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International Journal of Molecular... May 2022Vulvovaginal candidiasis (VVC) is one of the most common types of vaginal infections in women around the world and is often underestimated by both patients and doctors.... (Review)
Review
Vulvovaginal candidiasis (VVC) is one of the most common types of vaginal infections in women around the world and is often underestimated by both patients and doctors. Research on the pathogenesis of fungal vaginal infections over the last 20 years has resulted in a closer understanding of the virulence factors involved in epithelial invasion and their mechanisms of action. Recently, attention was drawn to the enormous complexity of the interaction between yeast-like fungi and host cells, as well as the level of complexity of the host's response to infection and their impact on the course and treatment of VVC. Our work provides a broad description of already known and some new reports on virulence factors (such as phenotypic switching or biofilm formation capacity) and their importance for tissue invasion in VVC. At the same time, we also focus on interactions with host cells and local innate immune mechanisms involved in the response to vaginal fungal invasion that are now considered equally important in this case. The presented review describes the most important aspects of the still unknown pathogenicity of associated with vaginal infections.
Topics: Antifungal Agents; Candida; Candida albicans; Candidiasis, Vulvovaginal; Female; Humans; Immunity; Vagina; Virulence Factors
PubMed: 35682581
DOI: 10.3390/ijms23115895 -
Journal of the Formosan Medical... Jul 2012Vulvovaginitisis the most common gynecological problem of childhood. The aim of the study was to determine and compare clinical and microbiological features of... (Comparative Study)
Comparative Study
BACKGROUND/PURPOSE
Vulvovaginitisis the most common gynecological problem of childhood. The aim of the study was to determine and compare clinical and microbiological features of vulvovaginitis in prepubertal and adolescent girls.
METHODS
In this retrospective study, the records of patients who were diagnosed with vulvovaginitis between January 2005 and December 2010 in the pediatric outpatient clinic at Fatih University Hospital were retrieved. Information regarding age, symptoms, history of antibiotic use within 1 month prior to presentation, findings on urinalysis, serum antistreptolysin-O levels, and results of urine/vaginal cultures was collected.
RESULTS
The records of 112 patients were evaluated, 72 of which were prepubertal (64.2%) and 40 were pubertal (35.7%) at the time of diagnosis. Thirty-eight prepubertal patients (52.7%) had a positive result on vaginal culture, the most commonly encountered microorganism being group A beta-hemolytic streptococcus (15.2%). Culture positivity rate in the pubertal group was 47.5% (19 patients), with Candida albicans being the most frequently isolated microorganism (27.5%).
CONCLUSION
The etiopathogenesis and culture results differ between prepubertal and adolescent girls with vulvovaginitis, which should be taken into consideration in the treatment approach of this disorder.
Topics: Adolescent; Age Factors; Candidiasis, Vulvovaginal; Child; Child, Preschool; Escherichia coli Infections; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Puberty; Retrospective Studies; Streptococcal Infections; Vagina; Vulva; Vulvovaginitis
PubMed: 22817817
DOI: 10.1016/j.jfma.2011.05.013 -
Frontiers in Immunology 2018Candidemia is a bloodstream fungal infection caused by species and is most commonly observed in hospitalized patients. Even with proper antifungal drug treatment,... (Review)
Review
Candidemia is a bloodstream fungal infection caused by species and is most commonly observed in hospitalized patients. Even with proper antifungal drug treatment, mortality rates remain high at 40-50%. Therefore, prophylactic or preemptive antifungal medications are currently recommended in order to prevent infections in high-risk patients. Moreover, the majority of women experience at least one episode of vulvovaginal candidiasis (VVC) throughout their lifetime and many of them suffer from recurrent VVC (RVVC) with frequent relapses for the rest of their lives. While there currently exists no definitive cure, the only available treatment for RVVC is again represented by antifungal drug therapy. However, due to the limited number of existing antifungal drugs, their associated side effects and the increasing occurrence of drug resistance, other approaches are greatly needed. An obvious prevention measure for candidemia or RVVC relapse would be to immunize at-risk patients with a vaccine effective against infections. In spite of the advanced and proven techniques successfully applied to the development of antibacterial or antiviral vaccines, however, no antifungal vaccine is still available on the market. In this review, we first summarize various efforts to date in the development of anti- vaccines, highlighting advantages and disadvantages of each strategy. We next unfold and discuss general hurdles encountered along these efforts, such as the existence of large genomic variation and phenotypic plasticity across strains and species, and the difficulty in mounting protective immune responses in immunocompromised or immunosuppressed patients. Lastly, we review the concept of "trained immunity" and discuss how induction of this rapid and nonspecific immune response may potentially open new and alternative preventive strategies against opportunistic infections by species and potentially other pathogens.
