Species identification and antifungal susceptibility pattern ofCandidaisolates in cases of vulvovaginal candidiasis

Abstract

Vulvovaginal candidiasis (VVC) remains one of the most common infections of the female genital tract. Correct identification of the isolated Candida species is essential to direct the empirical antifungal therapy. Objectives: This local study was conducted to identify the spectrum of Candida species associated with VVC using different phenotypic and genotypic methods and assess their antifungal susceptibility pattern. Materials and methods: High vaginal swabs were collected from 125 patients presenting with a clinical picture suggestive of VVC. Swabs were subjected to Gram-stain and culture on Sabouraud dextrose agar. Species identification of Candida isolates was done using phenotypic methods including germ tube test, Rice Tween-80 agar, Chrom ID (CAN2) agar and API 20C AUX, while PCR-RFLP was used as the gold standard method. Antifungal susceptibility testing was done using the disk diffusion method. Results: Vaginal swab cultures yielded Candida growth in 63 cases (50.4%). Candida albicans was the predominant isolated species (60.3%) while the most common non-albicans species was Candida glabrata (12.7%). Fortyfive (71.4%) and fifty-five (87.3%) Candida isolates were correctly speciated by Rice Tween-80 Agar and API 20C AUX, respectively, while fifty-seven isolates (90.5%) were correctly assigned into the 3 groups of yeasts identified by CAN2 agar. Amphotericin B was more effective than azoles against vaginal Candida isolates. Conclusion: C. albicans is the most common species associated with VVC. API 20C AUX was the most accurate phenotypic method for the proper identification of most Candida species whereas PCR-RFLP could properly confirm Candida species identification genotypically.

In vitro activity of five antifungal drugs against Candida albicans isolates in Sari, Iran

“…Elfeky et al [31], using disk diffusion method, demonstrated that 10.5% of C. albicans isolates were resistant to FLZ and VRZ, but 100% of the isolates were susceptible to AMB. Fothergill et al [25] revealed that FLZ resistance was increased in C. albicans from 2.1% to 5.7% and that VRZ resistance was 4.5%.…”

Isolation, speciation and antifungal susceptibility testing of Candida isolates from various clinical specimens at a tertiary care hospital, Nepal

“…Zone of inhibition around the disc was measured after incubating the media at 37 °C for 24 h. In case of C. krusei , repeated antifungal susceptibility testing to fluconazole was performed [12, 15]. …”

Prevalence and antifungal susceptibility of Candida species among pregnant women attending a school maternity at Natal, Brazil

“…This result shows that some phenotypic tools are still useful to the correct diagnosis of VVC, with the advantage of being of the most accurate method for the identification of Candida species, whereas molecular tools could confirm Candida species identification (Table ) (ElFeky et al . ).…”

“…; ElFeky et al . ). Thus, many professionals recommend in vitro susceptibility tests in cases of difficult treatment or infections caused by less frequent species to which there is less information (Mendling et al .…”

“…Studies reporting the increase of Candida sp. resistance against antifungal agents are causing great concern (Dota et al 2011 ;Mulu et al 2013;ElFeky et al 2015). Thus, many professionals recommend in vitro susceptibility tests in cases of difficult treatment or infections caused by less frequent species to which there is less information (Mendling et al 2015).…”