Mechanism of n-butanol alcohol extract of Baitouweng Decoction in treatment of vulvovaginal candidiasis based on negative regulation of NLRP3 inflammasome via PKCδ/NLRC4/IL-1Ra axis / 中国中药杂志

This study aimed to explore the mechanism of n-butanol alcohol extract of Baitouweng Decoction(BAEB) in the treatment of vulvovaginal candidiasis(VVC) in mice based on the negative regulation of NLRP3 inflammasome via PKCδ/NLRC4/IL-1Ra axis. In the experiment, female C57BL/6 mice were divided randomly into the following six groups: a blank control group, a VVC model group, high-, medium-, and low-dose BAEB groups(80, 40, and 20 mg·kg~(-1)), and a fluconazole group(20 mg·kg~(-1)). The VVC model was induced in mice except for those in the blank control group by the estrogen dependence method. After modeling, no treatment was carried out in the blank control group. The mice in the high-, medium-, and low-dose BAEB groups were treated with BAEB at 80, 40, and 20 mg·kg~(-1), respectively, and those in the fluconazole group were treated with fluconazole at 20 mg·kg~(-1). The mice in the VVC model group received the same volume of normal saline. The general state and body weight of mice in each group were observed every day, and the morphological changes of Candida albicans in the vaginal lavage of mice were examined by Gram staining. The fungal load in the vaginal lavage of mice was detected by microdilution assay. After the mice were killed, the degree of neutrophil infiltration in the vaginal lavage was detected by Papanicolaou staining. The content of inflammatory cytokines interleukin(IL)-1β, IL-18, and lactate dehydrogenase(LDH) in the vaginal lavage was tested by enzyme-linked immunosorbent assay(ELISA), and vaginal histopathology was analyzed by hematoxylin-eosin(HE) staining. The expression and distribution of NLRP3, PKCδ, pNLRC4, and IL-1Ra in vaginal tissues were measured by immunohistochemistry(IHC), and the expression and distribution of pNLRC4 and IL-1Ra in vaginal tissues were detected by immunofluorescence(IF). The protein expression of NLRP3, PKCδ, pNLRC4, and IL-1Ra was detected by Western blot(WB), and the mRNA expression of NLRP3, PKCδ, pNLRC4, and IL-1Ra was detected by qRT-PCR. The results showed that compared with the blank control group, the VVC model group showed redness, edema, and white secretions in the vagina. Compared with the VVC model group, the BAEB groups showed improved general state of VVC mice. As revealed by Gram staining, Papanicolaou staining, microdilution assay, and HE staining, compared with the blank control group, the VVC model group showed a large number of hyphae, neutrophils infiltration, and increased fungal load in the vaginal lavage, destroyed vaginal mucosa, and infiltration of a large number of inflammatory cells. BAEB could reduce the transformation of C. albicans from yeast to hyphae. High-dose BAEB could significantly reduce neutrophil infiltration and fungal load. Low-and medium-dose BAEB could reduce the da-mage to the vaginal tissue, while high-dose BAEB could restore the damaged vaginal tissues to normal levels. ELISA results showed that the content of inflammatory cytokines IL-1β, IL-18, and LDH in the VVC model group significantly increased compared with that in the blank control group, and the content of IL-1β, IL-18 and LDH in the medium-and high-dose BAEB groups was significantly reduced compared with that in the VVC model group. WB and qRT-PCR results showed that compared with the blank control group, the VVC model group showed reduced protein and mRNA expression of PKCδ, pNLRC4, and IL-1Ra in vaginal tissues of mice and increased protein and mRNA expression of NLRP3. Compared with the VVC model group, the medium-and high-dose BAEB groups showed up-regulated protein and mRNA expression of PKCδ, pNLRC4, and IL-1Ra in vaginal tissues and inhibited protein and mRNA expression of NLRP3 in vaginal tissues. This study indicated that the therapeutic effect of BAEB on VVC mice was presumably related to the negative regulation of NLRP3 inflammasome by promoting PKCδ/NLRC4/IL-1Ra axis.

