scholarly journals Recurrent Vulvovaginal Candidiasis: An Immunological Perspective

2020 ◽  
Vol 8 (2) ◽  
pp. 144 ◽  
Author(s):  
Diletta Rosati ◽  
Mariolina Bruno ◽  
Martin Jaeger ◽  
Jaap ten Oever ◽  
Mihai G. Netea
Keyword(s):  
Fungal Infections ◽  
Protective Role ◽  
Vulvovaginal Candidiasis ◽  
Candida Colonization ◽  
Childbearing Age ◽  
Recurrent Vulvovaginal Candidiasis ◽  
Long Time ◽  
Different Populations ◽  
New Hypothesis

Vulvovaginal candidiasis (VVC) is a widespread vaginal infection primarily caused by Candida albicans. VVC affects up to 75% of women of childbearing age once in their life, and up to 9% of women in different populations experience more than three episodes per year, which is defined as recurrent vulvovaginal candidiasis (RVVC). RVVC results in diminished quality of life as well as increased associated healthcare costs. For a long time, VVC has been considered the outcome of inadequate host defenses against Candida colonization, as in the case of primary immunodeficiencies associated with persistent fungal infections and insufficient clearance. Intensive research in recent decades has led to a new hypothesis that points toward a local mucosal overreaction of the immune system rather than a defective host response to Candida colonization. This review provides an overview of the current understanding of the host immune response in VVC pathogenesis and suggests that a tightly regulated fungus–host–microbiota interplay might exert a protective role against recurrent Candida infections.

scholarly journals Recurrent Vulvovaginal Candidiasis

2021 ◽  
Vol 5 (5) ◽  
pp. 474-483
Author(s):  
Cyntya Sari Sovianti ◽  
Mutia Devi
Keyword(s):  
Quality Of Life ◽  
Topical Therapy ◽  
Predisposing Factors ◽  
Vulvovaginal Candidiasis ◽  
Suppressive Therapy ◽  
Recurrent Vulvovaginal Candidiasis ◽  
Candida Sp ◽  
Microbiological Examination ◽  
Culture Negative

Vulvovaginal candidiasis is a common fungal infection caused by Candida Sp, especially Candida albicans. Recurrent vulvovaginal candidiasis was defined as the occurrence of four or more episodes of vulvovaginal candidiasis ​​in 12 months period. As many as 9% of women from various populations have recurrent vulvovaginal candidiasis. Vulvovaginal candidiasis affects the quality of life, mental health, and sexual activity. There are many predisposing factors that caused recurrent vulvovaginal candidiasis, such as genetics, host, habit, idiopathic and non-albican candida microbes. Management of recurrent vulvovaginal candidiasis includes elimination of predisposing factors; mycological culture diagnosis and identification of specific Candida species; followed by microbiological examination to confirm the sensitivity of the azole group to Candida sp. Further, oral, or topical therapy should be continued until the patient is asymptomatic and culture-negative. Patients should receive induction therapy followed by maintenance suppressive therapy for six months.

scholarly journals Oteseconazole: an advance in treatment of recurrent vulvovaginal candidiasis

2021 ◽  
Author(s):  
Jack D Sobel ◽  
Paul Nyirjesy
Keyword(s):  
Treatment Option ◽  
Symptom Control ◽  
Vulvovaginal Candidiasis ◽  
High Rate ◽  
Tolerability Profile ◽  
Cytochrome P450 Enzyme ◽  
Recurrent Vulvovaginal Candidiasis ◽  
Development Of Resistance ◽  
P450 Enzyme

Recurrent vulvovaginal candidiasis (RVVC) has significant disease, financial and quality-of-life burdens, affects women from all strata of society worldwide, and lacks an approved therapeutic solution. Fluconazole emerged in 2004 as an antifungal for RVVC; it provides symptom control and has been accepted worldwide as a first-line treatment. Its limitations include the development of resistance and a high rate of vulvovaginal candidiasis recurrence after therapy cessation. There is now an improved treatment option on the horizon: oteseconazole – a novel, oral, selective fungal cytochrome P450 enzyme 51 inhibitor, designed to avoid off-target toxicities. In clinical studies to date, oteseconazole has demonstrated impressive efficacy, a positive tolerability profile and hope for a superior RVVC treatment option.

scholarly journals Recurrent Vulvovaginal Candidiasis

2021 ◽  
Vol 5 (3) ◽  
pp. 498-507
Author(s):  
Cyntya Sari Sovianti ◽  
Mutia Devi
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Topical Therapy ◽  
Predisposing Factors ◽  
Vulvovaginal Candidiasis ◽  
Suppressive Therapy ◽  
Recurrent Vulvovaginal Candidiasis ◽  
Candida Sp ◽  
Culture Negative

