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.

A Critical Review on Thermo-Sensitive Vaginal Gel for the Foundation of Preparing Thermo-Sensitive Vaginal Gel of PVK (Panchvalkal Kashaya) Extract

RTI (Reproductive Tract Infection) is the vital cause of suffering in women and neonates. According to WHO estimation 340 million new cases of curable STI (Sexually Transmitted Disease) other than HIV/AIDS occurs every year, most of which are occurring in developing countries. Genital tract infection is the prime cause of most gynaecological disease. Vaginal candidiasis is the most common cause of Genital tract infection. It (Vaginal candidiasis) is a common condition and up to 75% of all women suffer at least one episode of this infection during their life time. For treating the pathological condition of genital tract, direct application or self application of medicine is very difficult and the residence time of the medicine is less due to self cleansing properties of vaginal canal. Application of the drug in other route may cause systemic adverse reaction. To overcome this arduous situation, in situ thermo-sensitive gel form has great importance. In this article an attempt have been made for the review of the thermo-sensitive vaginal gel and the scholar has gathered the basic knowledge to develop an Ayurvedic formulation Panchavalkal kashaya thermo-sensitive vaginal gel by this review. This work will be done in School of Pharmaceutical Science, Shoolini University, Solan, HP.

Prevalence of bacterial vaginosis among reproductive age group women in a tertiary care centre

Background: Vaginal discharge in reproductive age poses a serious problem in the developing countries. Bacterial vaginosis also known as non-specific vaginitis is the most common cause of vaginal infections, detecting the organism at an early stage and initiating a proper treatment is very difficult in our country due to lack of awareness and proper follow-up. The disease manifests in the form of vaginal discharge with or without itching. It has a strong association with preterm labor, preterm premature rupture of membranes and low birth weight in pregnancy. The objective of this study was to find out the prevalence of bacterial vaginosis among the reproductive age group women, in a tertiary care centre.Methods: A cross sectional study was conducted among 150 women of the reproductive age group in the department of obstetrics and gynaecology Sree Mookambika Institute of Medical Sciences over a period of one month October 2018 the diagnosis was made with history and nugents scoring system.Results: Out of the total 150 women enrolled in the study 74 had positive results, 50% of them were of the age group 26-30.Conclusions: The study shows us the high prevalence of bacterial vaginosis.

Therapeutic Efficacy of Voriconazole in Fluconazole Resistant Vaginal Candidiasis

Background: Candida species is known as the most commonopportunistic yeast affecting the genitourinary tract. Thetriazoles are commonly used for the treatment of candidiasis.But the increasing resistance of Candida to different azolescreated a demand for newer drugs.Objective: Voriconazole is a second generation azoleantifungal agent that shows excellent in vitro activity against awide variety of yeast and moulds. This study was done toassess the therapeutic efficacy of Voriconazole in Fluconazoleresistant vaginal candidiasis.Material and Methods: This one-group pretest-posttest quasiexperiment was conducted in a specialized private chamber ofFaridpur, Bangladesh from January 2018 to July 2019. Vaginalcandidiasis was diagnosed by clinical features, microscopicexamination, culture and sensitivity of high vaginal swab.Voriconazole was used only in Fluconazole resistant vaginalcandidiasis.Results: During the study period, 568 patients were presentedwith vulvovaginitis. Among them, in 267 (47%) patients,Candida albicans were isolated. All patients were treated byFluconazole as first-line treatment. 160 (60%) of those patientsdid not improve clinically and were treated by Voriconazole.Success rate was 93% (149). Regarding side effects ofVoriconazole, transient visual disturbance occurred in 35% ofthe patients, nausea and vomiting in 20% of the patients.Conclusion: Due to wide species variety of Candida andincreasing resistance, Voriconazole may be the second linetreatment of vaginal candidiasis.

