Clinicomycological Study of Vulvovaginal Candidiasis

Seeniammal, S (2015) Clinicomycological Study of Vulvovaginal Candidiasis. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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INTRODUCTION: Vaginal Candidiasis is a most common fungal infection of the vulva and vagina involving nearly 75% of adult women during their lifetime. Vaginal Candidiasis is otherwise called as vaginal thrush. It is caused by Candida species. Candidiasis of vulva and vagina is found to be the second most common cause of vaginitis after bacterial vaginosis. Candida albicans constitutes 85% to 90% of cases. Candida is a normal inhabitant of healthy mucosal surface of oral cavity, gastrointestinal tract and vagina. These are true opportunistic pathogens which utilise the host’s debilitated status and gain access to the circulation and deeper tissues. However, some factors or conditions like prolonged antibiotics usage which alter the balance of micro organisms in the vaginal milieu, pregnancy, diabetes in which increased glycogen provide nutrition to the candidial growth, immunosuppressive drugs and HIV infection may result in an overgrowth of Candida. Very young and very old are also at risk of getting the infection. The genus Candida is comprised of more than 200 species. The medically significant Candida species include Candida albicans, Candida glabrata, Candida tropicalis, Candida krusei, Candida parapsilosis, Candida lusitaniae, Candida kefyr, Candida stellatoidea, Candida guilliermondii, and Candida dubliniensis. Candida albicans is the most common opportunistic fungal infection which cause a range of mild superficial infections to life threatening systemic candidiasis which occurs in immunocompromised patients. In recent years non Candida albicans species which are resistant to traditional antifungals are emerging. Nowadays candidiasis has become more and more severe due to the spread of HIV infection and the frequent use of antibiotics and immunosuppressive therapies. Furthermore, the treatment of candidiasis is difficult due to the limited choices of antifungals. Classical clinical symptoms of vulvovaginal candidiasis include curdy white vaginal discharge and vaginal itching. Making a diagnosis of vaginal candidiasis includes performing a complete evaluation, detailed history and and physical examination, together with pelvic examination. This consists of taking a swab from the vaginal secretions and visualising it under a microscope to confirm an overgrowth of yeast. Sometimes patients may get dysuria and dysparunia. The surrounding tissue around the vulva and the vagina may become red and swollen. Vulvovaginal candidiasis can be managed with a variety of antifungal agents, few of which are available over-the-counter. Although the way to clearly diagnose vulvovaginal candidiasis is to see the pseudohyphae under the microscope, many women take medicines themselves based on their symptoms which favours infection with drug resistant species. Proper treatment usually results in complete resolution . So in view of these factors speciation and drug sensitivity of vulvovaginal candidiasis was done and the results were analysed. AIMS AND OBJECTIVES: This study was done in adult females in the Department of Dermatovenereology at Tirunelveli medical college with the following Objectives: 1. To diagnose vulvovaginal candidiasis amongst female patients with genital pruritus and discharge pervaginum by clinical and laboratory methods including wet mount, 10%KOH mount and Gram’s staining. 2. To identify the culture characteristics and species prevalence of Candida species. 3. To study the drug sensitivity pattern of vulvovaginal candidiasis those who were proved to have canidida infection by vaginal smear study. MATERIALS AND METHODS: Our study is a open prospective study which was conducted in the Department of Dermato-Venereoleprology after obtaining clearance from Ethical committee of Tirunelveli Medical College with the co-operation of Department of microbiology, over a period of one and half years from January 2013 to July 2014. INCLUSION CRITERIA: 1. All female patients aged more than 18 years with complaints of genital pruritus and discharge pervaginum attending the STD clinic of Department of Dermatovenereoleprology. 2. Those cases proved to have candida infection by vaginal smear for wet mount, KOH and Gram’s stain in the laboratory. EXCLUSION CRITERIA: 1. Female patients aged less than 18 years. 2. Patients already treated with antifungals. 3. Vaginal smear negative for Candida. 4. Pregnant women. OBSERVATION AND RESULTS: A total of 80 symptomatic female patients above 18 years who fulfilled the inclusion criteria were screened. Diagnosis of vulvovaginal candidiasis was confirmed in 50 case and they were taken for culture and sensitivity testing. The results we obtained is analysed and summarised in this section. All the results obtained were analysed statistically for their completedness, consistency and accuracy. SUMMARY: The following are the implications derived from this prospective study on clinicomycological study of vulvovaginal candidiasis among the patients more than 18 years of age over a period of one and a half years. 1. The most common age group affected was 18 to 35 years which constitutes 55% of the study group. 2. Clinical presentation of VVC was similar in HIV positive and HIV negative patients. Severe forms were found in non Candida albicans and RVVC patients. 3. The most common predisposing factor was HIV infection induced immunosuppression[48.7%] followed by antibiotic usage and diabetes mellitus. 4. The most common associated infection was HIV [48.7%] followed by bacterial vaginosis and trichomonas vaginalis. 5. Recurrent vulvovaginal candidiasis [RVVC] makes up 12% of total cases. Two third of them were HIV positives. 6. The most common species isolated was Candida albicans which constituted 82% and the rest were non Candida albicans species. 7. Candida glabrata was the most prevalent species among the non Candida albicans. 8. Drug sensitivity pattern of Candida albicans showed highest sensitivity to Nystatin 85.7% followed by triazoles [75-85%].Ketoconazole was more resistant[40-60%]. 9. Drug sensitivity pattern of non candida albicans showed 100% sensitivity to nystatin followed by triazoles [66-77%]. Ketoconazole showed highest resistance [45%]. CONCLUSION: Vulvovaginal candidiasis is common among women in the reproductive age group. Among various predisposing factors the deficient immune status of HIV predispose to pathogenic colonisation of vagina and frequent recurrences. Besides HIV some other factors like antibiotics, diabetes mellitus, IUCD usage and immunosuppressive drug intake also predisposes to vulvovaginal candidiasis. Species identification by culture methods showed Candida albicans to be the most prevalent species including the HIV positive patients in this study. Emergence of few nonCandida albicans species, recurrent vulvovaginal candidiasis necessitates the species identification and antifungal susceptibility to be done as a part of laboratory evaluation of vaginal candidiasis. Fluconazole, itraconazole and voriconazole were sensitive in both Candida albicans and non Candida albicans infections. Nystatin was found to be the highly sensitive drug followed by triazoles. Ketoconazole and miconazole were highly resistant to both Candida and non candida albicans species. According to our study results, elimination of predisposing factors and ensuring good immunity with identification of causative fungal species and treatment according to the drug sensitivity pattern will reduce the incidence of vulvovaginal Candidiasis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Vulvovaginal Candidiasis ; Clinicomycological study.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Punitha K
Date Deposited: 05 May 2018 09:44
Last Modified: 05 May 2018 09:44

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