Genotyping and Persistence of Candida albicans from Pregnant Women with Vulvovaginal Candidiasis
To study Candida albicans genotypes using RAPD and their susceptibility to fluconazole in healthy pregnant women and in vulvovaginal candidiasis (VVC) patients after topical treatment with clotrimazole.
Vaginal swabs were collected at t = 0 and t = 1 (1 month later) in pregnant women (control group, n = 33), and before (t = 0), at 1 month (t = 1) and at 2 months (t = 2) after clotrimazole treatment in pregnant women with VVC.
Candida albicans was isolated in 30% of healthy pregnant women and 80% of patients with VVC. A high genetic heterogeneity was observed in C. albicans genotypes between individuals. In patients with VVC, topical antifungal treatment with clotrimazole was clinically effective, but only in a 62% C. albicans was eradicated. In patients in which C. albicans was not eradicated, this microorganism persisted for 1 or 2 months after the antifungal treatment. The persistent colonies were not associated with a specific genotype, but they were associated with higher MICs in comparison with colonies isolated from the control group.
Therapy with topical clotrimazole, despite a good clinical outcome, could not eradicate completely C. albicans allowing the persistence of genotypes, with higher MICs to fluconazole. More studies with higher number of patients are needed to validate this preliminary finding.
KeywordsGenotypes Persistence RAPD Resistance C. albicans Vulvovaginal candidiasis Clotrimazole Pregnant women
- 2.Pfaller MA, Messer SA, Woosley LN, Jones RN, Castanheira M. Echinocandin and triazole antifungal susceptibility profiles for clinical opportunistic yeast and mold isolates collected from 2010 to 2011: application of new CLSI clinical breakpoints and epidemiological cutoff values for characterization of geographic. J Clin Microbiol. 2013;51:2571–81.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Pradenas M. InfeccIones cérvIco vagInales y embarazo. Rev Med Clin Condes. 2014;25:925–35.Google Scholar
- 21.Subcommittee on Antifungal Susceptibility Testing (AFST) of the ESCMID European Committee for Antimicrobial Susceptibility Testing (EUCAST). EUCAST definitive document EDef 7.1: method for the determination of broth dilution MICs of antifungal agents for fermentative yeasts. Clin Microbiol Infect. 2008;14:398–405.Google Scholar
- 29.Jewtuchowicz VM, Mujica MT, Malzone MC, Cuesta A, Nastri ML, Iovannitti CA, et al. Genetic relatedness of subgingival and buccal Candida dubliniensis isolates in immunocompetent subjects assessed by RAPD-PCR. J Oral Microbiol. 2009;1. doi: 10.3402/jom.v1i0.2003.
- 35.Arendrup MC, Cuenca-Estrella M, Lass-Flörl C, Hope WW. Breakpoints for antifungal agents: an update from EUCAST focussing on echinocandins against Candida spp. and triazoles against Aspergillus spp. Drug Resist Updates Rev Comment Antimicrob Anticancer Chemother. 2013;16:81–95.Google Scholar