Prevalence Of Vulvovaginal Candidiasis In Patients Attending A Tertiary Care Hospital

Abstract

Vulvovaginal candidiasis (VVC) is an important public health problem affecting women of all age groups. C.albicans is the commonest pathogenic species among candida. However, the non albicans candida (NAC) is on the increase in the recent years. The aim of this study is to investigate the prevalence of VVC and determine the antifungal susceptibility pattern of candida species in patients with clinical suspicion of vaginitis. A total of 260 women of age 15-65 years with clinical features suggestive of vaginitis were enrolled in the present study which included 100 diabetic and 160 non diabetic women. High vaginal swab samples were taken from them and processed for fungal culture. Candida isolates were identified using conventional methods and automated Vitek2 Compact (Biomerieux France). Antifungal susceptibility testing was performed for fluconazole, itraconazole, ketoconazole, nystatin, amphotericin B and clotrimazole by disc diffusion method. Multi drug resistant Candida isolates were analysed for biofilm forming ability and their identification was confirmed with amplification and sequencing of internal transcribed space regions with specific PCR. ERG11 gene was detected in fluconazole susceptible and resistant C.albicans and C.tropicalis isolates with amplification and sequencing.vi Candida was identified as the causative agent of vaginitis in 42.3% of the cases. Majority of the women infected with Candida belonged to the age group of 25-39 years. VVC was detected in 51% of diabetic women. Candida albicans (53.6%) was the most common species isolated in the study. The Non albicans Candida species isolated in the study included C.tropicalis (21.8%), C.glabrata (19%), C.parapsilosis (3.6%), C.krusei (0.9%), and C.auris (0.9%). Candida isolates showed a decreased susceptibility rate (73%) to fluconazole. Identification of Candida species and antifungal susceptibility testing is important for decreasing the emergence of resistant strains. Although fluconazole still appears to be effective against most of the Candida isolates, resistance rate of this drug (13%) to the Candida species highlights the need for performing antifungal susceptibility testing and alternate drug therapy in the routine practice. PCR is a rapid and reliable technique to identify the Candida species causing Vulvovaginal candidiasis. Biofilm formation by the Candida isolates is one of the risk factors for emergence of drug resistance. newlineKeywords: Candida species, vulvovaginal candidiasis, biofilm, electron microscopy, Polymerase chain reaction newline newline