A prospective study on vulvovaginal candidiasis: multicentre molecular epidemiology of pathogenic yeasts in China

Song, Nana; Kan, Siyue; Pang, Qiuyu; Mei, Huan; Zheng, Hailin; Li, Dongmei; Cui, Fan; Lv, Guixia; An, Ruifang; Li, P; Xiong, Zhengai; Fan, Shang­rong; Zhang, Mengzhen; Chen, Yanhong; Qiao, Qiao; Liang, Xudong; Cui, Manhua; Li, Dongyan; Liao, Qinping; Li, Xiaofang; Liu, Weida

doi:10.1111/jdv.17874

Cited by 7 publications

(8 citation statements)

References 47 publications

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“…This shows that there is agreement among the herbalists and the community on the medicinal plants for the management and treatment of candidiasis. OPC and VVC are caused by Candida spp [ 74 , 75 ], thus similar plants are used in their management and treatment. Chekole [ 76 ] pointed out that values of FIC indicate the magnitude of shared knowledge of the most important herbal plant species for treating diseases that are prevalent in the community.…”

Section: Discussionmentioning

confidence: 99%

Ethnobotanical study of medicinal plants utilized in the management of candidiasis in Northern Uganda

et al. 2022

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Background The emergence of resistant Candida species to antifungal drugs has led to resurgence in herbal usage globally. However, little is known about anti-candida plants. This study explored ethnomedicinal plants as treatment option for candidiasis in Pader, Northern Uganda. Methods A cross-sectional survey of potential anti-candida plants was conducted using questionnaires, focus group discussions and field observations in March 2022. Sixty-three respondents were selected by snowball technique. The frequencies of respondents/responses were analyzed, associations of respondents’ socio-demographics with indigenous knowledge of herbal usage established by Chi-square (χ2) test using SPSS 27. Informant Consensus Factor was computed to establish level of agreement on herbal usage, and thematic analysis done for focus group discussions. Results Candidiasis is still common and troublesome in Pader. All herbalist had equal chances of receiving and treating candidiasis patients irrespective of herbalist’s gender, age, education level, occupation, marital status and religion (p > 0.05). About 39.7% of herbalists received candidiasis patients weekly (p < 0.01). All herbalists had knowledge on candidiasis. Death (56.8%) and discomfort (36.8%) were the major health risks of oropharyngeal candidiasis (OPC) and vulvovaginal candidiasis (VVC), respectively. A total of 32 potential anti-candida plant species in 18 families were identified. Families of Fabaceae (9 species) and Asteraceae (5 species) had most plant species. Trees (50.0%) and herbs (43.8%) were the dominant life forms. The commonest plants by frequency of mention were: Momordica foetida (26), Sansevieria dawei (20), Khaya anthotheca (15), Piliostigma thonningii (10), Clerodendrum umbellatum (7), Hallea rubrostipulata (5) and unidentified plant, ‘Agaba/daa layata’ in Acholi dialect (5). Plant parts mainly used were roots (56.3%) and stem barks (15.6%) harvested majorly by cutting (46.9%) and uprooting (12.5%). Most respondents (females, 95%) preferred herbal to western medication (p < 0.01) due to its perceived effectiveness. There was high consensus among herbalists on herbal remedies for OPC and VVC (FIC = 0.9). Conclusions Pader communities have diverse indigenous knowledge on candidiasis and prefer herbal medicines to orthodox treatment for candidiasis. However, the herbalists use unsustainable harvesting techniques like uprooting whole plants and cutting main roots. Hence, the need to document such indigenous knowledge before being lost for community usage and scientific validation.

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Section: Discussionmentioning

confidence: 99%

Ethnobotanical study of medicinal plants utilized in the management of candidiasis in Northern Uganda

et al. 2022

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“…MLST studies have been conducted on C. albicans isolates from the digestive tract, blood infections, oral leukoplakia, and vaginal secretions (33)(34)(35)(36)(37). In addition, MLST has been applied widely to study nosocomial infection, which is important for the prevention and control of infection (38,39). Therefore, fine genotyping for clinically pathogenic C. albicans has important implications for the epidemiology of candidal infections, especially for infections with high incidence, such as VVC.…”