Aspectos da abordagem terapêutica sobre candidíase vulvovaginal / Aspects of the therapeutic approach to vulvovaginal candidiasis / Aspectos del abordaje terapéutico de la candidiasis vulvovaginal

A candidíase vulvovaginal, é uma infecção da vulva e vagina causada por vários tipos de Candida spp. Essa patologia afeta 75% de todas as mulheres pelo menos uma vez durante a vida, ocorrendo com mais frequência durante a idade fértil. A transmissão dessa infeção fúngica ocorre por meio de contato com mucosas e secreções em pele de portadores ou doentes, contato sexual, água contaminada e transmissão vertical. Alguns outros sintomas característicos mais vistos em casos de CVV, são lesões brancas, cremosas e planas, sendo mais intensos no período pré-menstrual, quando a acidez vaginal aumenta. numerosos antifúngicos estão disponíveis no mercado, os quais são encontrados para administração oral na forma de comprimidos ou, para uso tópico, na forma de cremes, loções, comprimidos vaginais, supositórios e tampões revestidos. O objetivo geral do trabalho foi analisar através da revisão de literatura, tratamentos convencionais e alternativos para abordagem terapêutica da Candidíase Vulvovaginal contextuando a mesma, utilizando definições, dados epidemiológicos e sua sintomatologia frente à sociedade. O presente trabalho é uma revisão integrativa, que teve a coleta de dados realizada de março de 2021 a outubro de 2021 nas bases de dados Lilacs, Scielo, Google acadêmico, A busca resultou em 902 artigos, dos quais 14 atenderam ao critério de inclusão. A busca por tratamentos frente a candidíase vulvovaginal tem se mostrado ampla de acordo com os artigos selecionadas. Concluímos que a patologia candidíase vulvovaginal, vem apresentando resistência em algumas abordagens terapêuticas, assim como algumas mulheres não aderem há algum tipo de tratamento, devido à falta de conhecimento sobre a patologia.

Vulvovaginal candidiasis is an infection of the vulva and vagina caused by various types of Candida spp. This condition affects 75% of all women at least once in their lifetime, occurring more frequently during their childbearing years. The transmission of this fungal infection occurs through contact with mucous membranes and secretions on the skin of patients or patients, sexual contact, contaminated water and vertical transmission. Some other characteristic symptoms more seen in cases of VVC are white, creamy and flat lesions, being more intense in the premenstrual period, when the vaginal acidity increases. numerous antifungals are available on the market which are available for oral administration in tablet form or, for topical use, in the form of creams, lotions, vaginal tablets, suppositories and coated tampons. The general objective of the work was to analyze, through a literature review, conventional and alternative treatments for the therapeutic approach of Vulvovaginal Candidiasis in its context, using definitions, epidemiological data and its symptoms in society. The present work is an integrative review, which had data collection carried out from March 2021 to October 2021 in the Lilacs, Scielo, Google academic databases. The search resulted in 902 articles, of which 14 met the inclusion criteria. The search for treatments against vulvovaginal candidiasis has been shown to be wide according to the selected articles. We conclude that the vulvovaginal candidiasis pathology has been showing resistance in some therapeutic approaches, as well as some women do not adhere to any type of treatment, due to lack of knowledge about the pathology.

La candidiasis vulvovaginal es una infección de la vulva y la vagina cau- sada por diversos tipos de Candida spp. Esta afección afecta al 75% de las mujeres al menos una vez en la vida, siendo más frecuente durante la edad fértil. La transmisión de esta infección fúngica se produce por contacto con mucosas y secreciones de la piel de pacientes o enfermos, contacto sexual, agua contaminada y transmisión vertical. Otros síntomas característicos más observados en los casos de CVV son las lesiones blancas, cremosas y planas, siendo más intensas en el período premenstrual, cuando aumenta la acidez vaginal. Existen en el mercado numerosos antifúngicos disponibles para adminis- tración oral en forma de comprimidos o, para uso tópico, en forma de cremas, lociones, comprimidos vaginales, supositorios y tampones recubiertos. El objetivo general del tra- bajo fue analizar, a través de una revisión bibliográfica, los tratamientos convencionales y alternativos para el abordaje terapéutico de la Candidiasis Vulvovaginal en su contexto, utilizando definiciones, datos epidemiológicos y su sintomatología en la sociedad. El pre- sente trabajo es una revisión integradora, que tuvo recolección de datos realizada de marzo de 2021 a octubre de 2021 en las bases de datos académicas Lilacs, Scielo, Google. La búsqueda resultó en 902 artículos, de los cuales 14 cumplieron los criterios de inclu- sión. La búsqueda de tratamientos contra la candidiasis vulvovaginal se ha mostrado am- plia según los artículos seleccionados. Concluimos que la patología de la candidiasis vul- vovaginal viene mostrando resistencia en algunos abordajes terapéuticos, así como algu- nas mujeres no se adhieren a ningún tipo de tratamiento, debido al desconocimiento de la patología.

