Prevalence and Antifungal Susceptibility of Candida albicans Causing Vaginal discharge Among Pregnant Women in Lebanon

Abstract

Background: Vaginal candidiasis is frequently prevalent in pregnant women and is associated with sepsis and adverse neonatal outcomes. This study determined the presence of Candida species in symptomatic pregnant women and evaluated the antifungal susceptibility profile of the isolated strains. It also aimed to explore whether Candida species predicts gestational complications and adverse neonatal outcomes. Methods: A total of 258 pregnant women at 35 to 37 week of gestation participated in this study. Vaginal swabs from these patients were collected at various obstetrics and gynecology clinics in Lebanon for a period of 12 months. Candida isolates were identified at species level and antifungal susceptibility of Candida albicans to fluconazole (FCZ), amphotericin B (AMB), itraconazole (ICZ) and voriconazole (VCZ) was determined by the agar-based E-test method. Results: Among 258 women tested, 100 (39%) were positive for Candida species. C. albicans, C. glabrata and C. krusei were isolated from 42%, 41% and 17% of the women, respectively. C. albicans had significant positive associations with gestational diabetes while C. kreusi or C. glabrata had significant positive associations with gestational complications and vaginal discharge. The antifungal susceptibility tests of C. albicans isolates revealed 97.5%, 90%, 87.5% and 97.5% susceptibility to AMB, FCZ, ICZ and VCZ, respectively. Conclusion: The current study revealed high incidence of both C. albicans and non-C. albicans strains causing vulvovaginitis among pregnant women in Beirut, Lebanon. Whereas the susceptibility rates of C. albicans against AMB and VCZ were high, FCZ and ICZ proved comparatively less efficacious. The resistance profile of circulating C. albicans among pregnant women can predict the best outcome of appropriate prophylaxis or treatment of neonatal candidiasis. Vaginal candida colonization might lead to adverse neonatal outcome or gestational complications thus Candida screening as antennal follow up is advised.

Analysis of Biofilm-Related Genes and Antifungal Susceptibility Pattern of Vaginal Candida albicans and Non-Candida albicans Species

“…In Greece, the antifungal susceptibility profile has shown that Candida isolates from patients with vulvovaginal candidiasis to AMB and VRC were 0.2% and 1.4%, respectively [36]. In addition, Ghaddar et al revealed that 97.5% of C. albicans isolates from VVC patients were resistant to VRC [37]. Our findings demonstrated that 23.4% and 10.6% of C. albicans isolates were resistant to FLC and ITC, respectively.…”

Isolation and genotyping of Candida albicans involved in vaginal candidiasis among pregnant women in Sulaymaniyah and Erbil cities

“…In the current study, the prevalence rate of vulvovaginal candidiasis was 33.53% between participated pregnant women. This result is lower than that reported in Lebanon (39%), 7 Pakistan (38%), 6 and India (42.37%). 23 However, another study reported a lower prevalence rate (29%) of VVC in Iraq.…”

“…It can also be found that the high occurrence rate of C. albicans could be due to increased physiological changes, estrogen, and rich glycogen content of the vaginal mucosa, thereby providing an adequate supply of utilizable sugar that favor its growth during pregnancy. 14 However, Ghaddar et al 7 reported a low incidence of C. albicans (42%) comparing to non-albicans Candida species (58%), where include C. glabrata and C. krusei. Molecular subtyping of C. albicans provides a useful tool for studying the epidemiology of this commonly causative agent of candidiasis in humans for identification of pathogenic subpopulation within this species, thereby assist in developing appropriate therapeutic strategies to combat the disease.…”

“…6 It has been estimated that nearly up to 40% of pregnant women worldwide may have vaginal colonization by Candida species. [5][6][7] Candida albicans is the most common causative pathogen of candidiasis. Recently, other Candida species known as non-albicans, such as C. glabrata, C. tropicalis, C. parapsilosis, C. krusei and C. dubliniensis have emerged as important opportunistically infectious fungi.…”

Whole genome sequencing of a clinical drug resistant Candida albicans isolate reveals known and novel mutations in genes involved in resistance acquisition mechanisms

“…Consequently, C. albicans infections pose a serious public health threat worldwide including Lebanon. To date only a handful of studies have addressed resistance of Lebanese C. albicans isolates to azoles, echinocandins, and polyenes [11][12][13][14][15][16][17] but none of the studies have looked at the entire genome of C. albicans to generate a complete picture of the genomic aspects of antifungal resistance.…”