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Infection and Drug Resistance 2023() is a major cause of vulvovaginal candidiasis (VVC), a condition that is commonly treated with azole agents. Biofilm formation and aspartyl proteinase production are...
BACKGROUND
() is a major cause of vulvovaginal candidiasis (VVC), a condition that is commonly treated with azole agents. Biofilm formation and aspartyl proteinase production are important virulence factors that could be linked to azole resistance in impeding therapy.
AIM
To find out the association of both factors with azole resistance among isolated from VVC cases in Egyptian nonpregnant women of childbearing age.
PATIENTS AND METHODS
In a cross-sectional study, was isolated from nonpregnant females diagnosed clinically as having VVC during a 1-year study period. Susceptibility to azole agents was tested using the disc diffusion method. Biofilm formation and aspartyl proteinase production were assessed phenotypically. Additionally, two biofilm-related genes ( and ) and three proteinase genes (, and ) were screened for using polymerase chain reaction (PCR).
RESULTS
Among 204 isolates, azole resistance ratios were as follows: voriconazole (30.4%), itraconazole (17.6%), fluconazole (11.3%) and econazole (6.4%). Biofilm-producing capacity was detected in 63.2% of isolates, and 63.2% were proteinase producers. The frequencies of and were 69.6% and 74.5%, respectively, while , and were 69.2%, 88.7%, and 64.7%, respectively. Biofilm formation was significantly associated with azole resistance (P < 0.001 for each tested azole agent) as was proteinase production (P < 0.001 for fluconazole, voriconazole, and econazole resistance and P = 0.047 for itraconazole).
CONCLUSION
Among nonpregnant Egyptian women of childbearing age, azole resistance in causing VVC is significantly associated with biofilm formation and proteinase production. The development of new therapeutic agents that can target these factors is warranted.
PubMed: 37601561
DOI: 10.2147/IDR.S420580 -
Frontiers in Microbiology 2023Vulvovaginal candidiasis (VVC) is a highly prevalent illness affecting women globally. Lactobacilli, which make up the majority of healthy vaginal microbiota (VMB),...
BACKGROUND
Vulvovaginal candidiasis (VVC) is a highly prevalent illness affecting women globally. Lactobacilli, which make up the majority of healthy vaginal microbiota (VMB), serve as a powerful barrier against infections. Probiotic therapy has been recommended for the treatment or prevention of VVC.
AIM OF WORK
To compare the therapeutic effects of (B-2178) vs. (LA-5) on VVC in a rat model, particularly highlighting the immune response of the host vaginal epithelium.
METHODS
In total, 30 female Sprague-Dawley rats were divided into 5 groups; Group 1: no intervention, Group 2: ovariectomy group, while animals in Groups 3-5 were subjected to ovariectomy and an intravaginal inoculation of to establish VVC. The animals in Groups 4 and 5 received intravaginal lactobacilli treatment with (LA-5) and (B-2178) strains, respectively, for 7 days. load was measured in a vaginal lavage 1, 3, and 7 days after the stoppage of the treatment. Histological, morphometric, and immunohistochemical studies of the vaginal tissues were done. IFN-γ, IL-4, and IL-17 were measured in the vaginal tissue.
RESULTS
Both and significantly reduced vaginal load (250 ± 77.46 and 133.33 ± 40.82 CFU/mL) compared to the count before treatment in both groups (4,850 ± 1419.51 and 4966.67 ± 852.45 CFU/mL) even after 7 days of stoppage of lactobacilli treatment. A statistically significant reduction of the pro-inflammatory cytokines IL-17 and IFN-γ was reported in both treated groups compared to the infected untreated group. has a significant effect on the reduction of hyphae formation of as well as the nuclear factor kappa B (NF-κB) immunostaining density of vaginal tissue compared to Moreover, treatment with significantly minimized the epithelium damage triggered by infection and restored normal vaginal architecture as evidenced by the histologic and morphometric studies when compared to
CONCLUSION
Through maintaining an immune tolerant state in the vaginal epithelium and ameliorating the undesirable uncontrolled inflammatory response in the vaginal tissue, (B-2178) has the potential to be utilized alone or in combination with other lactobacilli species in probiotic clinical trials to treat or prevent VVC.
PubMed: 37529322
DOI: 10.3389/fmicb.2023.1222503 -
Infection and Drug Resistance 2023Time-consuming culture methods and wet-mount microscopy (WMM) with low sensitivity have difficulties in diagnosing Vulvovaginal candidiasis (VVC). Rapid and highly...