Butyl alcohol extract of Baitouweng Decoction alleviates vulvovaginal candidiasis in mice by downregulating NLRP3 inflammasome and related signal pathways / 中国中药杂志

This study aims to explore the effect of butyl alcohol extract of Baitouweng Decoction(BAEB) on vulvovaginal candidiasis(VVC) in mice and to clarify the mechanism from Toll-like receptors(TLRs)/MyD88 and Dectin-1/Syk signal pathways and NLRP3 inflammasome. To be specific, female KM mice were randomized into control group(i.g., normal saline), model group, fluco-nazole group(i.g., 20 mg·kg~(-1)), and low-dose, medium-dose, and high-dose BAEB groups(i.g., 20, 40, and 80 mg·kg~(-1), respectively). VVC was induced in mice except the control group. After the modeling, administration began and lasted 7 days. The ge-neral conditions and body weight of mice were recorded every day. On the 1 st, 3 rd, 7 th, and 14 th after vaginal infection by Candida albicans, the fungal load in the vaginal lavage fluid of the mice was measured with the plate method, and the morphology of C. albicans in vaginal lavage fluid was observed based on Gram staining. After the mice were killed, vaginal tissues were subjected to hematoxylin-eosin(HE) staining and periodic acid-Schiff(PAS) staining for vaginal histopathological analysis. The content of cytokines in vaginal lavage fluid, such as interleukin(IL)-1β, IL-18, tumor necrosis factor-α(TNF-α), IL-6, and S100 a8, was determined by enzyme-linked immunosorbent assay(ELISA), and content of reactive oxygen species(ROS) in vaginal tissues by tissue ROS detection kit. The protein expression of NLRP3, ASC, caspase-1, Dectin-1, Syk, MyD88, TLR2, TLR4, and nuclear factor-κB(NF-κB) in vaginal tissues was detected by Western blot, and the levels and distribution of NLRP3, Dectin-1, Syk, MyD88, TLR2, and TLR4 in vaginal tissues were determined with the immunohistochemical method. The results show that BAEB can improve the general conditions of VVC mice, reduce the fungal load and C. albicans hyphae in vaginal secretion, decrease ROS content in vaginal tissues and content of cytokines in vaginal lavage fluid, and down-regulate the expression of NLRP3, ASC, caspase-1, Dectin-1, Syk, MyD88, TLR2, TLR4, and NF-κB in vaginal tissues. The above results indicate that BAEB exerts therapeutic effect on VVC mice by down-regulating the key proteins in the TLRs/MyD88 and Dectin-1/Syk signal pathways and NLRP3 inflammasome.

Prevalencia y sensibilidad a los antifúngicos de Candida albicans y sus especies relacionadas, Candida dubliniensis y Candida africana aisladas de muestras vulvovaginales en un hospital de Argentina / Prevalence and antifungal susceptibility of Candida albicans and its related species Candida dubliniensis and Candida africana isolated from vulvovaginal samples in a hospital of Argentina

Candida africana taxonomical status is controversial. It was proposed as a separate species within the Candida albicans species complex; however, phylogenetic analyses suggested that it is an unusual variety of C. albicans. The prevalence of C. albicans-related species (Candida dubliniensis and C. africana) as vulvovaginal pathogens is not known in Argentina. Moreover, data on antifungal susceptibility of isolates causing vulvovaginal candidiasis is scarce. The aims of this study were to establish the prevalence of C. dubliniensis and C. africana in vaginal samples and to evaluate the antifungal susceptibilities of vaginal C. albicans species complex strains. We used a molecular-based method coupled with a new pooled DNA extraction methodology to differentiate C. dubliniensis and C. africana in a collection of 287 strains originally identified as C. albicans isolated from an Argentinian hospital during 2013. Antifungal susceptibilities to fluconazole, clotrimazole, itraconazole, voriconazole, nystatin, amphotericin B and terbinafine were evaluated by using the CLSI M27-A3 and M27-S4 documents. Of the 287 isolates, 4 C. dubliniensis and one C. africana strains (1.39% and 0.35% prevalence, respectively) were identified. This is the first description of C. africana in Argentina and its identification was confirmed by sequencing the ITS2 region and the hwp1 gene. C. dubliniensis and C. africana strains showed very low MIC values for all the tested antifungals. Fluconazole-reduced-susceptibility and azole cross-resistance were observed in 3.55% and 1.41% of the C. albicans isolates, respectively. These results demonstrate that antifungal resistance is still a rare phenomenon in this kind of isolates.

