Management of persistent vulvo vaginal candidosis due to azole-resistant Candida glabrata.
CASE REPORT--SUBJECTS--Three cases are described of long-standing vaginal candidosis due to Candida glabrata. These had failed to respond to local and systemic antifungals. In each case the infecting strain appeared resistant to a range of azole drugs in vitro. CLINICAL COURSE--Case one--This patient recovered following prolonged treatment with oral itraconazole in combination with oral and vaginal nystatin. Case two. Yeasts were eradicated from this patient following cyclical treatment with oral dydrogesterone; prolonged vaginal treatment with nystatin may have helped. Case three. This patient did not respond to a prolonged course of oral itraconazole in combination with vaginal and oral nystatin, oral medroxyprogesterone or intravaginal boric acid. Eradication of C glabrata was finally achieved by local application of 1% gentian violet. Shortly after eradication of the C glabrata infection, both Case two and Case three developed infections with other Candida species responsive to azole antifungals.
Department of Genitourinary Medicine, Birmingham General Hospital, UK.
D J
DJ
White
E M
EM
Johnson
D W
DW
Warnock
D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D002181:Candidiasis, Vulvovaginal / Q000188:drug therapy*; D004352:Drug Resistance, Microbial; D004464:Econazole / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005840:Gentian Violet / Q000627:therapeutic use; D006801:Humans; D017964:Itraconazole; D007654:Ketoconazole / Q000031:analogs & derivatives / Q000627:therapeutic use; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D009761:Nystatin / Q000627:therapeutic use
D000935:Antifungal Agents; D009761:Nystatin; D017964:Itraconazole; D004464:Econazole; D015725:Fluconazole; D017258:Medroxyprogesterone Acetate; D005840:Gentian Violet; D007654:Ketoconazole