PURPOSE
Time-consuming culture methods and wet-mount microscopy (WMM) with low sensitivity have difficulties in diagnosing Vulvovaginal candidiasis (VVC). Rapid and highly sensitive polymerase chain reaction coupled with quantum dot fluorescence analysis (PCR-QDFA) for the diagnosis of VVC has not been reported to date. This study was the first to evaluate the performance of PCR-QDFA for diagnosis of strains in the leukorrhea samples from patients with suspected VVC.
PATIENTS AND METHODS
Leukorrhea samples from all visited patients were taken from the vagina using vaginal swabs by clinicians. We evaluated patients admitted with suspected VVC who completed WMM for diagnosis and reported the diagnostic effectiveness of PCR-QDFA and culture (gold standard) when testing leucorrhea samples.
RESULTS
A total of 720 leukorrhea samples from 387 VVC-positive patients and 333 VVC-negative patients were included in this study. Of the 387 leukorrhea samples from the VVC-positive patients, 391 strains were identified by culture. 99.23% (388/391) strains were included in the PCR-QDFA list. The 388 strains belonged to four different species of , including (n = 273, 70.36%), (n = 85, 21.91%), (n = 16, 4.12%), and (n = 14, 3.61%). PCR-QDFA diagnosed strains in 340/384 (88.54%) of the leucorrhea samples with strains infection. The sensitivity of PCR-QDFA for , and was 89.01%, 85.88%, 81.25% and 92.86%, respectively. The specificity of PCR-QDFA for and was 93.69%, 99.37%, 99.71%, and 99.57%, respectively.
CONCLUSION
The highly sensitive and specific PCR-QDFA technique can be exploited as a rapid (approximately 4 h) diagnostic tool for common strains of leucorrhea samples from patients with suspected VVC.
PubMed: 37520453
DOI: 10.2147/IDR.S410128 -
Journal of Xenobiotics Jul 2023Vulvovaginitis with spp. is the most common infection in women and the rate is increased during pregnancy. Antifungal prescription in pregnant women continues to...
Vulvovaginitis with spp. is the most common infection in women and the rate is increased during pregnancy. Antifungal prescription in pregnant women continues to present challenges and the decision must balance the risk of fetal toxicity with the benefits to the fetus and mother. Starting from the idea that clotrimazole is the most recommended antifungal in candidal vaginitis in pregnancy, we tested the sensitivity of different species of spp. to other azoles, polyenes, and antimetabolites. This retrospective study (January to June 2019) assessed 663 pregnant women hospitalized for various pregnancy-related symptoms in which samples of phage secretion were taken. The laboratory results confirmed 21% of cases, indicating 140 positive mycologic samples. In this study, vaginal candidiasis was mostly related to the first trimester of pregnancy (53.57%,) and less related in the last trimester (17.14%). was the most frequent isolated strain in this study, accounting for 118 cases, followed by 16 strains of and 6 cases of . The highest sensitivity for was found in azoles, mostly in miconazole (93.2%), while was completely resistant to polyene with low sensitivity in antimetabolites and even in some azoles, such as fluconazole. In our study, higher resistance rates to flucytosine were found, with and exhibiting greater resistance than .
PubMed: 37489336
DOI: 10.3390/jox13030023 -
Mycopathologia Dec 2023Mucosal and invasive candidiasis can be challenging to treat in the setting of drug intolerance, antifungal resistance, drug-drug interactions, or host immune status.... (Review)
Review
Mucosal and invasive candidiasis can be challenging to treat in the setting of drug intolerance, antifungal resistance, drug-drug interactions, or host immune status. Antifungals with novel mechanisms of action and distinct pharmacokinetic/pharmacodynamic properties have been developed in recent years. Rezafungin is an echinocandin with high-tissue penetration and an extended half-life that allows for once-weekly administration, making it a convenient treatment option for invasive candidiasis while obviating the need for central catheter placement. Ibrexafungerp is an oral glucan synthase inhibitor that is active against most echinocandin-resistant Candida species. At present, it is approved for the treatment of acute vulvovaginal candidiasis and is under investigation as an oral step-down therapy following initial treatment with an echinocandin for cases of invasive candidiasis. Oteseconazole is a long-acting tetrazole that exhibits a higher affinity for the fungal enzyme CYP51, resulting in a potentially lower risk of drug-drug interactions and side effects compared to other azoles. It is currently approved for the treatment of recurrent vulvovaginal candidiasis. Fosmanogepix has a novel mechanism of action and potent activity against several Candida strains resistant to other antifungals. Due to its considerable bioavailability and tissue penetration, it holds promise as a potential treatment option in patients with invasive candidiasis, including those with chorioretinitis or meningitis. Results from clinical trials and observational studies will further delineate the role of these agents in the management of candidiasis. As the usage of these novel antifungals becomes widespread, we expect to acquire a greater understanding of their efficacy and potential benefits.