La clasificación taxonómica de Candida africana está en discusión, es considerada una nueva especie dentro del complejo C. albicans o una variedad inusual de C. albicans. La prevalencia de las especies relacionadas a C. albicans (C. dubliniensis y C. africana) como agentes de vulvovaginitis en Argentina se desconoce. Los objetivos de este trabajo fueron determinar la prevalencia de C. dubliniensis y C. africana en muestras vaginales y evaluar la sensibilidad a los antifúngicos de aislamientos vaginales de las especies del complejo C. albicans. Para diferenciar C. dubliniensis y C. africana utilizamos un método molecular asociado a un nuevo método de extracción de ADN. Se utilizó una colección de 287 cepas originalmente identificadas como C. albicans aisladas durante 2013 en un hospital de Argentina. Se evaluó la sensibilidad a fluconazol, clotrimazol, itraconazol, voriconazol, nistatina, anfotericina B y terbinafina utilizando los documentos M27-A3 y M27-S4 del CLSI. De los 287 aislamientos, se identificaron 4 C. dubliniensis y 1 C. africana (1,39 y 0,35% de prevalencia, respectivamente). Esta es la primera descripción de C. africana en Argentina. Su identificación fue confirmada por secuenciación de la región ITS2 y del gen hwp1. Las cepas identificadas como C. dubliniensis y C. africana mostraron valores de CIM muy bajos para todos los antifúngicos probados. En los aislamientos de C. albicans, la sensibilidad reducida al fluconazol y la resistencia cruzada a todos los azoles se observó en el 3,55% y el 1,41%, respectivamente. Estos resultados demuestran que la resistencia a los antifúngicos es todavía un fenómeno raro en este tipo de aislamientos.

Chronic mucocutaneous candidiasis: a case with exuberant cutaneous horns in nipples

Chronic mucocutaneous candidiasis is a rare disorder characterized by persistent and recurrent infections by Candida due to changes in cellular immunity and may be associated with autoimmune endocrine disorders. It is refractory to the usual antifungal treatments, which merely control it with imidazole derivatives. This reports the case of a 50-year-old female patient who referred vaginal discharge associated with vulvar ulcerated lesions and whitish plaques on oral and genital mucous membranes of onset in adolescence besides cutaneous horns in nipples. The clinical picture, family history, culture and anatomopathological studies were consistent with chronic infection by candida. Treatment with systemic antifungals obtained partial response of lesions characterizing a clinical picture of Chronic Mucocutaneous Candidiasis.

Prevalence of Candida albicans and non-albicans isolates from vaginal secretions: comparative evaluation of colonization, vaginal candidiasis and recurrent vaginal candidiasis in diabetic and non-diabetic women / Prevalência de Candida albicans e não albicans isoladas de secreção vaginal: avaliação comparativa entre colonização, candidíase vaginal e candidíase vaginal recorrente em mulheres diabéticas e não diabéticas

CONTEXT AND OBJECTIVE: Vulvovaginal candidiasis (VVC) is caused by abnormal growth of yeast-like fungi on the female genital tract mucosa. Patients with diabetes mellitus (DM) are more susceptible to fungal infections, including those caused by species of Candida. The present study investigated the frequency of total isolation of vaginal Candida spp., and its different clinical profiles - colonization, VVC and recurrent VVC (RVVC) - in women with DM type 2, compared with non-diabetic women. The cure rate using fluconazole treatment was also evaluated. DESIGN AND SETTING: Cross-sectional study conducted in the public healthcare system of Maringá, Paraná, Brazil. METHODS: The study involved 717 women aged 17-74 years, of whom 48 (6.7%) had DM type 2 (mean age: 53.7 years), regardless of signs and symptoms of VVC. The yeasts were isolated and identified using classical phenotypic methods. RESULTS: In the non-diabetic group (controls), total vaginal yeast isolation occurred in 79 (11.8%) women, and in the diabetic group in 9 (18.8%) (P = 0.000). The diabetic group showed more symptomatic (VVC + RVVC = 66.66%) than colonized (33.33%) women, and showed significantly more colonization, VVC and RVVC than seen among the controls. The mean cure rate using fluconazole was 75.0% in the diabetic group and 86.7% in the control group (P = 0.51). CONCLUSION: We found that DM type 2 in Brazilian women was associated with yeast colonization, VVC and RVVC, and similar isolation rates for C. albicans and non-albicans species. Good cure rates were obtained using fluconazole in both groups. .

CONTEXTO E OBJETIVO: Candidíase vulvovaginal (CVV) é causada pelo crescimento anormal de fungos do tipo leveduras na mucosa do trato genital feminino. Pacientes com diabetes mellitus (DM) são mais susceptíveis a infecções fúngicas, incluindo por espécies de Candida. O presente estudo investigou a frequência de isolamento total de Candida spp. vaginal, e diferentes quadros clínicos (CVV e CVV recorrente- CVVR) em mulheres com DM tipo 2 comparadas às não diabéticas. A razão de cura do tratamento com fluconazol também foi avaliada. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado no sistema público de saúde de Maringá, Paraná, Brazil. MÉTODO: O estudo envolveu 717 mulheres de 17-74 anos de idade e, destas, 48 (6,7%) tinham DM 2 (média de 53,7 anos), independentemente de sinais e sintomas de CVV. As leveduras foram isoladas e identificadas por métodos fenotípicos clássicos. RESULTADOS: No grupo de não diabéticas (controle), leveduras vaginais totais foram isoladas em 79 (11,8%) mulheres, e no grupo de diabéticas, em 9 (18,8%) (P = 0,000). O grupo de diabéticas mostrou mais mulheres sintomáticas (CVV + CVVR = 66,66%) do que colonizadas (33.33%), e significativamente mais colonização, CVV e CVVR, que as controle. A razão média de cura com fluconazol foi de 75.0% no grupo diabéticas e 86.7% no controle (P = 0.51). CONCLUSÃO: Nós encontramos que DM 2 em mulheres brasileiras associou-se com colonização vaginal por leveduras, CVV e CVVR, razão similar de isolamento de C. albicans e espécies não albicans. Boa taxa de cura foi obtida com fluconazol em ambos os grupos.