Section: Discussionmentioning

confidence: 99%

Candida albicans Multilocus Sequence Typing Clade I Contributes to the Clinical Phenotype of Vulvovaginal Candidiasis Patients

et al. 2022

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Candida albicans is the most frequent fungal species responsible for vulvovaginal candidiasis (VVC), which exhibits distinct genetic diversity that is linked with the clinical phenotype. This study aimed to assess the genotypes and clinical characteristics of different C. albicans isolates from VVC patients. Based on multilocus sequence typing (MLST), clade 1 was identified as the largest C. albicans group, which appeared most frequently in recurrent VVC and treatment failure cases. Further study of antifungal susceptibility demonstrated that MLST clade 1 strains presented significantly higher drug resistance ability than non-clade 1 strains, which result from the overexpression of MDR1. The mRNA and protein expression levels of virulence-related genes were also significantly higher in clade 1 isolates than in non-clade 1 isolates. Proteomic analysis indicated that the protein stabilization pathway was significantly enriched in clade 1 strains and that RPS4 was a central regulator of proteins involved in stress resistance, adherence, and DNA repair, which all contribute to the resistance and virulence of MLST clade 1 strains. This study was the first attempt to compare the correlation mechanisms between C. albicans MLST clade 1 and non-clade 1 strains and the clinical phenotype, which is of great significance for VVC classification and treatment.

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“…Clinical C. albicans isolates (1052 and C1-14) and NAC species (Candida glabrata, Candida parapsilosis, Candida tropicalis) were selected from our previous multicenter epidemiology study on VVC in China (38). Two C. auris isolates (10913 and 14918) were obtained from Wester Dijk Fungal Biodiversity Institute, and the standard strains (SC5314 and ATCC 90028) were reserved in the Institute of Dermatology, Chinese Academy of Medical Sciences.…”

Section: Culture Of Candida Strains and Epithelial Cellsmentioning

confidence: 99%

“…Vulvovaginal candidiasis (VVC) caused by non-albicans Candida (NAC) species are increasingly reported today. Given that more drug-resistant strains have been found in NAC species, we next analyze the EGFR-MAPK responses during the NAC species infections by using 3 clinical NAC isolates of C. tropicalis, C. glabrata, C. parapsilosis previously isolated from VVC patients (38) and 2 strains of C. auris (CBS10913 and CBS14918). The results were compared with 4 strains of C. albicans (SC5314, ATCC90028, 1052 and C1-14).…”

Section: Differential Activation Of the Egfr Pathway In Vaginal Epith...mentioning

confidence: 99%

“…Although less commonly reported, the highly antifungal-resistant emerging pathogen C. auris was described in one case of VVC (35). In a study with VVC murine model, although single isolate of each NAC species was tested, the preliminary data indicated that most NAC species are incapable of forming hyphae and do not elicit robust immunopathology in vivo (36), but NAC do actively contribute to symptomatic VVC (37,38). While significant attention has been given to C. albicans-induced host immune response, little is known regarding the interaction of vaginal epithelial cells and clinical NAC species.…”

Section: Introductionmentioning

confidence: 99%

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Divergent EGFR/MAPK-Mediated Immune Responses to Clinical Candida Pathogens in Vulvovaginal Candidiasis

Zhang

Peng

et al. 2022

Front. Immunol.

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Vulvovaginal candidiasis (VVC) is characterized by symptomatic inflammatory responses in the vagina caused by Candida albicans and non-albicans Candida (NAC) species. The epidermal growth factor receptor (EGFR) -mitogen-activated protein kinase (MAPK) signaling pathway has been linked to immune responses of oral mucosa after C. albicans exposure, but whether this pathway plays a similar response in vaginal epithelial cells is not known. Here, we observed that phosphorylation of EGFR and p38 was continuously activated in vaginal epithelial cells by C. albicans strain SC5314. This differs markedly from oral epithelial cells, which respond in a biphasic manner in order to properly discriminate the morphology of C. albicans. When compared with SC5314, a highly azole-resistant C. albicans isolate 1052 can induce a stronger phosphorylated signal of EGFR and p38, while clinically-isolated NAC strains including C. tropicalis, C. glabrata, C. parapsilosis and C. auris trigger higher levels of phosphorylated ERK1/2 and c-Fos than C. albicans. Inhibition of EGFR significantly reduces inflammatory response and epithelial damage induced by C. albicans both in vitro and in vivo, while inhibition of p38 leads to significant repair of epithelial damage triggered by both C. albicans and NAC species. These results confirm the importance of the EGFR-MAPK signaling in VVC pathogenesis and highlight the remarkable immunogenic differences between C. albicans and NAC species in host-microbe interactions.

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A prospective study on vulvovaginal candidiasis: multicentre molecular epidemiology of pathogenic yeasts in China

Cited by 7 publications

References 47 publications

Ethnobotanical study of medicinal plants utilized in the management of candidiasis in Northern Uganda

Ethnobotanical study of medicinal plants utilized in the management of candidiasis in Northern Uganda

Candida albicans Multilocus Sequence Typing Clade I Contributes to the Clinical Phenotype of Vulvovaginal Candidiasis Patients

Divergent EGFR/MAPK-Mediated Immune Responses to Clinical Candida Pathogens in Vulvovaginal Candidiasis

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