Topics: Female; Humans; Antifungal Agents; Candidiasis, Vulvovaginal; Echinocandins; Candida; Candidiasis, Invasive
PubMed: 37470902
DOI: 10.1007/s11046-023-00759-5 -
Indian Journal of Sexually Transmitted... 2023Vaginal discharge is a common complaint among women attending the sexually transmissible infections (STIs) clinic and is a cause for concern and mental distress. It can...
BACKGROUND
Vaginal discharge is a common complaint among women attending the sexually transmissible infections (STIs) clinic and is a cause for concern and mental distress. It can be attributed to physiological or pathological causes. This study aims to understand the prevalence of various etiologies of vaginal discharge, which would help frame health policies based on local needs.
OBJECTIVES
(1) To estimate the prevalence of discharge per vaginum among sexually active women attending the STI clinic at a tertiary care center during a 1-year period, (2) To identify the organisms causing vaginal discharge, (3) To have a clinicoetiological correlation of the cases, and (4) To identify the subspecies of causing vaginal candidiasis.
MATERIALS AND METHODS
A total of 126 patients with vaginal discharge attending the STI clinic at a tertiary care center were included in the study. A detailed clinical history, physical examination of the external genitalia, and vaginal examination were done on each patient. Five swabs were taken from the posterior fornix and lateral vaginal wall for evaluation of the organisms.
RESULTS
The mean age of the study population was 31.51 ± 7.9 years. Vulvovaginal candidiasis (VVC) was found to be the most common cause of vaginal discharge, followed by bacterial vaginosis, mucopurulent cervicitis, herpes genitalis, and trichomoniasis. The most common species of was found to be .
CONCLUSION
Even though VVC still remains the major cause, other viral infections like herpes significantly contribute. Vaginal discharge is an important indicator of women's reproductive health and its detailed evaluation helps identify the prevalence of various STIs in the community.
PubMed: 37457531
DOI: 10.4103/ijstd.ijstd_65_21 -
European Journal of Pharmaceutical... Sep 2023Miconazole-loaded nanoparticles coated with hyaluronic acid (miconazole-loaded nanoparticles/HA) were developed to overcome the limitations of the conventional therapy...
Miconazole-loaded nanoparticles coated with hyaluronic acid (miconazole-loaded nanoparticles/HA) were developed to overcome the limitations of the conventional therapy of the vulvovaginal candidiasis (VVC). They were synthesized by emulsification and solvent evaporation techniques, characterized by diameter, polydispersity index, zeta potential, encapsulation efficiency, atomic force microscopy (AFM), evaluated in terms of efficacy against C. albicans in vitro, and tested in a murine VVC model. Nanoparticles showed 211nm of diameter with a 0.32 polydispersity index, -53mV of zeta potential, and 90% miconazole encapsulation efficiency. AFM evidenced nanoparticles with a spherical shape. They inhibited the proliferation of C. albicans in vitro and in vivo after a single administration. Nanoparticles released the miconazole directly in the site of action at low therapeutic doses, which was enough to eliminate the fungal burden in the murine VVC model. These systems were rationally designed since the existence of the HA induces their adhesion on the vaginal mucus and their internalization via CD44 receptors, inhibiting the C. albicans. Therefore, miconazole-loaded nanoparticles/HA represent an innovative non-conventional pharmaceutical dosage form to treat the VVC and recurrent VVC.
Topics: Humans; Female; Mice; Animals; Miconazole; Candidiasis, Vulvovaginal; Hyaluronic Acid; Antifungal Agents; Candida albicans; Nanoparticles
PubMed: 37379779
DOI: 10.1016/j.ejps.2023.106508 -
Pathogens (Basel, Switzerland) May 2023Epidemiological data on women suffering from vulvovaginal candidiasis and its recurrence are outdated and vague. The aim of this study was to identify the prevalence of...
Epidemiological data on women suffering from vulvovaginal candidiasis and its recurrence are outdated and vague. The aim of this study was to identify the prevalence of women diagnosed with vulvovaginal candidiasis, as well as the epidemiological profile and associated risk factors in the province of Granada (Spain). Data from the Centre for Sexually Transmitted Infections of the Granada province between 2000 and 2018 (N = 438) were used in this study. Associations between sociodemographic and sexual behaviour variables with vulvovaginal candidiasis were analysed using the Chi-square test and bivariate logistic regression. The prevalence of candidiasis was 14.6%. The sociodemographic profile corresponded to a woman aged 25.14 ± 4.8 years on average, who is of Spanish nationality (60.9%), a student (55.7%), in non-active employment (59.7%), with a higher education (56.7%), single (93.5%), and under 30 years of age (79.7%). Variables associated with this diagnosis were the absence of oro-genital contact (OR = 1.99; 95% CI = 0.25-0.74), having a regular partner (OR = 1.99; 95% CI = 1.05-3.75), and age of sexual debut, with the probability increasing by 12% (95% CI = 1.00-1.24) with each year. In this context, vulvovaginal candidiasis infection is common, and its epidemiological profile is contradictory, so our results do not suggest a relevant role of sexual risk behaviours in the diagnosis. Further research is needed to improve the estimates and factors associated with this infection.