Calendula officinalis L. en el tratamiento tópico de la candidiasis vaginal recurrente / Calendula officinalis L. for the topical treatment of recurrent vaginal candidiasis

La candidiasis vaginal recurrente (CVR) es una enfermedad con una elevada prevalencia y los fitofármacos constituyen una opción en su tratamiento. Se realizó un estudio descriptivo para evaluar el efecto terapéutico y la seguridad de la Calendula officinalis L. por vía tópica en el tratamiento de la CVR. De 127 mujeres, 46 pacientes se seleccionaron aleatoriamente y se trataron con tintura de “calendula” 20 por ciento. La “calendula” se aplicó tres veces a la semana, en días alternos, durante dos semanas. Las pacientes fueron evaluadas al inicio del estudio, a los 21 y a los 30 días. La edad promedio fue de 23.7+/- 5.2 años y el 95.2 por ciento de las mujeres eran sexualmente activas. Al inicio del estudio, 85.7 por ciento presentó secreción vaginal abundante, pero a medida que el tratamiento progreso disminuyó el número de pacientes con leucorrea. Al inicio, la mayoría de las pacientes (83.3 por ciento) presentó prurito, luego disminuyó significativamente. Se observó una reducción en el número de pacientes con cultivo vaginal positivo a los 21 días; sólo 7 pacientes (16.7 por ciento) tuvieron cultivos positivos. La mayoría de las pacientes evolucionaron hacia la curación y no se reportaron efectos adversos. Se concluye que la Calendula officinalis L constituye una opción terapéutica en el tratamiento de esta enfermedad.

Recurrent vaginal candidiasis (RVC) is a highly prevalent disease. Herbal medications constitute a therapeutic option in the treatment of this condition. A descriptive study was conducted to evaluate the safety and therapeutic effect of Calendula officinalis L. by topical route in the treatment of RVC. Of 127 women, 46 patients treated with tincture of “calendula” 20 percent were randomly selected. “Calendula” was applied three times per week, in alternating days, for two weeks. Patients were evaluated at the beginning of the study, and at 21 and 30 days. The average age was 23.7+/- 5.2 years and 95.2 percent of the women were sexually active. At the beginning of the study, 85.7 percent presented with a great quantity of vaginal discharge, but the number of patients with discharge decreased as treatment progressed. The majority of the patients (83.3 percent presented pruritus initially; later it diminished significantly. A reduction in the number of patients with positive vaginal culture was achieved at 21 days; only 7 patients (16.7 percent) had a positive vaginal culture. Most of the patients evolved towards the cure and adverse effects were not reported. We conclude that Calendula officinalis L constitutes a therapeutic option in the treatment of this disease.

Candidíase vaginal recorrente: manejo clínico / Recurrent vaginal candidiasis: clinical management

A candidíase vulvovaginal (CVV) é patologia extremamente frequente, atingindo 75% das mulheres em alguma fase da vida. Cerca de 5% delas terão candidíase vulvovaginal recorrente (CVVR), definida como quatro ou mais episódios a cada 12 meses. Apesar de existirem fatores de risco conhecidos, a maioria dos episódios ocorre na sua ausência. Com base na apresentação clínica, microbiologia e fatores do hospedeiro, ela é classificada em complicada e não-complicada. Um espectro de sintomas comuns a outras patologias, e a ausência de métodos rápidos, simples e baratos de diagnóstico, tornam seu manejo um desafio, mesmo para os mais experientes. O exame padrão-ouro para confirmar a infecção é cultura em meio específico. O presente estudo tem por objetivo revisar os métodos diagnósticos da CVV e descrever o manejo da CVVR.