A prevalence study of vaginal candidiasis among pregnant women

Background: Pregnancy is associated with specific anatomical, physiological and immunological changes that can predispose to infection and also alter the response to the disease process. Infections in pregnancy demands prompt adequate and careful management. The disease process as well as the treatment protocol may have profound effects on the outcome of pregnancy. Pregnant women frequently develop vaginal discharge which can lead to complications during pregnancy like abortions, premature birth, low birth weight and other morbidities. Some of the infections may be serious and life threatening for the mother while others may seriously jeopardize the fetus or neonate leaving the mother asymptomatic. The aim and objective of this study was based on the present study was aimed to study the prevalence of vaginal candidiasis among pregnant patients who were visited in outdoor patient’s department of Prasutitantra and Streeroga.Methods: About 135 high vaginal swabs were collected from the women who carrying 2nd and 3rd trimester of pregnancy with symptoms of vaginal infection. These samples were tested under microscopic examination and culture on Mac Conkey agar, blood agar and Sabouraud dextrose agar respectively. Colonial morphology, wet/K.O.H. preparation, gram staining, germ tube test, were carried out for identification of the isolated organisms.Results: Out of 135 samples collected, 61 (45.18%) patients were shown positive fungal infection of candidial species. The age group showing the highest number of positive candidiasis was of 20 to 25 years. Multigravida (60%) were more commonly affected than primigravida (40%) and commonly seen in third trimester (67.41%).Conclusions: Vaginal Candidiasis was common in pregnant women with more common in young adults.

The application value of DNA hybridization probe test in the diagnosis of bacterial vaginosis and vulvovagi-nal candidiasis / 实用医学杂志

Objective To investigate the sensitivity and specificity of DNA hybridization probe test(Af-firm VPIII) in the identification related microorganisms of bacterial vaginosis(BV),vulvovaginal candidiasis (VVC). Methods Vaginal secretion were detected in 103 patients with symptom and sign of vaginitis in the out patient department. According to Nungent score,the fungal culture as the gold standard. BV blue reagent assay and wet mount microscopy as a common detection method,evaluated the sensitivity and specificity of Affirm VPIII. Results Compared with the Nungent score,the sensitivity and specificity of Affirm VPIII were 98% and 96.2%. Compared with the fungi culture,the sensitivity and specificity of Affirm VPIII were 89.4% and 98.3%. Conclusion Affirm VPIII has high sensitivity and specificity which can identify pathogenic microorganisms of BV,VVC,especially in BV diagnosis.

Curcumin temperature-sensitive in situ hydrogels for treatment of vaginal candidiasis / 国际药学研究杂志

Objective To investigate the therapeutic effect of curcumin in situ hydrogels for treatment of vaginal candidiasis. Methods In situ hydrogels were prepared using poloxamer 407 and 188 as the gel matrix.Gelation temperature,gelation time and rheological characteristics were determined.Mice models with vaginal candidiasis were established.The animals were divided into six groups:the healthy mice group,the model group,the positive control group(ketoconazole cream),curcumin-loaded in situ hydrogels of 0.025,0.10 and 0.20 g/ml.Before treatment and after the fourth and eighth treatments,the vaginal smears were collected and Gram-stained.The vagina washings fluid of mice were collected to determine DNA of Lactobacillus.On 8thday,the mice were sacrificed and the vaginal tissues were excised for pathological detection.Results The gelation temperature and time of in situ hydrogels were 29℃and 2′30″,respectively.Rheological profiles demonstrated that it showed good retention effect in vivo.Compared with the model group, curcumin hydrogels of 0.025,0.10 and 0.20 g/ml could inhibit the growth of Candida albicans,inhibit vaginal mucosal edema,inflam?matory hyperplasia,and decrease the expression of inflammatory factors including TNF-α(P<0.01)and IL-1β(P<0.01).Howev?er,curcumin hydrogels could not influence the growth of lactobacillus in the vagina.It indicated that curcumin hydrogels did not de?pend on lactobacillus to treat fungal vaginitis.Conclusion Curcumin in situ hydrogels could inhibit candidiasis growth,decrease ede?ma of vaginal mucosa and inflammatory hyperplasia,and reduce the expression of inflammatory factors.It provides a novel choice for the treatment of clinical vaginal candidiasis.

