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PloS One 2020Candida africana is a pathogenic species within the Candida albicans species complex. Due to the limited knowledge concerning its prevalence and antifungal... (Meta-Analysis)
Meta-Analysis
Candida africana is a pathogenic species within the Candida albicans species complex. Due to the limited knowledge concerning its prevalence and antifungal susceptibility profiles, a comprehensive study is overdue. Accordingly, we performed a search of the electronic databases for literature published in the English language between 1 January 2001 and 21 March 2020. Citations were screened, relevant articles were identified, and data were extracted to determine overall intra-C. albicans complex prevalence, geographical distribution, and antifungal susceptibility profiles for C. africana. From a total of 366 articles, 41 were eligible for inclusion in this study. Our results showed that C. africana has a worldwide distribution. The pooled intra-C. albicans complex prevalence of C. africana was 1.67% (95% CI 0.98-2.49). Prevalence data were available for 11 countries from 4 continents. Iran (3.02%, 95%CI 1.51-4.92) and Honduras (3.03%, 95% CI 0.83-10.39) had the highest values and Malaysia (0%) had the lowest prevalence. Vaginal specimens were the most common source of C. africana (92.81%; 155 out of 167 isolates with available data). However, this species has also been isolated from cases of balanitis, from patients with oral lesions, and from respiratory, urine, and cutaneous samples. Data concerning the susceptibility of C. africana to 16 antifungal drugs were available in the literature. Generally, the minimum inhibitory concentrations of antifungal drugs against this species were low. In conclusion, C. africana demonstrates geographical variation in prevalence and high susceptibility to antifungal drugs. However, due to the relative scarcity of existing data concerning this species, further studies will be required to establish more firm conclusions.
Topics: Antifungal Agents; Candida; Candida albicans; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Female; Humans; Microbial Sensitivity Tests; Prevalence; Vagina
PubMed: 32817677
DOI: 10.1371/journal.pone.0237046 -
BJOG : An International Journal of... Dec 2019Oral fluconazole is used to treat vulvovaginal candidiasis during pregnancy. However, there are concerns regarding the pregnancy outcomes following exposure to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Oral fluconazole is used to treat vulvovaginal candidiasis during pregnancy. However, there are concerns regarding the pregnancy outcomes following exposure to fluconazole.
OBJECTIVES
To evaluate the pregnancy outcomes associated with exposure to oral fluconazole during the first trimester of pregnancy.
SEARCH STRATEGY
A systematic literature search was conducted to identify relevant studies published from inception until April 2019.
SELECTION CRITERIA
Relevant English-language citations using the terms oral fluconazole and pregnancy in humans.
DATA COLLECTION
Two reviewers independently abstracted data and assessed study quality.
MAIN RESULTS
Oral fluconazole use during the first trimester of pregnancy was marginally associated with an increased risk of congenital malformations (odds ratio [OR] 1.09, 95% CI 0.99-1.2, P = 0.088; n = 6 studies), whereas in the subgroup analysis, this association existed only for high-dose users (>150 mg) (OR 1. 19, 95% CI 1.01-1.4, P = 0.039; n = 2). Exposure to fluconazole also increased the risk of heart malformations (OR 1.31, 95% CI 1.09-1.57, P = 0.003; n = 4), cardiac septal defects (OR 1.3, 95% CI 1.1-1.67, P = 0.047; n = 3), and tetralogy of Fallot (OR 3.39 95% CI 1.71-6.74, P < 0.001; n = 2) in the offspring. In addition, exposure to fluconazole was significantly associated with an increased risk of spontaneous abortion (OR 1.99, 95% CI 1.38-2.88, P < 0.001; n = 3).
CONCLUSIONS
Oral fluconazole use during the first trimester of pregnancy appears to be associated with heart malformations and spontaneous abortion, but a causal link cannot be proven.
TWEETABLE ABSTRACT
Oral fluconazole during the first trimester of pregnancy may be associated with unfavourable pregnancy outcomes.
Topics: Abnormalities, Drug-Induced; Administration, Oral; Antifungal Agents; Candidiasis, Vulvovaginal; Craniofacial Abnormalities; Female; Fluconazole; Humans; Patient Safety; Pregnancy; Pregnancy Trimester, First
PubMed: 31446677
DOI: 10.1111/1471-0528.15913 -
BJOG : An International Journal of... Jan 2020Vaginal probiotics claiming to cure and/or prevent bacterial and/or fungal vaginal dysbiosis are available on the market but, until recently, did not have to be approved...
BACKGROUND
Vaginal probiotics claiming to cure and/or prevent bacterial and/or fungal vaginal dysbiosis are available on the market but, until recently, did not have to be approved as drugs for human use.
OBJECTIVES
We evaluated the impact of vaginal probiotics on bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) cure and/or recurrence, as well as vaginal microbiota (VMB) composition and vaginal detection of probiotic strains.
SEARCH STRATEGY
We performed a systematic literature search in MEDLINE and Embase up to 15 January 2019.
SELECTION CRITERIA
There were no restrictions in probiotic strains/formulations, study populations, and designs. BV had to be diagnosed by Nugent or Ison-Hay Gram stain scoring, VVC by culture, wet mount or PCR, and VMB composition/detection by molecular techniques.
DATA COLLECTION AND ANALYSIS
The authors independently extracted data.
MAIN RESULTS
All 22 vaginal probiotics evaluated in the 34 eligible studies contained Lactobacillus strains, and some contained additional active ingredients. The probiotics hold promise for BV cure and prevention, but much less so for VVC cure and prevention. No major safety concerns were reported in any of the studies. Vaginal detection of probiotic strains never lasted long beyond the dosing period, suggesting that they did not colonise the vagina. However, findings are not definitive because heterogeneity was high and the quality of most studies suboptimal.
CONCLUSIONS
Availability of vaginal probiotics for vaginal health indications will likely decline in 2020 because of regulatory changes. We urge the field to invest in clinical evidence-based product development and to conduct future trials more rigorously.
TWEETABLE ABSTRACT
Lactobacilli-containing vaginal probiotics hold promise for bacterial vaginosis cure and prevention, but not for vulvovaginal candidiasis.
Topics: Candidiasis, Vulvovaginal; Dysbiosis; Female; Humans; Lactobacillus; Microbiota; Probiotics; Treatment Outcome; Vagina; Vaginosis, Bacterial
PubMed: 31299136
DOI: 10.1111/1471-0528.15870