Vulvovaginal candidiasis is a common fungal infection caused by Candida Sp,especially Candida albicans. Recurrent vulvovaginal candidiasis was defined asthe occurrence of four or more episodes of vulvovaginal candidiasis in 12 monthsperiod. As many as 9% of women from various populations have recurrentvulvovaginal candidiasis. Vulvovaginal candidiasis affects the quality of life,mental health, and sexual activity. There are many predisposing factors thatcaused recurrent vulvovaginal candidiasis, such as genetics, host, habit,idiopathic and non-albican candida microbes. Management of recurrentvulvovaginal candidiasis includes elimination of predisposing factors; mycologicalculture diagnosis and identification of specific Candida species; followed bymicrobiological examination to confirm the sensitivity of the azole group toCandida sp. Further, oral, or topical therapy should be continued until the patientis asymptomatic and culture-negative. Patients should receive induction therapyfollowed by maintenance suppressive therapy for six months.

Influence of recurrent vulvovaginal candidiasis on quality of life issues

2019 ◽  
Vol 300 (3) ◽  
pp. 647-650 ◽  
Author(s):  
Eiko I. Fukazawa ◽  
Steven S. Witkin ◽  
Renata Robial ◽  
João G. Vinagre ◽  
Edmund C. Baracat ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Vulvovaginal Candidiasis ◽  
Recurrent Vulvovaginal Candidiasis ◽  
Life Issues

scholarly journals Immunopathogenesis of recurrent vulvovaginal candidiasis.

1996 ◽  
Vol 9 (3) ◽  
pp. 335-348 ◽  
Author(s):  
P L Fidel ◽  
J D Sobel
Keyword(s):  
Host Defense ◽  
Defense Mechanism ◽  
Peripheral Circulation ◽  
Vulvovaginal Candidiasis ◽  
Cell Mediated Immunity ◽  
Vaginal Mucosa ◽  
Childbearing Age ◽  
Vaginal Infections ◽  
Recurrent Vulvovaginal Candidiasis ◽  
Host Defense Mechanism

Recurrent vulvovaginal candidiasis (RVVC) is a prevalent opportunistic mucosal infection, caused predominantly by Candida albicans, which affects a significant number of otherwise healthy women of childbearing age. Since there are no known exogenous predisposing factors to explain the incidence of symptomatic vaginitis in most women with idiopathic RVVC, it has been postulated that these particular women suffer from an immunological abnormality that prediposes them to RVVC. Because of the increased incidence of mucosal candidiasis in individuals with depressed cell-mediated immunity (CMI), defects in CMI are viewed as a possible explanation for RVVC. In this review, we attempt to place into perspective the accumulated information regarding the immunopathogenesis of RVVC, as well as to provide new immunological perspectives and hypotheses regarding potential immunological deficiencies that may predispose to RVVC and potentially other mucosal infections by the same organism. The results of both clinical studies and studies in an animal model of experimental vaginitis suggest that systemic CMI may not be the predominant host defense mechanism against C. albicans vaginal infections. Rather, locally acquired mucosal immunity, distinct from that in the peripheral circulation, is now under consideration as an important host defense at the vaginal mucosa, as well as the notion that changes in local CMI mechanism(s) may predispose to RVVC.

scholarly journals Prevalence and Antifungal Susceptibility Pattern of Candida Isolates from Women with Recurrent Vulvovaginal Candidiasis in Ghana - A Review of Laboratory Reports.

2020 ◽  
Author(s):  
George Antepim Pesewu ◽  
Patrick Kwame Feglo ◽  
Richard Kwaku Boateng ◽  
Samuel Adetona Fayemiwo
Keyword(s):  
Antifungal Susceptibility ◽  
Rflp Analysis ◽  
Vulvovaginal Candidiasis ◽  
Diffusion Method ◽  
Childbearing Age ◽  
Candida Spp ◽  
Disk Diffusion Method ◽  
Recurrent Vulvovaginal Candidiasis ◽  
Pcr Rflp ◽  
Common Infection

