Candida Speciation and Antifungal Susceptibility in Vulvovaginitis: Insights from Clinical Isolates

Abstract

Abstract: Background: Vulvovaginal candidiasis presents a worldwide concern owing to its connections with economic burdens, sexually transmitted infections, and the potential for infection to ascend the genital tract, resulting in various complications for both pregnant and non-pregnant women. It ranks second only to bacterial vaginosis and impacts roughly 40-62% of women in their reproductive years. Moreover, there has been a notable rise in resistance to antifungal treatments over the past decade. As such, it is crucial to accurately identify Candida strains down to the species level and perform susceptibility testing for antifungal agents as part of the management of Candidal infections. Methods: During a 6-month period, 60 Candida species were obtained from 100 clinically diagnosed vaginitis cases. The growth of these isolates on Sabouraud dextrose agar followed established protocols, and subsequent Candida speciation was carried out using CHROM agar. Antifungal susceptibility testing was conducted utilizing the Etest method. Results: Out of the 100 patients with vaginitis, 60 tested positive for Candida species. The isolated Candida species were categorized into four types: C. albicans (25 cases, 42.8%), C. krusei (20 cases, 35.7%), C. tropicalis (10 cases, 12.5%), and C. glabrata (5 cases, 8.9%). Antifungal susceptibility testing results revealed that all Candida isolates exhibited 100% susceptibility to amphotericin B, nystatin, and voriconazole. However, C. krusei isolates demonstrated 100% resistance to fluconazole, while C. glabrata isolates exhibited 100% resistance to ketoconazole. Conclusion: In our current research, C. albicans emerged as the most prevalent species, closely followed by

1. krusei. The process of initially presuming the identity of Candida species, followed by confirming it, proves essential in facilitating the prompt commencement of suitable antifungal therapies. Notably, the relatively elevated resistance observed in Non-albicans Candida species to commonly prescribed antifungal agents such as fluconazole and ketoconazole underscores the importance of routinely conducting antifungal susceptibility testing for all Candida isolates.