Topics: Antifungal Agents; Candida; Candidemia; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Female; Fungal Vaccines; Humans; Immunocompromised Host; Opportunistic Infections; Treatment Outcome
PubMed: 29755472
DOI: 10.3389/fimmu.2018.00897 -
Biomedica : Revista Del Instituto... Aug 2022Proteases and phospholipases are virulence factors of Candida spp. that play an important role in tissue invasion. Among the factors related to the host some are...
INTRODUCTION
Proteases and phospholipases are virulence factors of Candida spp. that play an important role in tissue invasion. Among the factors related to the host some are associated with environmental characteristics and others with Candida colonization.
OBJECTIVES
To determine phospholipase and protease activities in colonizing and pathogenic strains, isolated from pregnant women in Cartagena de Indias.
MATERIALS AND METHODS
Phospholipase and protease activity was determined in 56 isolates, evaluating substrate degradation and calculating the enzyme activity coefficient. Phospholipase and protease activities were compared between colonizing and pathogenic strains.
RESULTS
“Very high” (<0.69) phospholipase and protease activity was found in 34 and 14 isolates, respectively. There was no significant difference when comparing phospholipase and protease activities between colonizing and pathogenic isolates.
CONCLUSIONS
Phospholipase activity predominated as a virulence factor in the studied strains, but no significant difference found between colonizing and pathogenic strains for phospholipase and protease activities.
Topics: Female; Humans; Candida; Vulvovaginitis
PubMed: 37721921
DOI: 10.7705/biomedica.6759 -
Infection and Immunity Mar 2018For over 3 decades, investigators have studied the pathogenesis of vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC) through clinical studies and animal models.... (Review)
Review
For over 3 decades, investigators have studied the pathogenesis of vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC) through clinical studies and animal models. While there was considerable consensus that susceptibility was not associated with any apparent deficiencies in adaptive immunity, protective immune mechanisms and the role of innate immunity remained elusive. It was not until an innovative live-challenge design was conducted in women that a fuller understanding of the natural history of infection/disease was achieved. These studies revealed that symptomatic infection is associated with recruitment of polymorphonuclear neutrophils (PMNs) into the vaginal lumen. Subsequent studies in the established mouse model demonstrated that infiltrating PMNs were incapable of reducing the fungal burden, which supported the hypothesis that VVC/RVVC was an immunopathology, whereby and the host response drive symptomatic disease. Further studies in mice revealed the requirement for hyphae and identified pattern recognition receptors (PRRs) and proinflammatory mediators responsible for the PMN response, all of which are critical pieces of the immunopathogenesis. However, a mechanism explaining PMN dysfunction at the vaginal mucosa remained an enigma. Ultimately, by employing mouse strains resistant or susceptible to chronic VVC, it was determined that heparan sulfate (HS) in the vaginal environment of susceptible mice serves as a competitive ligand for Mac-1 on PMNs, which effectively renders the PMNs incapable of binding to to initiate killing. Hence, the outcome of symptomatic VVC/RVVC is postulated to be dependent on a PMN-mediated immunopathogenic response involving HS that effectively places the neutrophils in a state of functional anergy.
Topics: Animals; Candida albicans; Candidiasis, Vulvovaginal; Female; Humans; Neutrophil Infiltration; Neutrophils; Vagina
PubMed: 29203543
DOI: 10.1128/IAI.00684-17 -
Frontiers in Cellular and Infection... 2023Antifungal agents are not always efficient in resolving vulvovaginal candidiasis (VVC), a common genital infection caused by the overgrowth of spp., including , or in...
INTRODUCTION
Antifungal agents are not always efficient in resolving vulvovaginal candidiasis (VVC), a common genital infection caused by the overgrowth of spp., including , or in preventing recurrent infections. Although lactobacilli (which are dominant microorganisms constituting healthy human vaginal microbiota) are important barriers against VVC, the metabolite concentration needed to suppress VVC is unknown.
METHODS
We quantitatively evaluated metabolite concentrations to determine their effect on spp., including 27 vaginal strains of , and , with inhibitory abilities against biofilms of clinical isolates.