Susceptibilidad antifúngica de aislados vaginales de Candida spp / Antifungal susceptibility of Candida spp. vaginal isolates

Introducción: la vulvovaginitis constituye una de las principales afecciones ginecológicas, y su causa más frecuente es la candidiasis. Candida albicans se considera el agente etiológico más importante de esta entidad; sin embargo, estudios recientes revelan un incremento en la incidencia de otras especies del género. Algunas de estas tienen la particularidad de presentar resistencia a los tratamientos usuales con antimicóticos. Objetivo: evaluar la susceptibilidad antifúngica de aislados vaginales de pacientes cubanas con sospecha de candidiasis vulvovaginal que se obtuvieron en el 2015. Métodos: a 28 aislados pertenecientes al género Candida, se les realizó las pruebas de susceptibilidad in vitro con la galería ATBTM Fungus 3 frente a diferentes antifúngicos (5-fluorocitosina, anfotericina B, fluconazol, itraconazol y voriconazol). Resultados: todos los aislados fueron sensibles a la anfotericina B y uno de C. albicans se informó resistente a los azoles estudiados. Todas las especies diferentes de C. albicans fueron susceptibles al voriconazol (CMI≤ 1 mg/L). Conclusiones: el estudio de patrones de susceptibilidad en aislados de Candida provenientes de mujeres con vulvovaginitis permite profundizar en cómo abordar la terapéutica de esta afección; el fluconazol resultó el tratamiento de elección. Los resultados alertan sobre la emergencia de C. glabrata, C. krusei, C. parapsilosis, C. tropicalis, C. inconspicua y C. lusitaniae como agentes causales de la candidiasis vulvovaginal(AU)

Introduction: vulvovaginitis is one of the main gynecological diseases frequently caused by candidiasis. Candida albicans is considered as the most important etiological agent for the disease; however, recent students have revealed an increased incidence of other species of the genus. Some of them may show particular resistence to usual antimycotic treatments. Objective: to evaluate the antifungal susceptibility of vaginal isolates from Cuban female patients suspected of vulvovaginal candidiasis in 2015. Methods: twenty eight Candida genus isolates underwent in vitro susceptibility tests with ATBTM Fungus 3 using several antifungal agents (5 fluorocytosine, anphotericin B, fluconazole, itraconazole and vorixonazole). Results: all isolates were susceptible to B anphotericin and one C. albicans isolate was reported as resistant to the studied azoles. All the species other thanC. albicans were susceptible to voriconazole (CMI≤ 1mg/L). Conclusions: the study of susceptibility patterns in Candida isolates from women with vulvovaginitis allow delving into the different ways of approaching the therapeutics of this disease; fluconazole was the treatment of choice. The results show emergence of C. glabrata,C. krusei, C. parapsilosis, C. tropicalis, C. inconspicua and C. lusitaniae as causative agents of vulvovaginal candidiasis(AU)

Pharmacodynamic study of Sophora flavescens alkaloid gels for treatment of vaginal candidiasis / 国际药学研究杂志

Objective To explore the pharmacodynamic effect of Sophora flavescens alkaloid (SFA)gels for the treatment of vaginal candidiasis on animal models. Method The BALB/c mice models having vaginal candidiasis were prepared. The animals were divided into four groups: the model group, the blank gel group, the SFA gel group, and the ketoconazole cream group. The regimens were administered to the animals once a day for seven days. Before treatment and after the fourth and seventh treatments, the vaginal smears were collected and Gram-stained. The vaginal washings were cultured to detect Candida albicans. On day 7, the mice were sacrificed and the vaginal tissues were excised for pathological detection. Results Compared with the model and the blank gel groups, the SFA gel and ketoconazole cream groups reduced the C. albicans colonies in the vagina. Moreover, the SFA gels increased the number of Lactobacillus, the helpful bacteria in vagina but the ketoconazole creams did not. The SFA gels and ketoconazole creams inhibited the growth of C. albicans according to the investigation of in vitro culture of vaginal washings (P<0.01). Furthermore, the SFA gels inhibited the inflammatory hyperplasia and edema. Conclusion The therapeutic action of SFA gels on vaginal candidiasis is achieved by inhibiting the growth of candidiasis, promoting lactobacillus growth and inhibiting the inflammatory hyperplasia.

