title: Species-specific prevalence of vaginal candidiasis among patients with diabetes mellitus and its relation to their glycaemic status.
abstract: OBJECTIVE
  Non- C. albicans Candida species are increasingly being recognized as the cause of vulvo-vaginal candidiasis. These species are often less susceptible to antifungal agents. Patients with diabetes mellitus are at risk for vulvo-vaginal candidasis. We assessed the species-specific prevalence rate and risk of candidiasis in patients with diabetes mellitus and healthy controls.
  
  
  METHODS
  Genital tract examination, direct microscopy and fungal cultures of discharge collected by high vaginal swab were undertaken among 78 consecutive patients with diabetes mellitus (mean (+/-sd) age 32+/-12 years and body mass index (BMI) 22.3+/-5.5kg/m(2)) and 88 age- and BMI-matched healthy females. Glycaemic control in the diabetic cohort was assessed by measuring total glycosylated haemoglobin.
  
  
  RESULTS
  Candida species were isolated in 36 of 78 (46%) subjects with diabetes mellitus and in 21 of 88 (23%) healthy subjects (Chi-squared 9.11, P=0.0025). The predominant Candida species isolated in diabetics with vulvo-vaginal candidiasis were Candida glabrata (39%), C. albicans (26%) and C. tropicalis (17%). In contrast, in the control group, C. albicans, C. glabrata and C. hemulonii comprised 30% each, with none having C. tropicalis infection (for C. tropicalis: diabetic vs. control; 17% vs. nil, P=0. 05). Among the diabetic group, subjects with vulvo-vaginal candidiasis had significantly higher mean HbA1 when compared to those who had no such infection (12.8+/-2.6% vs. 9.7+/-1.7% respectively, P=0.001). The overall accuracy of direct microscopy and clinical examination for predicting vulvo-vaginal candidiasis was only 77% and 51%, respectively, in the diabetic group, and 83% and 65% in the control group.
  
  
  CONCLUSIONS
  Patients with diabetes mellitus had a high prevalence rate (46%) of vulvo-vaginal candidiasis with relative risk of 2.45. The non- C. albicans species such as C. glabrata and C. tropicalis were the predominant species isolated among them. There seems to be a significant link between hyperglycaemia and vulvo-vaginal candidiasis.
authors.affiliation: Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: R
authors.initials: R
authors.lastname: Goswami
authors.forename: V
authors.initials: V
authors.lastname: Dadhwal
authors.forename: S
authors.initials: S
authors.lastname: Tejaswi
authors.forename: K
authors.initials: K
authors.lastname: Datta
authors.forename: A
authors.initials: A
authors.lastname: Paul
authors.forename: R N
authors.initials: RN
authors.lastname: Haricharan
authors.forename: U
authors.initials: U
authors.lastname: Banerjee
authors.forename: N P
authors.initials: NP
authors.lastname: Kochupillai
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002181:Candidiasis, Vulvovaginal / Q000150:complications* / Q000382:microbiology; D016022:Case-Control Studies; D015331:Cohort Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood; D005260:Female; D006801:Humans; D015995:Prevalence; D012307:Risk Factors; D013045:Species Specificity; D019522:Vaginal Discharge
chemical_list: D001786:Blood Glucose