RESULTS
culture supernatants suppressed viable fungi by approximately 24%-92% relative to preformed biofilms; however, their suppression differed among strains and not species. A moderate negative correlation was found between lactate production and biofilm formation, but no correlation was observed between hydrogen peroxide production and biofilm formation. Both lactate and hydrogen peroxide were required to suppress planktonic cell growth. strains that significantly inhibited biofilm formation in culture supernatant also inhibited adhesion to epithelial cells in an actual live bacterial adhesion competition test.
DISCUSSION
Healthy human microflora and their metabolites may play important roles in the development of new antifungal agent against -induced VVC.
Topics: Female; Humans; Candida albicans; Hydrogen Peroxide; Lactobacillus; Candida; Candidiasis, Vulvovaginal; Antifungal Agents; Epithelial Cells; Biofilms
PubMed: 37201113
DOI: 10.3389/fcimb.2023.1113401 -
Revista Brasileira de Ginecologia E... Aug 2021To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and...
OBJECTIVE
To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota.
METHODS
Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women > 18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of and . The Cohen kappa coefficient was used in the concordance analysis.
RESULTS
Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant ( = 0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa = 0.21; = 0.003) and candidiasis (Kappa = 0.22; = 0.001), and slight for trichomoniasis (Kappa = 0.14; = 0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests.
CONCLUSION
The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms.
Topics: Adolescent; Candidiasis, Vulvovaginal; Chile; Clinical Laboratory Techniques; Cross-Sectional Studies; Female; Humans; Trichomonas Vaginitis; Vaginal Discharge; Vaginosis, Bacterial
PubMed: 34547794
DOI: 10.1055/s-0041-1735299 -
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 -
Mycoses May 2016Vulvovaginal candidosis (VVC) is a common gynaecological disorder that is delineated by the inflammation of vaginal wall and it is caused by the opportunistic fungal... (Review)
Review
Vulvovaginal candidosis (VVC) is a common gynaecological disorder that is delineated by the inflammation of vaginal wall and it is caused by the opportunistic fungal pathogen Candida species. In fact, three out of every four women will experience at least one occasion of VVC during some point in their lives. Although uncomplicated VVC is relatively harmless, the complicated VVC such as recurrent attack often creates restlessness and depression in the patients, thus greatly affects their quality of life. Managements of VVC are usually associated with the use of antimycotic suppositories, topical cream or oral agents. These antimycotic agents are either available over-the-counter or prescribed by the clinicians. In recent decades, the rise of clinical challenges such as the increased prevalence of resistant Candida strains, recurrent VVC infection and adverse effects of multidrug interactions have necessitated the development of novel therapeutic or prophylactic options to combat the complicated VVC in the future. In this review, we discuss the current antimycotic treatments available for Candida vaginitis and the problems that exist in these seemingly effective treatments. Besides, we attempt to contemplate some of the future and prospective strategies surrounding the development of alternative therapeutic and prophylactic options in treating and preventing complicated VVC respectively.
Topics: Administration, Oral; Administration, Topical; Antifungal Agents; Candida; Candidiasis, Vulvovaginal; Drug Interactions; Drug Resistance, Fungal; Female; Humans; Nonprescription Drugs; Pregnancy; Pregnancy Complications, Infectious; Recurrence
PubMed: 26765516
DOI: 10.1111/myc.12455 -
Annals of Medicine Apr 1995Vulvodynia is a complex multifactorial and multidisciplinary clinical syndrome of unexplained vulvar pain, sexual dysfunction, and psychological disability. Because of... (Review)
Review
Vulvodynia is a complex multifactorial and multidisciplinary clinical syndrome of unexplained vulvar pain, sexual dysfunction, and psychological disability. Because of the absence of abnormal physical findings among such patients, vulvodynia was long thought to be solely a psychosomatic syndrome. The incidence or prevalence of vulvodynia has not been well studied. The recognition of specific subtypes of vulvodynia is important in the management of patients with vulvodynia. The most common subtypes are vulvar vestibulitis syndrome, cyclic vulvovaginitis and dysesthetic vulvodynia. Simple practice guidelines can be developed to facilitate the evaluation and management of such patients. Systematic epidemiological, etiological and therapeutic studies of vulvodynia are urgently needed.
Topics: Female; Humans; Mental Disorders; Pain; Prevalence; Prognosis; Risk Factors; Sexual Dysfunction, Physiological; Syndrome; Vulvar Diseases; Vulvovaginitis
PubMed: 7632410
DOI: 10.3109/07853899509031955