Pharmacodynamic study of Sophora flavescens alkaloid gels for treatment of vaginal candidiasis / 国际药学研究杂志

Objective To explore the pharmacodynamic effect of Sophora flavescens alkaloid(SFA)gels for the treatment of vaginal candidiasis on animal models. Method The BALB/c mice models having vaginal candidiasis were prepared. The animals were divided into four groups:the model group,the blank gel group,the SFA gel group,and the ketoconazole cream group. The regi?mens were administered to the animals once a day for seven days. Before treatment and after the fourth and seventh treatments ,the vag?inal smears were collected and Gram-stained. The vaginal washings were cultured to detect Candida albicans. On day 7,the mice were sacrificed and the vaginal tissues were excised for pathological detection. Results Compared with the model and the blank gel groups,the SFA gel and ketoconazole cream groups reduced the C. albicans colonies in the vagina. Moreover,the SFA gels increased the number of Lactobacillus,the helpful bacteria in vagina but the ketoconazole creams did not. The SFA gels and ketoconazole creams inhibited the growth of C. albicans according to the investigation of in vitro culture of vaginal washings(P<0.01). Furthermore,the SFA gels inhibited the inflammatory hyperplasia and edema. Conclusion The therapeutic action of SFA gels on vaginal candidiasis is achieved by inhibiting the growth of candidiasis,promoting lactobacillus growth and inhibiting the inflammatory hyperplasia.

Investigação da atividade antifúngica de mangifera indica l. frente a diferentes espécies de candida ssp. associadas à candidíase vulvovaginal / Research of mangifera indica l. antifungal activity in different candida ssp. species associated with vulvovaginal candidiasis

Candidíase Vaginal é a infecção fúngica oportunista mais comum e importante nas mulheres. O aumento na utilização de drogas antifúngicas, nos últimos anos, tem causado resistência aos medicamentos disponíveis para o tratamento. O objetivo deste estudo foi investigar a atividade antifúngica de Mangifera indica em estirpes associadas à candidíase vaginal. Os testes in vitro foram realizados com o extrato bruto e frações orgânicas contra as estirpes de Candida albicans (URM 4385), Candida glabrata (URM 4264) e Candida tropicalis (URM 4262), gentilmente cedidas pela Micoteca da Universidade Federal de Pernambuco (UFPE), por meio do ensaio de difusão em ágar por meio de poço e determinação da concentração inibitória mínima (CIM). O extrato etanólico foi o mais ativo, com diâmetro de inibição variando entre 25,5 e 18,5 mm, valores semelhantes à droga padrão, não apresentando diferença estatística. A CIM variou de 0,04 e 0,16 mg/ml em microrganismo testado. As frações acetato de etila e metanólica apresentaram atividade antifúngica relevante contra C. glabrata e C. albicans, respectivamente. Estudo químico para a extração e o isolamento dos compostos ativos é recomendado para ensaios in vitro destes compostos para investigar a sua atividade antifúngica.

Vaginal Candidiasis is the most common and important opportunistic fungal infection in women. The increased use of antifungal drugs in recent years has caused resistance to the drugs available for treatment. The aim of this study was to investigate the antifungal activity of Mangifera indica on strains associated to vaginal candidiasis. In-vitro tests were conducted with crude extract and organics fractions against strains of Candida albicans (URM 4385), Candida glabrata (URM 4264) and Candida tropicalis (URM 4262), a courtesy of the Federal University of Pernambuco (UFPE), through diffusion in agar-bem assay and minimal inhibitory concentrations (MIC). The ethanolic extract was the most active, with inhibition diameter ranging between 25.5 to 18.5 mm, values that are similar to the standard drug, not presenting statistic different. The MIC varied from 0.04 to 0.16 mg/ml for the tested microorganism. The ethyl and methanolic acetate organic fractions presented relevant antifungal activity against C. glabrata and C. albicans, respectively. The chemical study for the extraction and isolation of active compounds is recommended for in-vitro assays of these compounds to investigate the antimicrobial activity.

