title: Yeast vaginitis during pregnancy: susceptibility testing of 13 antifungal drugs and boric acid and the detection of four virulence factors.
abstract: A higher prevalence of vulvovaginal candidiasis (VVC) is seen in pregnant women compared with those who are not pregnant. Recurrence is also more common in pregnant women, and therapeutic responses are reduced. In this investigation, 207 vaginal yeast isolates recovered from pregnant women were tested for susceptibility to 13 antifungal drugs and boric acid and through these studies four virulence factors were also determined. The isolates were recovered from vaginal samples of patients with acute VVC [AVVC, (n = 73)], symptomatic recurrent VVC [RVVC, (n = 89)], asymptomatic RVVC (n = 27), and those without signs and symptoms (n = 18). Candida albicans was the most common species found (59.9%), followed by C. glabrata (19.8%), other Candida spp., (19.8%), and Saccharomyces cerevisiae (0.5%). Antifungal susceptibility testing was performed as described in CLSI document M27-A3. Additionally, we examined phospholipase and proteinase production, adhesion to vaginal epithelial cells and hemolytic activity. Notably, the MIC values of Candida spp. isolates derived from patients with VVC were no different from those of the controls (P > 0.05). In addition, Candida isolates derived from patients with AVVC or RVVC produced significantly higher amounts of phospholipase and proteinase compared with the controls (P < 0.05). Antifungal testing and the determination of virulence factors may lead to the effective and prompt treatment of VVC, particularly in pregnant women.
authors.affiliation: Department of Medical Microbiology, Faculty of Medicine, University of Gazi, Ankara, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Kalkanci
authors.forename: Ahmet Bariş
authors.initials: AB
authors.lastname: Güzel
authors.forename: Israa Ibrahim Jabban
authors.initials: II
authors.lastname: Khalil
authors.forename: Merve
authors.initials: M
authors.lastname: Aydin
authors.forename: Macit
authors.initials: M
authors.lastname: Ilkit
authors.forename: Semra
authors.initials: S
authors.lastname: Kuştimur
mesh_terms: D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000494:pharmacology; D000818:Animals; D000935:Antifungal Agents / Q000494:pharmacology*; D001888:Boric Acids / Q000494:pharmacology*; D002176:Candida albicans / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification / Q000472:pathogenicity; D041221:Candida glabrata / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification / Q000472:pathogenicity; D002181:Candidiasis, Vulvovaginal / Q000382:microbiology*; D002448:Cell Adhesion; D004847:Epithelial Cells / Q000382:microbiology; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D005656:Fungal Proteins / Q000378:metabolism; D006461:Hemolysis; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010740:Phospholipases / Q000378:metabolism; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology*; D012008:Recurrence; D012441:Saccharomyces cerevisiae / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification / Q000472:pathogenicity; D014621:Vagina / Q000382:microbiology; D037521:Virulence Factors / Q000378:metabolism; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D001888:Boric Acids; D005656:Fungal Proteins; D037521:Virulence Factors; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole; D010740:Phospholipases; C032688:boric acid