Premenopausal women asymptomatic for Vulvovaginal candidiasis harbor virulent and antifungal resistant strains of Candida in the presence of lactobacilli
Premenopausal women asymptomatic for Vulvovaginal candidiasis harbor virulent and antifungal resistant strains of Candida in the presence of lactobacilli Clara Charles Aranha1*, Rinku Pramanick1, Niranjan Mayadeo 2 1ICMR-National Institute for Research in Reproductive Health; 2Seth G.S.Medical College and King Edward Memorial (KEM) Hospital *Corresponding author
Vulvovaginal Candidiasis (VVC) is a common urogenital tract infection, affecting women of reproductive age. Asymptomatic VVC is less studied with respect to the virulence and antifungal resistance properties. Besides, little is known about the association of Candida with the resident lactobacilli that could influence fungal virulence factor expression and impact their antimicrobial susceptibility profile. The study aimed to ascertain the distribution, virulence and antimicrobial resistance of vaginal Candida spps. from asymptomatic women and identify the co-colonizing lactobacilli. Isolates were speciated by culture and molecular methods. Of the 205 women recuited, 30.73% colonized Candida, of which 76.24% were Non-albicans Candida (NACs). C.glabrata was predominant species,followed by C.albicans,C.krusei and C.tropicalis. All C.albicans strains produced phospholipase compared to NACs (13.95%). Isolates producing phospholipase, haemolysin were more frequently present in BV flora (75%;75%); compared to intermediate (22.2%;44.4% ) and normal flora (26.7%,53.3%). Of the five virulence factors tested, 75% isolates, primarily C.albicans, from BV flora showed three virulent properties, whereas only 10% from normal flora. Contrarily, percent of virulent C.glabrata isolates were higher in normal flora (66.7%) than BV flora (25%). Phospholipase production by C.albicans was significantly associated to the abundance of lactobacilli (p=0.03).Additionally, fluconazole resistance of Candida isolates significantly varied in women who harboured abundant lactobacilli (p=0.03) as compared to those with bacterial vaginosis. L. iners, L. jensenii, L. rhamnosus were prevalent in women colonizing Candida. The study indicated Candida could exist as a nonvirulent commensal or as a virulent pathogen without any clinical manifestations. The Lactobacillus species that co-harbor with Candida might also play an important role in determining its pathogenesis. The resident lactobacilli could be used as a therapeutic option against Candida infection.
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