Vulvovaginal candidiasis (VVC) is an extremely frequent pathology, affecting 75% of women in some phase of life. About 5% of them will have recurrent vulvovaginal candidiasis (RVVC), defined as four or more episodes every 12 months. In spite of known risk factors, most of the episodes happen in its absence. Based on the clinical presentation microbiology and factors of the host, it is classified in complicated and non-complicated. A spectrum of symptoms common to other pathologies, and the absence of fast, simple and inexpensive methods of diagnosis, turns it into a challenge even for experts. The gold standard exam to confirm the infection is a culture in specific medium. The present study has the objective of revising the diagnosis methods of VVC and to describe the management of RVVC.

Clinical study of candida vaginitis in Ahvaz, Iran and susceptibility of agents to topical antifungal

To evaluate etiological agents of vaginal candidiasis in Ahvaz, Iran. In addition, susceptibility isolates were also considered against topical anti fungal agents. Cotton swabs were used for sampling from vaginal lesions and inoculated on CHRO Magar Candida. Cultured media were incubated at 37°C for 2-4 days aerobically. Colonies producing a green coloration were presumptively identified as Candida. albicans. C. glabrata produced pink colonies on CHRO Magar Candida. One hundred vaginal isolates of Candida were sub-cultured on SDA and incubated at 37°C. A suspension of isolates containing 1x106 - 5x106 cfu/ml was used for susceptibility tests. Clotrimazole, miconazole and nystatin disks were used for determine of susceptibility. Prevalence of Candida among the 300 women enrolled was found to be 49%. Recurrent and acute vaginal candidiasis were 48.3% and 51.7% respectively. C. albicans was the most common species among the isolates followed by C. glabrata, C. dubliniensis and Candida species. Antifungal susceptibility testing in our study revealed that none of the Candida isolates tested were resistant to tested antifungal. However, isolates were susceptible to clotrimazole followed by miconazole and nystatin. Candida vaginitis is more prevalent among women in Ahvaz and the most common agent is C. albicans. In addition our isolates were sensitive to clotrimazole followed by miconazole and nystatin

Candida glabrata: un oportunista emergente en vulvovaginitis / Candida glabrata: an emergent opportunist in vulvovaginitis

Introducción: El género Candida comprende varias especies; en años recientes algunas como Candida glabrata ha incrementado su frecuencia con trascendencia clínica. Material y métodos: Se realizó un estudio para determinar la frecuencia de Candida glabrata en 468 pacientes con sintomatología clínica para candidosis vulvovaginal, así como la sensibilidad de la misma a fluconazol por métodos de difusión en agar con sensidiscos y microdilución en caldo. Resultados: La frecuencia para esta especie fue de 12.6 %. La resistencia de Candida glabrata al tratamiento con fluconazol se corroboró en este estudio: 68.2 % de las cepas fue resistente en pruebas de placas (sensidiscos) y 51.2 % en prueba de microdilución en caldo (método NCLSI), con una concentración mínima inhibitoria de 16 μg/ml. Conclusiones: La frecuencia de Candida glabrata se ha incrementado y presenta resistencia a los tratamientos habituales, lo que influye en la persistencia y recurrencia de infecciones genitales y sistémicas.

BACKGROUND: Candida genus has various species. The incidence of C. glabrata has presented itself with more frequency over the past years with clinical importance. METHODS: A case study was made to determine the frequency of C. glabrata in 468 patients who presented clinical symptomatology for vulvovaginal candidiasis and the in vitro response for fluconazole using two methods: diffusion in agar plates and microdilution in liquid medium [NCLSI (NCCLS) method]. RESULTS: The frequency for this specie was 12.6%, almost double the frequency observed 10 years ago. The resistance of C. glabrata to fluconazole treatment was confirmed in this study, representing 68.2% resistance in all strains on test plates and 51.2% on NCLSI method with a MIC of 16 microg/ml. Conclusions: The frequency of Candida glabrata has increased over the past years. It presents resistance to usual treatments, which promotes the persistence and recurrence of genital and systemic infections.

Avaliação do tratamento antifúngico oral e tópicooral para a candidíase vulvovaginal / Clinical cure after treatment regimens oral, topical, oral and topical for vulvovaginal candidiasis

Em avaliação clínica do tratamento oral e tópico oral para a candidíase vulvovaginal, verificou-se que não há diferença entre o tratamento oral e tópico oral (p>0,05). Desta forma, acredita-se que o tratamento oral deva ser estimulado, não associado ao medicamento tópico, pois incrementa o custo, sem benefícios adicionais.

The authors present the clinical evaluation of oral treatment, topical and oral-topic for vulvovaginal candidiasis, and ensure that there is no difference between the oral and topical oral treatment (p> 0.05). Believe that the oral treatment should be encouraged, not associated with the drug topic, it increases the cost without additional benefit. Believe that the topical medication should be limited to patients with contra-indication tooral maedication.

