Roy Mahuya, Majumdar Tapan, Ray Jayanta
Department of Microbiology, Agartala Government Medical College, Agartala, India.
Department of Obstetrics and Gynaecology, Agartala Government Medical College, Agartala, India.
Indian J Med Microbiol. 2024 Nov-Dec;52:100738. doi: 10.1016/j.ijmmb.2024.100738. Epub 2024 Oct 4.
Candida colonisation in vagina was found to be 20 %, rising to 30 % during pregnancy. According to studies, the prevalence of VVC during pregnancy is higher than healthy women. During pregnancy, candidal colonisation increases, both symptomatic and asymptomatic. However, the difference between strains causing symptomatic infection and those that cause asymptomatic infection is unknown.
This study aimed to compare the virulence factors of Candida VVC isolates from symptomatic and asymptomatic pregnant women.
The study included 120 pregnant women- 60 symptomatic and 60 asymptomatic, who presented to the Obstetrics and Gynaecology Outpatient Department with vaginitis symptoms. High vaginal swabs from the patient and used for gram stain, direct wet mount, pH detection and fungal culture in SDA with and without antibiotics. Germ tube tests, growth in CMA, and HiCrome Candida Differential Agar were used to identify yeast colonies grown in culture. The isolates were then examined for virulence factors like biofilm formation, phospholipase, coagulase, and hemolysin. Antifungal susceptibility was determined using E-test.
The current study reveals a high prevalence of Vulvovaginal Candidiasis in pregnant women(35 %). Asymptomatic patients had lower proportion of VVC than symptomatic patients. Non albicans Candida(NAC) outnumbered Candida albicans. Although Candida albicans growth was predominant in asymptomatic patients. Virulence studies revealed that Candida spp. isolated from symptomatic patients expressed a higher proportion of virulence factors. Besides NAC has higher proportion of expressing virulence factors than Candida albicans and has higher propensity to cause infection especially in symptomatic pregnant women. Antifungal susceptibility testing shows Itraconazole to be most sensitive for VVC treatment but Candida albicans was most susceptible to fluconazole while NAC had the least.
The study emphasizes the importance of routine screening of symptomatic pregnant women for VVC, as syndromic treatment will increase antifungal resistance, particularly in NAC.
研究发现，阴道念珠菌定植率为20%，孕期升至30%。研究表明，孕期外阴阴道假丝酵母菌病（VVC）的患病率高于健康女性。孕期念珠菌定植增加，包括有症状和无症状的情况。然而，引起有症状感染的菌株与引起无症状感染的菌株之间的差异尚不清楚。
本研究旨在比较有症状和无症状孕妇的VVC念珠菌分离株的毒力因子。
该研究纳入了120名孕妇，其中60名有症状，60名无症状，她们因阴道炎症状到妇产科门诊就诊。采集患者的高阴道拭子，用于革兰氏染色、直接湿片检查、pH值检测以及在含和不含抗生素的沙氏葡萄糖琼脂（SDA）上进行真菌培养。芽管试验、在玉米粉琼脂（CMA）上的生长情况以及HiCrome念珠菌鉴别琼脂用于鉴定培养中生长的酵母菌落。然后对分离株进行生物膜形成、磷脂酶、凝固酶和溶血素等毒力因子检测。使用E-test法测定抗真菌药敏性。
本研究显示孕妇中外阴阴道假丝酵母菌病的患病率很高（35%）。无症状患者的VVC比例低于有症状患者。非白色念珠菌（NAC）的数量超过白色念珠菌。尽管白色念珠菌在无症状患者中生长占主导。毒力研究表明，从有症状患者分离出的念珠菌属表达毒力因子的比例更高。此外，NAC表达毒力因子的比例高于白色念珠菌，尤其在有症状的孕妇中引起感染的倾向更高。抗真菌药敏试验表明，伊曲康唑对VVC治疗最敏感，但白色念珠菌对氟康唑最敏感，而NAC最不敏感。
该研究强调了对有症状孕妇进行VVC常规筛查的重要性，因为症状性治疗会增加抗真菌耐药性，尤其是在NAC感染中。