Vaginal Candidiasis Infection among Pregnant Women in Aba, Abia State, Nigeria.

Epidemiological monitoring of vaginal candidiasis infection associated with preterm delivery and death of the infants is highly desirable especially on pregnant women. The objectives of this study were to determine the prevalence of vaginal candidiasis and the occurrence of Candida species in pregnant women attending antenatal clinics (not necessarily presenting any disease symptoms) in Aba, Abia State, Nigeria. Selection was by subject consent and presence at the clinics. Vaginal swab and urine samples were collected from 400 pregnant women between the months of May and October, 2014. Candida species were identified using sabouraud dextrose agar (SDA). All cultures were screened for the presence of Candida albicans using the germ tube test. Out of 400 pregnant women sampled, 126 (31.5%) tested positive. The age group 19-28 years had the highest prevalence rate with 48 (39.7%) while 49 years and above recorded the least prevalence rate – 23 (26.7%). The result also showed that women at their third trimester recorded the highest prevalence rate of 71 (38.0%). In terms of the effect of the levels of education, the illiterate pregnant women recorded the highest rate with 22 (46.8%) while the least was obtained from those with tertiary education. Based on their occupation, the traders recorded the highest rate -76 (47.8%) while house wives had the least with 8 (8.3%). There is a need for routine surveillance and education of pregnant women on Candida albicans as a holistic procedure in antenatal care.

Prevalencia de resultado positivo de la citología para vaginosis bacteriana, candidiasis y tricomoniasis en una Empresa Social del Estado de Medellín (Colombia), 2010-2012 / Prevalence of positive cytology results for bacterial vaginosis, candidiasis and trichomoniasis in a Social State Institution in Medellín, Colombia, 2010-2012

Objetivo: determinar la prevalencia del resultado positivo de la citología para vaginosis bacteriana, candidiasis y tricomoniasis vaginal, y su distribución según edad, método de planificación y sector de residencia.Materiales y métodos: estudio de corte transversal en especímenes citológicos obtenidos de mujeres atendidas entre los años 2010-2012 en Metrosalud, red de instituciones de la que hacen parte cincuenta centros de salud y unidades hospitalarias de primer nivel en Medellín (Colombia). Se incluyó toda la población de mujeres del régimen subsidiado atendida en la institución, se excluyeron las citologías con muestras insatisfactorias por ausencia de células, exceso de eritrocitos o leucocitos, y extendido defectuoso. Se usó fuente de información secundaria. Los datos se almacenaron y analizaron en SPSS 21®, con medidas de resumen y frecuencias absolutas y relativas.Resultados: se incluyeron 206.035 registros. La prevalencia de vaginosis bacteriana fue 18 %, candidiasis 4,7 % y tricomoniasis 0,8 %. Los subgrupos con mayor prevalencia de infecciones fueron los adolescentes, con 22,8 % de vaginosis bacteriana, 9,2 % de candidiasis y 1,0 % para tricomoniasis; y quienes usan el dispositivo intrauterino (DIU) con 25,6, 5,1 y 1,2 % respectivamente.Conclusión: se halló una elevada prevalencia de las infecciones estudiadas, principalmente en adolescentes y usuarias del DIU; esta información resulta útil para los tomadores de decisiones en salud y para evaluar la pertinencia de estructurar programas de tamización de infecciones del tracto genital aunados a la tamización del cáncer cérvico-uterino.