Clinical, microbiological and therapeutic aspects of vulvovaginal candidiasis and recurrent vulvovaginal candidiasis: importance of regionalsurveys

Vulvovaginal candidiasis (VVC) has a varied aetiology. The yeasts involved in this disease have presented increased resistance to the azoles and poliens, the drugs of choice for treatment. In recurrent VVC, the therapeutic difficulties are even greater. The epidemiological relevance of aetiological diagnosis and of the antifungigram in clinical treatment is discussed.

Abordagem racional dos corrimentos vaginais / Current approach of vaginal discharge

O corrimento vaginal é um dos principais sintomas referidos em consultórios de ginecologia. Sua abordagem correta depende da identificação das principais causas de corrimento e de como fazer um diagnóstico fidedigno, permitindo uma conduta mais coerente e eficaz. A infecção vaginal é responsável pela maioria dos corrimentos, decorrente freqüentemente de candidíase, vaginose bacteriana ou tricomoníase. Estima-se que a freqüência dos corrimentos seja de 5-15 porcento em clínicas ginecológicas em geral, enquanto que, em clínicas especializadas em doenças sexualmente transmissíveis (DST), possa atingir 32-64 porcento. Não é possível diferenciar as causas de vaginite apenas pelos aspectos clínicos, entretanto alguns autores mostram que aspectos como sinais inflamatórios, odor de peixe e medida do pH são capazes de aumentar a sensibilidade no rastreamento dos corrimentos. Uma análise criteriosa dos métodos diagnósticos disponíveis mostra aqueles mais adequados a depender da suspeita clínica. Por fim, o tratamento adequado deve ser instituído, baseado no diagnóstico correto, a fim de que o sucesso terapêutico seja atingido.

The epidemiology of mycotic vulvovaginitis and the use of antifungal agents in suspected mycotic vulvovaginitis and its implications for clinical practice / Epidemiología de la Vulvovaginitis Micótica y el uso de Agentes Antifungales Ante la Sospecha de Vulvovaginitis Micótica, y sus Implicaciones en la Práctica Clínica

Data in the Caribbean documenting the speciation of yeast associated with vulvovaginitis are lacking. The widespread use of antibiotics and increased availability of antimycotic agents, both prescribed and over-the-counter, predisposes both to a change in the epidemiologic patterns and the possible development of secondary resistance among previously susceptible yeast. This study was conducted to evaluate the aetiologic agents associated with mycotic vulvovaginitis and to review the appropriateness of prescribed antifungal therapy. Of 134 positive isolates, the most frequent yeast isolate was C. albicans accounting for 78%, C. tropicalis 10%, Prototheca wickerhamii (P. wickerhamii) 5%, C. glabrata 4%, Cryptococcus albidus (C. albidus) 2% and C. lusitaniae (1%) were also isolated. Of the positive cases, 75% were treated with antifungals, 17% with antibiotics and 8% were not treated. The azole group was the most frequently prescribed antifungal (71%). Of cases with negative yeast cultures, 83% were treated with antifungals. The presence of non-albicans Candida species and other opportunistic fungi is an important finding and combined with the pattern of therapy, represents a major challenge for future empirical therapeutic and prophylactic strategies in the treatment of mycotic vulvovaginitis

La región del Caribe carece de datos que documenten la especiación de la levadura asociada con la vulvovaginitis. El uso extendido de antibióticos y la mayor disponibilidad de agentes antimicóticos ­ tanto los adquiridos mediante prescripción facultativa como los que pueden comprarse sin receta médica ­ predisponen por un lado a un cambio en los patrones epidemiológicos, y por otro al posible desarrollo de resistencia secundaria en la levadura previamente susceptible. Este estudio se llevó a cabo con el fin de evaluar los agentes etiológicos asociados con la vulvovaginitis micótica y examinar cuán adecuada resulta la terapia antifúngica prescrita. De 134 aislados positivos, el aislado de levadura más frecuente fue el C albicans responsable del 78%. También fueron aislados C tropicalis 10%, Prototheca wickerhamii (P wickerhamii) 5%, C glabrata 4%, Cryptococcus albidus (C albidus) 2% y C lusitaniae (1%). El 75% de los casos positivos fueron tratados con antifúngicos, el 17% con antibióticos, en tanto que un 8% no recibió tratamiento alguno. Los medicamentos antifungosos de la familia azol (71%) fueron los más frecuentemente prescritos. El 83% de los casos con cultivos de levadura negativos, fue tratado con antifúngicos. La presencia de especies de Candida no albicans y otros hongos oportunistas, constituye un hallazgo importante, y en combinación con el modelo de terapia, representa un desafío de importancia considerable para las futuras estrategias empíricas ­ tanto terapéuticas como profilácticas ­ en el tratamiento de la vulvovaginitis micótica.

