Background: Vulvo-vaginal candidiasis (VVC) remains one of the most common infections of the female genital tract. It has been estimated that up to 75% of women will have at least one episode of vaginal candidiasis during their lives. The aim of this study was to determine the frequency of Candida species isolation from pregnant women with VVC and to study antifungal susceptibility, phospholipase and proteinase production by the isolated Candida species. Methods: The study was conducted on 100 female patients complaining of symptoms of vulvovaginitis attending the Obstetrics and Gynecological Outpatient Clinic of Benha University Hospital from June 2011 to April 2012. The test group included 50 pregnant women in the third trimester of pregnancy, while the control group included 50 non-pregnant women in the childbearing period. Isolation and complete identification of Candida species was performed. Antifungal susceptibility testing was done by disc diffusion method and finally detection of proteinase & phospholipase exoenzymes production was performed. Results: Results showed significant higher number of positive cultures in pregnant women 56% (28/50) versus 34% (17/50) in non-pregnant women (p=0.026). C. albicans was the most common species associated with VVC (71.4% in pregnant women versus 64.7 % in non pregnant women). The results of in vitro antifungal susceptibility testing demonstrated that 100% of Candida kefyr (C.kefyr), 96.7% of C.albicans, 66.6% of C.glabrata, 50% of C.tropicalis were found to be sensitive to fluconazole. All Candida species tested were susceptible to voriconazole and nystatin (100%). There was insignificant difference in the number of phospholipase and proteinase producing isolates of C. albicans and non albicans species in pregnant and non pregnant women (p< 0.05). Conclusion VVC is more prevalent in pregnant women. The best approach for the diagnosis of VVC is to consider microscopic examination of vaginal secretion with culture. Due to its efficacy and low risk profile, nystatin remains the first line treatment for Candida infections during pregnancy. Phospholipase and proteinase activity do not have predominance in Candida species isolated from pregnant women with higher predominance in C.albicans than non albicans species in both groups. |