Objective: To determine the prevalence of positive cytology results for bacterial vaginosis, candidiasis and vaginal trichomoniasis, and distribution by age, birth control method and place of residence. Materials and methods: Cross-sectional study of cytology samples from women seen between 2010 and 2012 at Metrosalud, a network of institutions comprising 50 healthcare centres and level I hospitals in Medellín, Colombia. All the female population under the subsidized insurance regime was included, and inadequate samples due to absence of cells, excess red or white blood cells, and defective smear were excluded. A secondary source of information was used. Data were stored and analysed using the SPSS 21®, with summary measurements and absolute and relative frequencies. Results: Overall, 206,035 records were included. The prevalence of bacterial vaginosis was 18 %, and the prevalence of candidiasis and trichomoniasis was 4.7 % and 0.8 %, respectively. The subgroups with the highest prevalence of infections were adolescents with 22.8 % bacterial vaginosis, 9.2 % candidiasis and 1.0 % trichomoniasis. Among women using the intrauterine device (IUD), the prevalence was 25.6 %, 5.1 % and 1.2 %, respectively.Conclusion: A high prevalence of the infections studied was found, mainly among adolescents and IUD users. This information is useful for healthcare decision-making and for evaluating the relevance of structuring screening programs for genitourinary tract infections together with screening for cervical and uterine cancer.

Atypical presentations of congenital cutaneous candidiasis- presenting a cohort of 8 cases.

Congenital cutaneous candidiasis is an extremely rare disorder that usually presents within the first 6 days of life. We report 8 neonates who presented with generalized skin eruptions within first 6 days of life, characterized by erythematous macules, papules, vesicles, bullae and pustules. Candida albicans was demonstrated on direct KOH smear, fungal culture and skin biopsy. The disease implies a congenital intrauterine infection and is different from neonatal candidiasis, which manifests as thrush or diaper dermatitis.Although congenital cutaneous candidiasis is a rare diagnosis and the predisposing factors like prematurity,candidial infection in the mother are not obvious, a high index of suspicion is required to diagnose the neonates with this condition and it is very evident that congenital cutaneous candidiasis has got a good prognosis. This article apart from revealing the atypical presentations of cutaneous congenital candidiasis, also emphasizes the need to screen all pregnant women for vaginal candidiasis .

In vitro/in vivo performance of different complexes of itraconazole used in the treatment of vaginal candidiasis

A large majority of new chemical entities and many existing drug molecules exhibit poor aqueous solubility, which may limit their potential use in developing drug formulations, with optimum bioavailability. One of the approaches to improve the solubility of a poorly water soluble drug and eventually its bioavailability is complexation with agents like humic acid (HA), fulvic acid (FA), β-cyclodextrin (β-CD), 2-hydroxypropyl-β-cyclodextrin (HP-β-CD) and caffeine (Caff). The current work emphasized at employing these agents to prepare different complexes and their in vitro/in vivo assessment. All the complexes evaluated for their complexation efficiency and authenticated by molecular modeling; conformational analysis, differential scanning calorimetry (DSC), X-ray diffraction (XRD), nuclear magnetic resonance (NMR) and mass spectroscopy. Furthermore, the complexes were assessed in an in vivo, rat vaginal model for their efficacy in treatment of vaginal candidiasis. Amongst the five tested complexes, fulvic acid-itraconazole complex yielded better solubility as well as in vivo efficacy and therefore may further be explored for developing a commercial formulation for treating vaginal candidiasis.

A maioria das novas entidades químicas e muitas moléculas de fármacos existentes apresenta fraca solubilidade em água, o que pode limitar seu uso potencial no desenvolvimento de formulações com biodisponibilidade ideal. Uma das abordagens para melhorar a solubilidade de um fármaco pouco solúvel em água e, eventualmente, a sua biodisponibilidade é a complexação com agentes como o ácido húmico (HA), ácido fúlvico (FA), β-ciclodextrina (β-CD), 2-hidroxipropil-β-ciclodextrina (HP-β-CD) e cafeína (Caff). O presente trabalho baseia-se no uso desses agentes para preparar diferentes complexos e suas avaliações in vitro/in vivo. Todos os complexos foram avaliados quanto à eficiência de complexação por modelação molecular, análise conformacional, calorimetria de varredura diferencial (DSC), difração de raios-X (XRD), ressonância magnética nuclear (RMN) e espectroscopia de massas. Além disso, os complexos foram avaliados in vivo, em ratas, no tocante à sua eficácia no tratamento de candidíase vaginal. Entre os cinco complexos testados, o complexo de ácido fúlvico-itraconazol foi o que apresentou melhor solubilidade, bem como melhor eficácia in vivo e, portanto, pode ser explorado para o desenvolvimento de uma formulação comercial para o tratamento de candidíase vaginal.

