Arastehfar Amir, Kargar Melika Laal, Mohammadi Shahla Roudbar, Roudbary Maryam, Ghods Nayereh, Haghighi Ladan, Daneshnia Farnaz, Tavakoli Mahin, Jafarzadeh Jalal, Hedayati Mohammad Taghi, Wang Huiwei, Fang Wenjie, Carvalho Agostinho, Ilkit Macit, Perlin David S, Lass-Flörl Cornelia
Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States.
Department of Mycology, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran.
Front Microbiol. 2021 Apr 28;12:655069. doi: 10.3389/fmicb.2021.655069. eCollection 2021.
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 -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 -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) isolates, and the relevance of these phenotypes to FTF. The results indicated that about 53% of the patients (43/81) experienced RVVC. and . constituted approximately 90% of the yeast isolates (72 patients). Except for one FLZT . isolate, FLZR and FLZT phenotypes were detected exclusively in patients with RVVC; among them, 27.9% (12/43) harbored FLZR strains. 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.
复发性外阴阴道念珠菌病（RVVC）是人类中最常见的真菌感染之一，尤其是在发展中国家；然而，它被低估了，被认为是一种易于治疗的疾病。RVVC可能由微生物群失调以及其他与宿主、病原体和抗真菌药物相关的因素引起。尽管已经对影响结果的宿主相关因素进行了多项研究，但关于微生物群衍生因素及其与RVVC的关联的此类研究却很缺乏。因此，耐氟康唑（FLZT）分离株可能导致氟康唑治疗失败（FTF），但这一概念尚未在与微生物群相关的阴道炎背景下进行评估。伊朗是RVVC负担最高的国家之一；然而，详细描述这种并发症的临床和微生物学特征的综合研究却很少。因此，我们进行了一项为期1年的前瞻性研究，旨在确定转诊至德黑兰一家妇科医院的女性中的RVVC负担、先前接触克霉唑和氟康唑与FLZT和耐氟康唑（FLZR）分离株出现的关联，以及这些表型与FTF的相关性。结果表明，约53%的患者（43/81）患有RVVC。白色念珠菌和光滑念珠菌约占酵母分离株的90%（72例患者）。除了一株FLZT光滑念珠菌分离株外，FLZR和FLZT表型仅在RVVC患者中检测到；其中，27.9%（12/43）携带FLZR菌株。光滑念珠菌分别占FLZR分离株的81.2%（13/16）和FLZT分离株的100%（13/13），这两种表型都可能导致FTF，在感染氟康唑敏感分离株的RVVC患者中也观察到了FTF。因此，FTF可能归因于宿主、药物和病原体相关特征。我们的研究表明，FLZT和FLZR分离株可能在接触非处方（OTC）局部唑类药物（克霉唑）后出现，并且这两种表型都可导致FTF。因此，OTC唑类药物广泛使用会影响氟康唑治疗成功率，凸显了控制伊朗女性中弱效局部抗真菌药物使用的必要性。