Abstract Vulvovaginal candidiasis (VVC) is a common infection among women of childbearing age, and few of these women experience recurrent vulvovaginal candidiasis (RVVC). The study was aimed at determining the virulent factors, and antifungal susceptibility of the Candida species isolated from women with RVVC attending the Nkawie Government Hospital, Ashanti-Region, Ghana. Over a 6–month period (October 2016 to March 2017), a total of 288 women with RVVC were evaluated. Isolation of the yeast was performed after the inoculation of the vaginal specimens onto Sabouraud Dextrose Agar (SDA), and incubated for 24-48 hours at 37oC. The isolates were identified by standardized conventional methods. The enzymatic activities of esterase, phospholipase, haemolysis and biofilm production were evaluated for the identification of the yeast isolates. Susceptibility to antifungal agents was determined by using the Kirby-Bauer disk diffusion method. Azole resistant isolates were further tested for ERG11 gene which encodes the enzyme (cytochrome P450 lanosterol 14-α-demethylase) by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Vaginal swabs cultures of 200 women (64.4) from 288 samples yielded Candida species. Candida albicans was the commonest isolated specie (33.0%), followed by Candida glabrata (29.5 %), Candida tropicalis (23.0%), and Candida krusei (15.5%). Hemolysin production, phospholipase enzyme activity, and biofilms formation were found in 84.5%, 83%, 77.5%.of the isolates respectively. Most phospholipase producing Candida isolates also formed biofilms. All Candida spp isolated were susceptible to itraconazole while majority of them were resistant to voriconazole. ERG11 genes were detected in 11.1% of Azole resistant Candida species. There is a significant increase in the rate of antifungal resistance among the Candida isolates to fluconazole and voriconazole. There is need for continuous surveillance as well as antifungal susceptibility testing on the Candida spp to guide therapy. A larger epidemiological study is also advocated to determining the degree of spread of ERG11 genes.

scholarly journals Identification of etiologic agents of recurrent vulvovaginal candidiasis in patients from Isfahan, Iran

2020 ◽  
Vol 7 (2) ◽  
pp. e18-e18
Author(s):  
Kiana Shirani ◽  
Zahra Allameh ◽  
Azadeh Moshtzan
Keyword(s):  
Candida Albicans ◽  
Candida Glabrata ◽  
Vulvovaginal Candidiasis ◽  
Antifungal Drugs ◽  
Childbearing Age ◽  
Recurrent Vulvovaginal Candidiasis ◽  
Number Of Children ◽  
Common Pathogen ◽  
Etiologic Agents ◽  
Meaningful Relationship

Introduction: Occurrence of vulvovaginal candidiasis (VVC), as a common condition in women of childbearing age, is increasing all over the world as a result of extensive use of antibiotics and antifungal drugs. Objectives: In the present study to gain the up-to-date information on involved species and the prevalence of the recurrent vulvovaginal candidiasis (RVVC) in Isfahan, Iran, we assessed the etiologic agents of aforementioned disease in women referred to the Al-Zahra hospital (Isfahan, Iran). Furthermore, we surveyed the possible relationship between age, education and marital status with prevalence of albicans and non-albicans candidiasis. Patients and Methods: Our study was conducted on subjects who were admitted to the gynecology and midwifery clinic between September 2017 and August 2018 and had clinical presentations of vulvovaginitis. Sampling of 100 women was done using sterile swab. Samples were transferred to the hospital laboratory for cellular and molecular investigations. Results:Candida albicans was the main pathogen involved in the pathogenesis of RVVC and Candida glabrata is the second most common pathogen. Moreover, none of the 100 cases that we tested were infected with Candida krusei. We found a meaningful relationship between age and RVVC triggered by Candida albicans (P<0.05) but there was no significant relationship between age and RVVC that triggered by non-albicans fungi. There was no meaningful correlation between levels of education, number of children and types of delivery with RVVC that infected by various albicans and non-albicans candidiasis (P>0.05). Conclusion:Candidaalbicans was the main pathogen involved in the pathogenesis of RVVC in Isfahan while Candida glabrata is the second most common pathogen. Despite their high cost, molecular methods have high value in accurate diagnosis of the RVVC.

scholarly journals Use of fluconazole in women of reproductive age with vulvovaginal candidiasis

2018 ◽  
pp. 96-102
Author(s):  
E. A. Mezhevitinova ◽  
P. R. Abakarova ◽  
Sh. M. Pogosyan
Keyword(s):  
Quality Of Life ◽  
Vulvovaginal Candidiasis ◽  
Reproductive Age ◽  
Common Disease ◽  
Women Of Reproductive Age ◽  
Recurrent Vulvovaginal Candidiasis ◽  
Group I ◽  
Relapse Therapy