PubMed: 37375446
DOI: 10.3390/pathogens12060756 -
Frontiers in Medicine 2023Vaginal microecology has a definite influence on human papillomavirus (HPV) infection and clearance, but the specific correlation is still controversial. This research...
BACKGROUND
Vaginal microecology has a definite influence on human papillomavirus (HPV) infection and clearance, but the specific correlation is still controversial. This research aimed to investigate the differences in the vaginal microenvironment of different types of HPV infection and also provide data supporting clinical diagnosis and treatment.
METHODS
According to strict inclusion and exclusion criteria, the case data of 2,358 female patients who underwent vaginal microecology and HPV-DNA tests at the same time in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Xi'an Jiaotong University from May 2021 to March 2022 were retrospectively analyzed. The population was divided into two groups: an HPV-positive group and an HPV-negative group. HPV-positive patients were further classified into HPV16/18-positive group and HPV other subtypes positive group. The vaginal microecology of HPV-infected patients was analyzed using the chi-square test, Fisher's exact test, and logistic regression.
RESULTS
Among the 2,358 female patients, the HPV infection rate was 20.27% (478/2,358), of which the HPV16/18 infection rate was 25.73% (123/478), and the HPV other subtypes infection rate was 74.27% (355/478). The difference in HPV infection rates between the age groups was statistically significant ( < 0.01). The prevalence of mixed vaginitis was 14.37% (339/2,358), with bacterial vaginosis (BV) paired with aerobic vaginitis (AV) accounting for the majority (66.37%). The difference in HPV infection rates among mixed vaginitis was not statistically significant ( > 0.05). The prevalence of single vaginitis was 24.22% (571/2,358), with the most frequent being vulvovaginal (VVC; 47.29%, 270/571), and there was a significant difference in HPV infection rates among single vaginitis ( < 0.001). Patients with BV had a higher risk of being positive for HPV16/18 (OR: 1.815, 95% CI: 1.050-3.139) and other subtypes (OR: 1.830, 95% CI: 1.254-2.669). Patients with were at higher odds of other HPV subtype infections (OR: 1.857, 95% CI: 1.004-3.437). On the contrary, patients with VVC had lower odds of becoming infected with other HPV subtypes (OR: 0.562, 95% CI: 0.380-0.831).
CONCLUSION
There were disparities in HPV infection among different age groups; therefore, we should pay attention to the prevention and treatment of susceptible individuals. BV and are linked to HPV infection; hence, restoring the balance of vaginal microecology could assist in the prevention of HPV infection. As a protective factor for other HPV subtype infections, VVC may provide new insights into the development of immunotherapeutic therapies.
PubMed: 37324149
DOI: 10.3389/fmed.2023.1138507 -
Microorganisms May 2023Vulvovaginal candidiasis (VVC), which is primarily caused by , is an infection that affects up to 75% of all reproductive-age women worldwide. Recurrent VVC (RVVC) is... (Review)
Review
Vulvovaginal candidiasis (VVC), which is primarily caused by , is an infection that affects up to 75% of all reproductive-age women worldwide. Recurrent VVC (RVVC) is defined as >3 episodes per year and affects nearly 8% of women globally. At mucosal sites of the vagina, a delicate and complex balance exists between spp., host immunity and local microbial communities. In fact, both immune response and microbiota composition play a central role in counteracting overgrowth of the fungus and maintaining homeostasis in the host. If this balance is perturbed, the conditions may favor overgrowth and the yeast-to-hyphal transition, predisposing the host to VVC. To date, the factors that affect the equilibrium between spp. and the host and drive the transition from commensalism to pathogenicity are not yet fully understood. Understanding the host- and fungus-related factors that drive VVC pathogenesis is of paramount importance for the development of adequate therapeutic interventions to combat this common genital infection. This review focuses on the latest advances in the pathogenic mechanisms implicated in the onset of VVC and also discusses novel potential strategies, with a special focus on the use of probiotics and vaginal microbiota transplantation in the treatment and/or prevention of recurrent VVC.
PubMed: 37317186
DOI: 10.3390/microorganisms11051211