Species distribution and susceptibility profiles of Candida species isolated from vulvovaginal candidiasis, emergence of C. lusitaniae

• Main Authors: Seyedebrahim Hashemi, Tahereh Shokohi, Mahdi Abastabar, Narges Aslani, Mahbobeh Ghadamzadeh, Iman Haghani
• Format: Article
• Language: English
• Published: Mazandaran University of Medical Sciences 2019-12-01
• Series: Current Medical Mycology
• Subjects: vulvovaginal candidiasis; candida species; pcr-rflp; antifungal susceptibility testing; c. lusitaniae
• Online Access: http://cmm.mazums.ac.ir/article_97301_5cf8af5ce98b13df8bdf3f5298dfe945.pdf
• ISSN: 2423-3439; 2423-3420

<strong>Background and Purpose</strong>: The aim of the current study was to investigate the epidemiology of vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC), as well as the antifungal susceptibility patterns of <em>Candida</em> species isolates.<br /> <strong>Materials and Methods</strong>: A cross-sectional study was carried out on 260 women suspected of VVC from February 2017 to January 2018. In order to identify <em>Candida</em> species isolated from the genital tracts, the isolates were subjected to polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) using enzymes <em>Msp I</em> and sequencing. Moreover, antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute guidelines (M27-A3).<br /> <strong>Results</strong>: Out of 250 subjects, 75 (28.8%) patients were affected by VVC, out of whom 15 (20%) cases had RVVC. Among the <em>Candida</em> species, <em>C. albicans</em> was the most common species (42/95; 44.21%), followed by <em>C. lusitaniae</em> (18/95; 18.95%), <em>C. parapsilosis</em> (13/95; 13.69%),  <em>C. glabrata</em> (8/95; 8.42%), <em>C. kefyr</em> (6/95; 6.31%), <em>C. famata</em> (5/95; 5.26%), <em>C. africana </em>(2/95; 2.11%), and <em>C. orthopsilosis </em>(1/95; 1.05%), respectively. Multiple <em>Candida</em> species were observed in 28% (21/75) of the patients. Nystatin showed the narrowest range of minimum inhibitory concentration (MIC) (0.25-16 μg/ml) against all<em> Candida </em>strains, whereas fluconazole (0.063-64 μg/ml) demonstrated the widest MIC range. In the current study,<em> C. lusitaniae, </em>as the second most common causative agent of VVC, was susceptible to all antifungal agents. Furthermore, 61.1% of <em>C. lusitaniae </em>isolates were inhibited at a concentration of ≤ 2 μg/ml<em>, </em>while38.9% (n=7)of them exhibited fluconazole MICs above the epidemiologic cutoff values (ECV). <em>Candida</em> species showed the highest overall resistance against fluconazole (61.3%), followed by itraconazole (45.2%) and caspofungin (23.7%). All of <em>C. albicans</em> strains were resistant to itraconazole with a MIC value of ≥ 1 μg/ml; in addition, 87.5% of them were resistant to fluconazole. Moreover, 100% and 87.5% of <em>C. glabrata</em> strains were resistant to caspofungin and fluconazole, respectively.<br /> <strong>Conclusion: </strong>As the findings revealed, the majority of VVC cases were caused by non-<em>albicans Candida</em> species which were often more resistant to antifungal agents. <em>Candida lusitaniae</em> generally had fluconazole MICs above the ECV. Given the propensity of <em>C. lusitaniae</em> to develop resistance under drug pressure, antifungals should be administered with caution. The emergence of these species justify the epidemiological surveillance surveys to watch out the distribution of yeast species.