Increasing Virulence of Vulvovaginal Candididiasis (VVC) in the Modern Era with Reducing Immunity by Different Candida Species Along with Increasing Resistance and Management -An Update

Abstract

Although Candida yeasts are present as vaginal microbiota, presence of them always doesn't lead to clinical symptoms. Interactions between host defense functions besides synergism with a variety of microorganisms from the vaginal mucosa are the ones which maintain balance of vaginal surroundings. On breakdown of the vaginal ecosystem, overgrowth of Candida yeasts is helped that results in development of vulvovaginal candidiasis (VVC). VVC is an opportunistic mucosal infection being 2 nd commonest vaginal infection that affects women in reproductive age, affecting 75% of these women of which 50% at least get recurrence of the same infection once. Recently globally it has been found candidiasis is becoming a threat especially for women with poor immunity specially those with HIV infection. Further not only the original conventional candida albicans is becoming responsible for the infection with candida but other species like C. tropicalis and C. parapilasis and C. gabratus ar becoming the pathogenic organisms involved in causing VVC not only in nonpregnant women but also in women with pregnancy where it is becoming a threat for the fetus as well.Here we review the role of various Lactobacillus species, their biosurfactant properties and role of moonlighting proteins in the virulence of candida, besides further measures to reduce the virulence and treatment of VVC effectively. Although Candida yeasts are present as vaginal microbiota, presence of them always doesn't lead to clinical symptoms. Interactions between host defense functions besides synergism with a variety of microorganisms from the vaginal mucosa are the ones which maintain balance of vaginal surroundings [1]. On breakdown of the vaginal ecosystem, overgrowth of Candida yeasts is helped that results in development of vulvovaginal candidiasis (VVC) [2]. VVC an opportunistic mucosal infection being 2nd commonest vaginal infection that affects women in reproductive age [3], affecting 75% of women once in a lifetime, and 50% of them suffering a minimum of a single recurrence [3,4]. Initial symptoms of VVC are pruritus and soreness of the vulva, dysuria, white cottage cheese like vaginal discharge along with dyspareunia. Quality of life gets affected by VVC besides predisposing to development of HIV susceptibility [5]. Though very little mortality is there with VVC symptoms =>marked morbidity mainly in women infected with human immunodeficiency virus (HIV) [6]. Moreover, women having vaginal colonization of Candida spp during 2nd trimester of Methods Thus we used the search engine PubMed using the Me SH terms like vulvovaginal candidiasis; candida species; lactobacillus species; drugs for treatment of VVC; Drug resistance; virulence; VVC in pregnancy; moonlighting proteins; probiotics; immunodeficiency and VVC. pregnancy have less neonatal birth weights and > preterm birth in contrast to colonization by other microbes [7]. Results and DiscussionWe found a total of 3846 articles out of which we selected 50 articles for this review. No meta-analysis was done. ...