title: An intravaginal live Candida challenge in humans leads to new hypotheses for the immunopathogenesis of vulvovaginal candidiasis.
abstract: Acute and recurrent vulvovaginal candidiasis (VVC) remains a significant problem in women of childbearing age. While clinical studies of women with recurrent VVC (RVVC) and animal models have provided important data about a limited protective role of adaptive immunity, there remains a paucity of information on the protective mechanisms or factors associated with susceptibility to infection. In the present study, an intravaginal live Candida challenge in healthy adult women showed a differential susceptibility to symptomatic VVC, where 3 (15%) of 19 women with no history of VVC acquired a symptomatic infection compared to 6 (55%) of 11 women with an infrequent history of VVC. Furthermore, these studies revealed that protection against infection is noninflammatory while symptomatic infection correlates with a vaginal infiltration of polymorphonuclear neutrophils (PMNs) and a high vaginal fungal burden. Thus, the presence of symptomatic infection appears more dependent on host factors than on properties of the organism. Finally, vaginal lavage fluid from women with a symptomatic infection, but not those asymptomatically colonized, promoted the chemotaxis of PMNs. These results suggest that rather than RVVC/VVC being caused by an aberrant adaptive immune response, symptoms that define infection appear to be due to an aggressive innate response by PMNs.
authors.affiliation: Department of Microbiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA. pfidel@lsuhsc.edu
authors.forename: Paul L
authors.initials: PL
authors.lastname: Fidel
authors.forename: Melissa
authors.initials: M
authors.lastname: Barousse
authors.forename: Terri
authors.initials: T
authors.lastname: Espinosa
authors.forename: Mercedes
authors.initials: M
authors.lastname: Ficarra
authors.forename: Joy
authors.initials: J
authors.lastname: Sturtevant
authors.forename: David H
authors.initials: DH
authors.lastname: Martin
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Quayle
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dunlap
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D001826:Body Fluids / Q000276:immunology; D002176:Candida albicans / Q000276:immunology* / Q000472:pathogenicity*; D002181:Candidiasis, Vulvovaginal / Q000209:etiology* / Q000276:immunology*; D002634:Chemotaxis, Leukocyte; D015169:Colony Count, Microbial; D005260:Female; D006801:Humans; D007113:Immunity, Innate; D066298:In Vitro Techniques; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology; D014621:Vagina / Q000276:immunology / Q000382:microbiology