Candidíase vulvovaginal: uma revisão de literatura / Vulvovaginal candidiasis: a review

A candidíase vulvovaginal é a infecção da mucosa vaginal causada por fungos do gênero Candida, colonizantes habituais do trato gastrintestinal, que podem, em condições especiais, tornar-se patogênicos. É uma das causas mais comuns de vaginite, com incidência aproximada de 25 porcento, que acomete cerca de 75 porcento das mulheres, pelo menos uma vez na vida e se caracteriza por leucorréia, prurido intenso, hiperemia vulvar, disúria e dispareunia. Vários fatores predisponentes estão relacionados com a ocorrência da candidíase vulvovaginal: gravidez, diabetes mellitus, uso de anticoncepcionais hormonais, terapia de reposição hormonal, antibióticos e corticóides, doenças imunossupressoras e outros. Para haver infeção é necessário um estímulo estrogênico alto, razão pela qual sua ocorrência é mais comum durante o menacme e na mulher climatérica sob terapia de reposição hormonal, sendo o processo de adesão do fungo primordial para que ela se estabeleça. Entre as mulheres que apresentam candidíase vulvovaginal, cerca de 5 porcento desenvolve a forma recorrente, definida por pelo menos quatro episódios de vaginite por cândida sp no intervalo de um ano. O diagnóstico é essencialmente clínico, podendo ser corroborado por exame microscópico e excepcionalmente por cultura. O tratamento pode ser tópico e/ou sistêmico, sendo os imidazóis as drogas mais indicadas

Candidíase vulvovaginal: aspectos clínicos, tratamento oral com azólicos e suscetibilidade in vitro / Vulvovaginal candidiasis: clinical aspects, oral treatment with azoles and susceptibility in vitro

A candidíase vulvovaginal (CVV) é a infecção mais comum do trato genital feminino. Estima-se que aproximadamente 75 por cento das mulheres terão pelo menos um episódio de CVV durante seu período reprodutivo. A maioria desses episódios é causada por Candida albicans, um fungo dimórfico comensal dos aparelhos gastrointestinal e reprodutor feminino. Experiências clínicas mostram que as influências hormonais e o uso de antibióticos podem predispor à CVV. Sinais e sintomas da infecção podem incluir prurido, ardor, dispareunia, disúria e corrimento vaginal, mas nenhum desses sintomas é específico para CVV, nem está invariavelmente associado a ela. Antifúngicos orais e tópicos podem ser usados no tratamento desta infecção, sendo que bons resultados têm sido obtidos para as duas formas de administração. Estudos, no entanto, indicam que muitas mulheres preferem a terapia oral. Derivados azólicos orais como itraconazol e fluconazol são largamente usados e eficazes na terapia da CVV. Parâmetros como sintomas, fatores clínicos e tratamento representam um problema que necessita ser esclarecido.

Estudo da eficácia e tolerabilidade do fenticonazol no tratamento da vulvovaginite por Candida albicans / Study on the efficacy and tolerability of fenticonazole in the treatment of vulvovaginal candidiasis

Este estudo näo comparativo teve por objetivo avaliara eficácia e tolerabilidade do derivado imidazólico nas vulvovaginites por Candida albicans. A casuística envolveu 46 mulheres entre 19 e 60 anos. Com diagnóstico clínico e micológico de candidíase, selecionadas em dois centros. O tratamento consistiu em aplicaçöestópicas diária de 5 gramas de fenticinazol creme vaginal a 2 porcento durante sete noites consecutivas. A eficácia foi avaliada por um escore de sinais e sintomas e pela evoluçäo do exame micológico em duas visitas: entre os dias 10-14 (V1) e dias 33-44 (V2). A tolerabilidade foi avaliada pelo registro dos edversos relatados durante o período do estudo. Houve reduçäo estatisticamente da intensidade dos sinais e sintomas: ardor, leucorréia, prurido, hiperemia, edema, descamaçäo do epitélio, bem como da soma dosescores associados a eles após o tratamento. Houve reduçäosignificativado número de pacientes que apresentaram Candida e levedura nas culturas da V1 (X21 = 6,67- p<0,05) e V2(X21 = 5,82 - p<0,05). Na V1, 54,3 porcento daspacientes se encontravam sem doença clínica com micológiconegativo e na V2 esta porcentagem subiu para 63,3 porcento das pacientes (X21 = 17,05 - p<0,001). Apenas três pacientes (6,5 porcento) reportaram eventos adversos com o uso de fenticonazol. Em conclusäo, este estudo multicêntrico aberto demonstrou a eficácia do fenticonazol creme vaginal a 2 porcento na candidíase vaginal e sua boa tolerabilidade, sendo adequado para o tratamento de rotina desta afecçäo