Prevalence and clinico-mycological profile of vulvovaginal candidiasis in a tertiary care hospital
Keywords:Vulvovaginal candidiasis, Papanicalou stain, Non albicans, Inflammation
Background: Vulvovaginal candidiasis is an infectious condition caused by Candida and its species remains a global health morbidity among females especially in the reproductive age group. Vulvovaginal candidiasis has been associated with variable clinical profile and being a potential relationship with obstetric morbidities, the prevalence still remains high. The emergence of Non albicans species and its diagnosis at laboratory levels remains a challenge to the pathologists often warranting a supportive diagnostic modalities. The present study had been aimed to monitor the prevalence of vulvovaginal candidiasis in our tertiary care hospital and correlate the clinic-mycological profile with pathological findings on light microscopy.
Methods: All patients presented with specific clinical symptoms of reproductive age group were included. With few exclusion criteria, the clinical history was obtained and high vaginal smears were collected and stained with Papanicalou stain and pathological interpretation was documented. In few available and indicated cases, culture procedure was performed. The data obtained were compared and correlated with clinical and laboratory diagnostic findings.
Results: Among 125 cases studies, 62 positive cases for Candidiasis were reported with an approximate incidence of 50%. Further speciation identification showed C. albicans positivity in 45 cases and 17 cases for non albicans species. Women of second and third decade were predominantly affected by vulvovaginal candidiasis with abdominal pain and pruritis being a common clinical presentation.
Conclusions: The prevalence of vulvovaginal candidiasis is on higher margin especially among reproductive age group. Clinical profile must be further correlated with laboratory data for speciation, thereby guiding in prompt and appropriate treatment modalities on best patient care.
James, William D.; Berger, Timothy G. Andrews' Diseases of the Skin: clinical Dermatology. 2nd. Edn. Saunders Elsevier; 2006: 309-320.
Foxman B, Barlow R, Arcy H, Gillespie B, and Sobel JD, Candida vaginitis: self-reported incidence and associated costs, Journal of Sexually Transmitted Diseases,2005; vol. 27, no. 4, pp. 230– 235.
Røttingen, W. D. Cameron,Garnett P, “A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known? Journal of Sexually Transmitted Diseases, 2001;28(10):579–97.
Sobel JD, Faro S, Force RW, Vulvovaginal candidiasis: Epidemiologic diagnostic and therapeutic considerations, Am. J. Obstet. Gynecol. 1998;198:203-11.
Ferrer J. Vaginal candidosis: epidemiological and etiological factors. Intl J Gynecol Obstet. 2000;71:S21-7.
Spinillo A, Capuzzo E, Gulminetti R, Marone P, Colonna L, Piazzi G. Prevalence of and risk factors for fungal vaginitis caused by non-albicans species. Am J Obstet Gynecol. 1997;176:138-41.
Manchanda V, Agarwal S, Verma N. Yeast identification in routine clinical Microbiology laboratory and its clinical relevance. Indian Journal of Medical Microbiology. 2011;29(2):172-7.
Jones JM. Laboratory Diagnosis of Invasive Candidiasis. Clin Microbiol Rev. 1990;3:32-45.
Pfaller MA, Nosocomial Candidiasis: The emerging species, reservoirs and modes of transmission. Clinical Infect Disease. 1996;22:89-9.
Rizvi MW, Malik A. C.albicans infections in a north Indian tertiary care hospital, Aligarh, research article biology & medicine. 2002;3(2):176-81.
Mahmoudi Rad M, Zafarghandi S, Abbasabadi B. The epidemiology of Candida species associated with vulvovaginal candidiasis in an Iranian patient population, European Journal of Obstetrics Gynaecology and Reproductive Biology. 2011;155: 199–203
Chander J, Candidiasis: A text book of Medical Mycology, Mehta Publishers, New Delhi, (2009) 266-90.
Geiger A.M, Foxman B, Gillespie BW. “The epidemiology of vulvovaginal candidiasis among university students,”American Journal of Public Health. 1995;85(8):1146–8.
Kent HL. Epidemiology of vaginitis. American Journal of Obstetrics & Gynecology. 1996;165(4):1168–76.
Marrazzo J. Vulvovaginal candidiasis. British Medical Journal. 2003:326(7397):993–4.
Koenig M, Jejeebhoy S, Singh S, Sridhar S, “Investigating gynaecological morbidity in India: not just another KAP survey,” Reproductive Health Matters. 1998;6(11):84–97.
Bang RA, Baitule M, Sarmukaddam S, Bang AT, Choudhary Y. “High prevalence of gynaecological diseases in rural Indian women,” Lancet. 19981(8629):85–8.
Stephenson R, Koenig MA, Ahmed S. “Domestic violence and symptoms of gynecologic morbidity among women in North India.,” International Family Planning Perspectives. 2006;32(4):201–8.
Krupp K, Madhivanan P, Karat C. “Novel recruitment strategies to increase participation of women in reproductive health research in India,” Global Public Health, 2007; vol. 2, no. 4, pp. 395–403.
Prasad JH, Abraham S, Kurz KM. “Reproductive tract infections among young married women in Tamil Nadu, India,” International Family Planning Perspectives, 2005;vol. 31, no.2, pp. 73–82.
Akortha EE, Nwaugo V, Chikwe N. Antifungal resistance among Candida species from patients with genitourinary tract infection isolated in Benin City, Edo state, Nigeria, Afr. J. Microbiol. Res.2009; Vol. 3(11): 694-699
Srujana Mohanty, Immaculata S. Prevalence & susceptibility to fluconazole of Candida species causing vulvovaginitis, Indian Journal of Medical Research Publisher. 2007;126:315-60.
Ako-Nai A, Kassim O, Adeniran M. Study of urinary tract infections at Ile-Ife, Nigeria. East African Medical Journal, 1993;70: 10-14.
Sobel JD. Vulvovaginal candidiasis, Lancet. 2007;9 (2):1961-71.
Mirela Babi, Candida albicans and non albicans species as etiological agent of vaginitis in pregnant women, Bosnian Jourl of Basic Med Sciences.2010;10 (1):90-7.
Roberts, C. L.; Rickard, K.; Kotsiou, G.; Morris, J. M. Treatment of asymptomatic vaginal candidiasis in pregnancy to prevent preterm birth: An open-label pilot randomized controlled trial. BMC Pregnancy and Childbirth. 2001;11:18.
Lundstrom T, Sobel. Nosocomial candiduria- a review, CID.2001; vol.5: 1602-1607.
Fan P, Liu XP, Li W, Clinical characteristics of vulvovaginal candidiasis and antifungal susceptibilities of Candida species isolates among patients in southern China from 2003 to 2006, Journal of Obstetrics and Gynaecology Research. 2008;3 :561–6.
Ahmad A, Khan U. Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India. European Journal of Obstetrics Gynecology and Reproductive Biology. 2009;144:68-71.
Corsello S, Spinillo A, Osnengo G. An epidemiological survey of vulvovaginal candidiasis in Italy, Eur J Obstet Gynecol Reprod Biol. 2003;110:66-72.
Spinillo A, Pizzoli G, Colonna L, Nicola S, De Seta F, Guaschino S. Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candidiasis. Obstet Gynecol 1993;81:721–7.
Mendling W, Brasch, J. German Society for Gynecology and Obstetrics- Working Group for Infections and immunology in Gynecology and Obstetrics. Mycoses. 2001;55 Suppl 3: 1–13.
Obel JD. Epidemiology and pathogen esis of recurrent vulvovaginal candidiasis. Am J Obstet Gynecol, 1985;152:924–35.