acid, formyl dodecanoate and lipoic acid in the vulvovaginal candidiasis group; N-(tetradecanoyl)-sphinganine, DL-PPMP, 1-oleoyl-cyclic phosphatidic, palmitic acid and 5-aminopentanoic acid in the cytolytic vaginosis group; and 1-nonadecanoyl-glycero-3-phosphate, eicosadienoic acid, 1-stearoyl-cyclic-phosphatidic acid, 1-(9Z,12Z-heptadecadienoyl)-glycero-3-phosphate, formyl 9Z-tetradecenoate and 7Z,10Z-hexadecadienoic acid in the control group.
CONCLUSIONS
Lipids related to oxidative stress and apoptosis were found in higher concentrations in women with vulvovaginal candidiasis and cytolytic vaginosis, while lipids related to epithelial tissue integrity were more pronounced in the control group. Furthermore, in women with cytolytic vaginosis, we observed higher concentrations of lipids related to bacterial overgrowth.
Topics: Adolescent; Adult; Apoptosis; Candidiasis, Vulvovaginal; Chromatography, Liquid; Cross-Sectional Studies; Cytodiagnosis; Female; Humans; Lipid Metabolism; Mass Spectrometry; Oxidative Stress; Pilot Projects; Vagina
PubMed: 30133508
DOI: 10.1371/journal.pone.0202401 -
Current Medical Mycology Jun 2022Vulvovaginal candidiasis (VVC) is considered the most common mucosal infection caused by species. Azoles were considered the first-line treatment for VVC or recurrent...
BACKGROUND AND PURPOSE
Vulvovaginal candidiasis (VVC) is considered the most common mucosal infection caused by species. Azoles were considered the first-line treatment for VVC or recurrent vulvovaginal candidiasis (RVVC) in both healthy and immunocompromised populations. Recently, azole-resistant isolates, especially among non- samples have been encountered. This study aimed to evaluate the antifungal susceptibility profile of spp. isolated from VVC or RVVC patients and assess the molecular resistance mechanism of spp. to azole and echinocandin.
MATERIALS AND METHODS
Point mutation analysis was performed on the and candidate genes of azole- and caspofungin-resistant and isolates. Real-time polymerase chain reaction was performed to gain insight into the differential expression of mRNA.
RESULTS
Variations in the amino acid D116E were observed in fluconazole- and itraconazole-resistant strains, and changes in amino acid E517Q were observed only in fluconazole-resistant strains. No polymorphisms were observed in the complete sequence alignment of the gene in one azole-resistant isolate. The mutation triggered the changes in the amino acid serine in the reference gene by the leucine at position 642 (S642L) of the isolates.
CONCLUSION
In patients with persistent or recurrent infection, the choice of an antifungal agent is often challenging and requires monitoring of the antifungal susceptibility of the colonizing strain. and isolates can be resistant to azole and caspofungin antifungal agents without mutations in the and regions of the gene.
PubMed: 36654793
DOI: 10.18502/cmm.8.2.10326 -
Journal of Infection in Developing... Oct 2018The number of fungal infections occurring each year in Iran is not known. As the burden of fungal disease is a measure used to assess and compare the relative impact of...
INTRODUCTION
The number of fungal infections occurring each year in Iran is not known. As the burden of fungal disease is a measure used to assess and compare the relative impact of different type of fungal diseases on populations, we have estimated the burden of fungal diseases in Iran.
METHODOLOGY
We estimated the burden of human fungal diseases based on the specific populations at risk, existing epidemiological data in both local and international databases, and modelling previously described by the LIFE program (http://www.LIFE-worldwide.org).
RESULTS
Among the population of Iran (79,926,270 in 2016), 6,670,813 (8.3%) individuals are estimated to suffer from a fungal infection each year. A total of 2,791,568 women aged between 15 and 50 years are estimated to suffer from recurrent vulvovaginal candidiasis, annually. In addition, considering the 13.3% prevalence rate of tinea capitis in children, a total of 2,552,624 cases per year are estimated. The estimated burden of invasive aspergillosis in the 3 groups of patients with hematologic malignancy, lung cancer and chronic pulmonary obstructive disease was 6394 (8.0 per 100,000). The estimate for the burden of allergic disease related to fungi including allergic bronchopulmonary aspergillosis, severe asthma with fungal sensitization and allergic fungal rhinosinusitis was 272,095 (340 per 100,000). Based on the 28,663 cases of HIV infection reported, an estimated 900 and 113 cases with pneumocystosis and cryptococcal meningitis are annually anticipated, respectively.
CONCLUSION
Our estimates indicate that the importance of fungal infections is high but overlooked in Iran, which warrants further actions by health care authorities.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Cost of Illness; Female; Humans; Incidence; Infant; Infant, Newborn; Iran; Male; Middle Aged; Mycoses; Prevalence; Young Adult
PubMed: 32004161
DOI: 10.3855/jidc.10476