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ORIGINAL ARTICLE
Year : 2022  |  Volume : 24  |  Issue : 2  |  Page : 71-75

Vulvovaginal candidiasis: Clinical profile, species distribution and antifungal susceptibility pattern


1 Department of Clinical Microbiology and Infection Control, Gleneagles Global Hospitals, Hyderabad, Telangana, India
2 Department of Clinical Microbiology and Infection Control, Gleneagles Global Hospitals; Department of Clinical Microbiology and Infection Control, Rainbow Children's Hospital and Birthright, Hyderabad, Telangana, India
3 Department of Obstetrics and Gynaecology, Rainbow Children's Hospital and Birthright, Hyderabad, Telangana, India

Correspondence Address:
Rekha Rao Jangam
Department of Clinical Microbiology and Infection Control, Gleneagles Global Hospitals, 6-1-1070/1 to 4, Lakdikapul, Hyderabad - 500 004, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacm.jacm_24_22

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INTRODUCTION: Vulvovaginal candidiasis (VVC) is a common problem seen in women and 70%–75% of women experience VVC at least once in their lifetime. The relative incidence of vaginitis caused by non-albicans Candida (NAC) species is increasing which poses a problem as NAC is less susceptible to fluconazole which is commonly used for the treatment of VVC. In this study, we determined the species distribution of Candida isolates causing VVC and the antifungal susceptibility pattern of these isolates to fluconazole. MATERIALS AND METHODS: A prospective study was done in a tertiary care hospital in Hyderabad, South India (August 2019–December 2020), on 500 women with suggestive clinical features and culture-confirmed VVC. Five hundred Candida strains isolated from the vaginal swab of these women were speciated and fluconazole antifungal susceptibility testing (AFST) was done by broth microdilution technique (CLSI guidelines) for 103 isolates. The following fluconazole concentrations were tested: 0.125 μg/ml, 0.25 μg/ml, 0.5 μg/ml, 1 μg/ml, 2 μg/ml, 4 μg/ml, 8 μg/ml, 16 μg/ml, 32 μg/ml and 64 μg/ml which encompassed the clinical breakpoint concentrations and the expected results for the quality control strains. RESULTS: The majority of the women (93%) with VVC were in the reproductive age group (21–40 years). The most common presenting symptoms were vaginal discharge (66.4%) and pruritus (26.6%). The most common predisposing factor for VVC was pregnancy (44.8%). Candida albicans (62.8%) was the most common species isolated, followed by Candida glabrata (27.2%). Overall fluconazole susceptibility was 57%. About 72.2% of C. albicans were fluconazole susceptible. CONCLUSION: VVC has a wide clinical presentation with non-specific signs and symptoms. Diagnosis based only on signs and symptoms leads to over treatment. Thus, culture confirmation is crucial for the accurate diagnosis and to detect VVC caused by NAC which is less susceptible to fluconazole. Fluconazole AFST on these isolates would help in developing local antibiograms and to monitor resistance trends.


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