title: Highlights Regarding Host Predisposing Factors to Recurrent Vulvovaginal Candidiasis: Chronic Stress and Reduced Antioxidant Capacity.
abstract: We studied host factors that could predispose women to develop recurrent vulvovaginal candidiasis (RVVC), including glycemia, insulin resistance, chronic stress, antioxidant capacity, overall immune status, local inflammation and vaginal microbiota. The presence of yeasts in vaginal culture was screened in 277 women, with or without signs and symptoms of VVC and RVVC. The presence of an inflammatory process and microbiota were analyzed through vaginal bacterioscopy and cervical-vaginal cytology, respectively. Fasting-blood samples were collected by standard venipuncture for biochemical analyses. Flow cytometry was employed to obtain the T helper/T cytotoxic lymphocyte ratio, and insulin resistance was assessed by the HOMA index (HI). Yeasts were isolated from 71 (26%) women: 23 (32.4%) with a positive culture but without symptoms (COL), 22 (31%) in an acute episode (VVC), and 26 (36.6%) with RVVC. C. albicans was the main yeast isolated in all clinical profiles. The control group (negative culture) comprised 206 women. Diabetes mellitus and insulin resistance were more associated with the positive-culture groups (COL, VVC and RVVC) than with negative ones. The RVVC group showed lower mean levels of cortisol than the control group and lower antioxidant capacity than all other groups. The T Helper/T cytotoxic lymphocyte ratio was similar in all groups. The RVVC group showed a similar level of vaginal inflammation to the control group, and lower than in the COL and VVC groups. Only the CVV group showed a reduction in vaginal lactobacillus microbiota. Our data suggest that both chronic stress (decreased early-morning cortisol levels) and reduced antioxidant capacity can be host predisposing factors to RVVC.
authors.affiliation: Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Brazil.|Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Brazil.
authors.forename: Luciene
authors.initials: L
authors.lastname: Akimoto-Gunther
authors.affiliation: Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Brazil.|Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Brazil.
authors.forename: Patrícia de Souza
authors.initials: Pde S
authors.lastname: Bonfim-Mendonça
authors.affiliation: Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Brazil.
authors.forename: Gisele
authors.initials: G
authors.lastname: Takahachi
authors.affiliation: Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Brazil.
authors.forename: Mary Mayumi T
authors.initials: MM
authors.lastname: Irie
authors.affiliation: Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Brazil.
authors.forename: Sônia
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Brazil.|Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Brazil.
authors.forename: Márcia Edilaine Lopes
authors.initials: ME
authors.lastname: Consolaro
authors.affiliation: Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Brazil.|Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Brazil.
authors.forename: Terezinha I Estivalet
authors.initials: TI
authors.lastname: Svidzinsk
mesh_terms: D000293:Adolescent; D000328:Adult; D000975:Antioxidants / Q000378:metabolism*; D001786:Blood Glucose / Q000032:analysis; D002176:Candida albicans; D002181:Candidiasis, Vulvovaginal / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications; D007333:Insulin Resistance; D064307:Microbiota; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*; D014621:Vagina / Q000382:microbiology; D055815:Young Adult
chemical_list: D000975:Antioxidants; D001786:Blood Glucose