Low-dose ketoconazole-fluconazole combination versus fluconazole in single doses for the treatment of vaginal candidiasis.

Background: Vaginal candidiasis (VC) is one of the most common fungal diseases. Candida albicans is the most common causative fungus and has been isolated from more than 80% of specimens obtained from women with VC. Ketoconazole is the first orally active antifungal, the dosage for VC is 200 mg twice daily for 5 days. Fluconazole is the newer oral antifungal, its dosage for VC is a single oral dose of 150 mg. Since fluconazole 150 mg is considerably expensive, a single dose of 100 mg ketoconazole and 40 mg fluconazole in combination has been tested for the treatment of VC. The results showed that from 11 women with confirmed VC, 1-2 weeks after drug administration, the mycological culture was negative in 8 women, positive in 1 woman, and 2 woman lost to follow-up. This promising result led to the present study with the objective to confirm the efficacy and safety of the above combination in a formal clinical trial. Methods: A total of 165 female patients, aged 18 years or older, with the diagnosis of VC from clinical symptoms (pruritus or burning or excessive discharge) and positive microscopic smear (pseudohyphae and/or yeast cells) were randomized to receive a single dose of either keto-fluco combination (n = 85) or fluconazole (n = 80), and returned for follow-up visit on day 8. Results: Among these patients, 39 patients had negative baseline culture, leaving 126 patients eligible for efficacy evaluation. The mycological eradication in the keto-fluco group was 74.5% (41 patients from a total of 55 patients with available mycological culture), while that in the fluconazole group was 70.2% (40 patients from 57 patients with available culture) and this difference was not significant. The clinical favorable response (clinical cure and clinical improvement) in the keto-fluco arm (n = 60) was 98.3%, while that in the fluconazole group (n = 66) was 100%. Adverse events were found in 5 patients, 3 patients in the keto-fluco group (3/85 = 3.5%) and 2 patients in the fluconazole group (2/80 = 2.5%). Conclusion: The present study showed that the efficacy and safety of ketoconazole 100 mg and fluconazole 40 mg combination was not inferior compared to fluconazole 150 mg in single doses for the treatment of vaginal candidiasis.

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.

Diagnóstico y prevalencia de infecciones vaginales / Diagnosis and prevalence of vaginal infections

Las infecciones del aparato genital femenino constituyen un problema importante de la práctica ginecoobstétrica. Son causa de morbilidad, mortalidad materna y neonatal. Entre los factores que explican su frecuencia están: aborto provocado, aumento de intervenciones quirúrgicas e infecciones de transmisión sexual. OBJETIVO: Realizar el diagnóstico y determinar la prevalencia de infecciones vaginales en mujeres que asisten al Laboratorio de Microbiología del Hospital Ginecoobstétrico "Ramón González Coro" con la utilización del Juego de diagnóstico de infecciones vaginales Newvagin C-Kure. MÉTODOS: Se examinaron 150 mujeres, de edades entre 17 y 74 años, de mayo a octubre de 2007. Se utilizó examen directo, criterios de Amsel y cols, así como prueba de aglutinación al látex. RESULTADOS: La prevalencia de las infecciones vaginales estudiadas fue de 62 % al examen directo y de 58,6 % con la prueba de aglutinación al látex. La infección vaginal con mayor prevalencia fue vaginosis bacteriana, seguida de candidiosis vaginal y trichomoniosis vaginal. El grupo de edad con mayor prevalencia de estas infecciones fue el de 28-37 años. La manifestación clínica más frecuente fue la leucorrea. El inicio precoz de las relaciones sexuales, la realización del acto sexual sin protección y el uso de métodos anticonceptivos, estuvieron relacionados con la presencia de estas infecciones vaginales. CONCLUSIONES: El uso del Juego de diagnóstico de infecciones vaginales NEWVAGIN C-Kure, en consultorios de médicos de familia, policlínicos comunitarios y consultas de ginecología resulta ventajoso. La realización del diagnóstico por el personal paramédico, su rapidez y la certeza en la indicación del tratamiento médico son los principales factores a considerar

