Systemic Cell-Mediated Immune Reactivity in Women with Recurrent Vulvovaginal Candidiasis

Abstract

It has been suggested that impaired cell-mediated immunity (CMI) against Candida antigens is responsible for susceptibility to recurrent vulvovaginal candidiasis (RVVC) in adult women. To address this, we conducted a comprehensive longitudinal study examining in vivo and in vitro systemic CMI reactivity in RVVC patients. Results showed that RVVC patients frequently demonstrated a transient loss of Candida-specific delayed cutaneous skin test reactivity during episodes of symptomatic vaginitis. In contrast, in vitro peripheral blood lymphoproliferation and Th1-type lymphokine production by RVVC patients in response to a T cell mitogen and multiple Candida and bacterial antigens were similar to controls both during acute episodes of vaginitis and during periods of infection-free remission. These results suggest that women with RVVC have no detectable impairment of systemic CMI in peripheral blood and that transient reductions in skin test reactivity appear to be a result of vaginal Candida infection and not a predisposing factor to RVVC.

Cytokine and Chemokine Production by Human Oral and Vaginal Epithelial Cells in Response toCandida albicans

“…Although cell-mediated immunity (CMI) is considered important for protection against mucosal and/or systemic candidiasis (4,5), the role of systemic CMI against vaginal (12)(13)(14)(15)38) and more recently oral (27) candidiasis has been challenged to various degrees. Thus, investigations have shifted to the role of local oral and vaginal CMI.…”

Potential Role for a Carbohydrate Moiety in Anti-CandidaActivity of Human Oral Epithelial Cells

“…Although cell-mediated immunity is considered an important host defense mechanism against mucosal and/or systemic candidiasis (4,5), the role of systemic cellmediated immunity against vaginal (20,21,22,23,58) and, more recently, oral (37) candidiasis has been challenged to various degrees. Likewise, the role of antibodies and innate resistance against oral and vaginal candidiasis is largely unknown and/or controversial (3,11,19,55).…”

Candida-Specific Antibodies during Experimental Vaginal Candidiasis in Mice

“…While acute VVC is usually associated with predisposing factors such as antibiotic or oral contraceptive usage, pregnancy, or diabetes (30,42,43), RVVC is idiopathic, with no known predisposing factors (42,43). Rather, susceptibility to RVVC is thought to be associated with a local immune dysfunction or deficiency that allows the overgrowth of the commensal organism and subsequent conversion to the pathogenic form (16,20). Understanding the natural protective response(s) against VVC is important in determining the immunological factor(s) that contribute to RVVC.…”

“…However, in women with RVVC, recurrent episodes occur in the presence of normal levels of systemic Candida-specific Th1-type CMI, suggesting that any dysfunction or deficiency is at the local level (16). Likewise, in the estrogen-dependent murine model of vaginal candidiasis, systemic Candida-specific Th1-type CMI plays little to no protective role (17,19).…”