Topicality: vulvovaginal candidiasis (VVC) is a common disease caused by the infectious damage of the vulva and vagina by yeast-like fungi from Candida genus. According to the literature, a VVC episode occurs in 75% of women, and 5-8% of them get a recurring course of the disease. Frequent recurrences of the disease may result in the psychosexual disorder and reduce the women’s quality of life and recurrent vulvovaginal candidiasis (VVC) therapy is still a very difficult task.Purpose of the study: evaluate the efficacy of fluconazole (150 mg) in acute and recurrent vulvovaginal candidiasis.Materials and methods:A total of 89 women of reproductive age with acute and recurrent HCV were enrolled in the study, which were subdivided into 2 groups: the first group included women with acute vulvovaginal candidiasis (AVVC) (n = 51), and the second group - women with recurrent vulvovaginal candidiasis (RVVC) (n = 38). The Group I (AVVC) received fluconazole 150 mg once. Depending on the prescribed therapy, the second group (RVVC) was subdivided into two subgroups: patients in the IIa subgroup received fluconazole 150 mg intravenously, three times, at intervals of 2 days, and women in the IIb subgroup received fluconazole 150 mg for a period of 6 months in addition to the three-fold intake of fluconazole weekly. The follow-up period was 6 months after the end of therapy, during which the frequency of VVC recurrence and the effectiveness of the therapy was evaluated.Results of the study: our data showed that all patients with acute VVC had a discontinuation of symptoms of the disease and a normalization of laboratory parameters after treatment with fluconazole, and after the anti-relapse therapy course the incidence of VVC recurrences was significantly lower compared to the period before anti-relapse therapy (p = 0.038). It was shown that all the investigated strains of C. albicans (100%) were sensitive to fluconazole, and resistance was detected only in 1 strain of C. glabrata and 1 strain of C. krusei. 

scholarly journals A High Rate of Recurrent Vulvovaginal Candidiasis and Therapeutic Failure of Azole Derivatives Among Iranian Women

2021 ◽  
Vol 12 ◽  
Author(s):  
Amir Arastehfar ◽  
Melika Laal Kargar ◽  
Shahla Roudbar Mohammadi ◽  
Maryam Roudbary ◽  
Nayereh Ghods ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Therapeutic Failure ◽  
Vulvovaginal Candidiasis ◽  
High Rate ◽  
Iranian Women ◽  
Related Factors ◽  
Therapeutic Success ◽  
Over The Counter ◽  
Factors Affecting ◽  
Recurrent Vulvovaginal Candidiasis

Recurrent vulvovaginal candidiasis (RVVC) is one of the most prevalent fungal infections in humans, especially in developing countries; however, it is underestimated and regarded as an easy-to-treat condition. RVVC may be caused by dysbiosis of the microbiome and other host-, pathogen-, and antifungal drug-related factors. Although multiple studies on host-related factors affecting the outcome have been conducted, such studies on Candida-derived factors and their association with RVVC are lacking. Thus, fluconazole-tolerant (FLZT) isolates may cause fluconazole therapeutic failure (FTF), but this concept has not been assessed in the context of Candida-associated vaginitis. Iran is among the countries with the highest burden of RVVC; however, comprehensive studies detailing the clinical and microbiological features of this complication are scarce. Therefore, we conducted a 1-year prospective study with the aim to determine the RVVC burden among women referred to a gynecology hospital in Tehran, the association of the previous exposure to clotrimazole and fluconazole with the emergence of FLZT and fluconazole-resistant (FLZR) Candida isolates, and the relevance of these phenotypes to FTF. The results indicated that about 53% of the patients (43/81) experienced RVVC. Candida albicans and C. glabrata constituted approximately 90% of the yeast isolates (72 patients). Except for one FLZT C. tropicalis isolate, FLZR and FLZT phenotypes were detected exclusively in patients with RVVC; among them, 27.9% (12/43) harbored FLZR strains. C. albicans constituted 81.2% of FLZR (13/16) and 100% of the FLZT (13/13) isolates, respectively, and both phenotypes were likely responsible for FTF, which was also observed among patients with RVVC infected with fluconazole-susceptible isolates. Thus, FTF could be due to host-, drug-, and pathogen-related characteristics. Our study indicates that FLZT and FLZR isolates may arise following the exposure to over-the-counter (OTC) topical azole (clotrimazole) and that both phenotypes can cause FTF. Therefore, the widespread use of OTC azoles can influence fluconazole therapeutic success, highlighting the necessity of controlling the use of weak topical antifungals among Iranian women.

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