Acute versus Recurrent vulvovaginal candidiasis: evaluation of host and fungal factors

MIRÓ, MARÍA SOLEDAD; RODRIGUEZ, EMILSE; CASTILLO, GRACIELA; VIGEZZI, CECILIA; ICELY, PAULA ALEJANDRA; VARGAS, LARA; ABIEGA, CLAUDIO; RIERA, FERNANDO; AZCURRA, ANA ISABEL; CAEIRO, JUAN PABLO; SOTOMAYOR, CLAUDIA ELENA

Santiago de Chile

Congreso; XIV Forum on Fungal Infection in the Clinical Practice; 2016

Vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC) are two forms of a disease that affects a large number of otherwise healthy women caused by Candida species. Up to 8% of all VVC patients suffer from RVVC characterized by more than four episodes each year. A number of predisposing factors such as oral contraceptive usage, pregnancy, uncontrolled diabetes mellitus and long-term broad spectrum antibiotic treatment have been identified. The factors that determine which women will undergo the transition from sporadic VVC to RVVC are still undefined. Morphogenesis as fungal hydrolytic enzymes are relevant virulence factors during Candida vaginal infection. Meanwhile the importance of acid aspartic proteases (SAPs) during vaginal infection is known, lipases (LIPs) participation is still unclear.The aim of this study was the comparative analysis of host and fungal factors between acute (AVVC) and recurrent vulvovaginal candidiasis in patients. Patients were divided in two groups: 19 AVVC patients (27±6 years old), who had only one symptomatic episode and 61 RVVC (35±7 years old), who had four or more symptomatic episodes per year. Risk factors, treatment and treatment efficiency were obtained from medical records. Yeast samples were taken from the lateral vaginal wall using sterile swabs and growth in Sabouraud dextrose agar plates. Yeast identification was made by Maldi-Tof (Biomerieux). LIP activity was evaluated through the release of fatty acids by a plate test using the rhodamine B method. Determination of SAP production was assayed using the albumin agar plate medium supplemented with bovine serum albumin (BSA; Sigma?Aldrich). Protease and lipase activities result in a clear zone around the colony. The diameters were evaluated to semiquantify enzyme activities. C.albicans SC5314 was used as control.We found that the percentage of RVVC patients with no associated risk factors (56%) was more than two times than AVVC patients (25%). Treatment was very complex and diverse in the recurrent group compared with the single episode group. Its efficacy was higher in AVVC (80%) than in RVVC (54%). C.albicans was the most frequent strain identified in both groups. Comparative studies of the activity of both proteolitic enzyme families in AVVC and RVVC isolated Candidas have never been done. We found no differences in the activity of LIP or SAP of Candidas from both experimental groups and it was comparable with the control strain used. Our study provides evidence that 56% of patients develop the recurrent infection without having any risk factor, and we found no differences in the expression of important virulence factors between Candidas recovered from AVVC and RVVC patients. This might imply that it is the host rather than the pathogen that plays an important role in the susceptibility of RVVC.