The infections of female genital tract are a significant problem of gynecologic and obstetric practice. They are cause of morbidity and of mother and neonatal mortality. Among factors explaining its frequency are: provoked abortion, increase of surgical interventions and sexual transmitted infections. OBJECTIVES:To make the diagnosis and to determine the vaginal infections prevalence in women served in Microbiology Laboratory of "Ram¾n Gonzßlez Coro" using the NEWVAGIN C-Cure diagnosis kit. METHODS: Authors examined to 150 women aged between 17 and 24 from May to October, 2007. Direct examination, Amsel et al criteria and latex agglutination test were used. RESULTS: Prevalence of study vaginal infections was of 62 percent in direct examination and of 58.6 percent using the latex agglutination test. The more prevalent vaginal infection was the bacterial vaginosis followed by vaginal candidiasis and vaginal trichomoniasis. The more prevalent age group with these infections was that aged 28-37. More frequent clinical manifestation was the leucorrhea. The early onset of sexual intercourse, the intercourse without protection and the use of contraceptive methods were related to presence of these vaginal infections. CONCLUSIONS: The use of NEWVAGIN C-Kure diagnosis kit for vaginal infections in family consulting room, community polyclinics and Gynecology consultations is very advantageous. Making diagnosis by paramedical staff, its speed and accuracy in prescription of medical treatment are the leading factors to be considered

Local IL-23 Expression in Murine Vaginal Candidiasis and Its Relationship with Infection and Immune Status / 华中科技大学学报（医学）（英德文版）

To investigate the expression of vaginal IL-23 and its role in experimental murine vaginal candidiasis and its relationship with infection and immune status, immuno-competent (group A) and immuno-suppressed (group B) murine models of vaginal candidiasis were established in estrogentreated mice. Non-estrogen-treated mice were used as controls (group C). The level of IL-23 p19 mRNA in murine vaginal tissue was determined by RT-PCR. Significantly increased levels of IL23p19mRNA were observed on the 4th, the 7th and 14th day after inoculation in immuno-competent group when compared with that in control group (P＜0.01, P＜0.05), However, significant increase of IL-23 p19mRNA were only observed on the 7th day and the 14th day after inoculatuon in immuno-suppressed groups (P＜0.05). On the 4th and 7th day, the levels of IL-23 p19mRNA were significantly increased in immuno-competent group than those in immuno-suppressed group (P ＜0.05). Local IL-23 may play a role in the pathogenesis of murine vaginal candidiasis and has a protective function during infection. Low vaginal IL-23 level may correlate with the increased susceptibility to Candida albicans in immuno-suppressed group.

Susceptibility to Vaginal Candidiasis under Different Conditions in Mice / 华中科技大学学报（医学）（英德文版）

In order to study the susceptibility of murine vaginal mucosa to Candida albicans under different conditions, vaginal lavage fluid and vaginal tissue of mice were observed and compared be tween murine models with normal immune system (estrogen-treated mice) and immunosuppressed murine model, and between primary infection model of vaginal candidiasis and secondary infection one. The average level of colony forming unit (CFU) from the immuosuppressed group was higher than that from estrogen-treated group at each time point and the peak time was delayed. The differences between the two groups were statistically significant (P＜0.05) from the fourth day after in oculation. A significant difference existed in the average level of CFU between the control group and the estrogen-treated group (P＜0.05), and between the control group and the immuosuppressed group (P＜0.01). It was concluded that the vaginal mucosa from the immunosuppressed mice is more susceptible to Candida albicans and no difference is found in susceptibility between mice with primary infection and secondary infection.