Actividad de fosfolipasas y proteasas en aislamientos de especies de Candida colonizadoras y causantes de vulvovaginitis en mujeres gestantes / Phospholipase and proteinase activities of isolatesof colonizing Candida spp. causing vulvovaginitis in pregnant women

Introducción. Las proteasas y las fosfolipasas son factores de virulencia de Candida spp. que cumplen un papel importante en la invasión de los tejidos. Entre los factores relacionados con el huésped, se encuentran algunos asociados con las características ambientales y otros con la colonización. Objetivo. Determinar la actividad de fosfolipasas y proteasas en aislamientos de especies colonizadoras y patógenas de Candida spp., aisladas de mujeres gestantes de Cartagena de Indias. Materiales y métodos. Se determinó la actividad de fosfolipasas y proteasas en 56 aislamientos mediante degradación del sustrato y cálculo del coeficiente de actividad enzimática. Se compararon las actividades de fosfolipasas y proteasas, entre los aislamientos colonizadores y los patógenos. Resultados. La actividad de la fosfolipasa fue "muy alta" (< 0,69) en 34 aislamientos e, igualmente, la de la proteasa en 14. No hubo diferencias significativas al comparar las actividades de las fosfolipasas y de las de las proteasas, entre los aislamientos colonizadores y los patógenos. Conclusiones. La actividad de las fosfolipasas predominó como factor de virulencia en los aislamientos estudiados. No obstante, no se encontró una diferencia significativa entre los grupos de aislamientos colonizadores y los patógenos, en cuanto a las actividades de fosfolipasas y proteasas.

Introduction. Proteases and phospholipases are virulence factors of Candida spp. that play an important role in tissue invasion. Among the factors related to the host some are associated with environmental characteristics and others with Candida colonization. Objectives. To determine phospholipase and protease activities in colonizing and pathogenic strains, isolated from pregnant women in Cartagena de Indias. Materials and methods. Phospholipase and protease activity was determined in 56 isolates, evaluating substrate degradation and calculating the enzyme activity coefficient. Phospholipase and protease activities were compared between colonizing and pathogenic strains. Results. "Very high" (<0.69) phospholipase and protease activity was found in 34 and 14 isolates, respectively. There was no significant difference when comparing phospholipase and protease activities between colonizing and pathogenic isolates. Conclusions. Phospholipase activity predominated as a virulence factor in the studied strains, but no significant difference was found between colonizing and pathogenic strains for phospholipase and protease activities.

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.

Perfil de resistencia antifúngica en el tratamiento de candidiasis vaginal: Un diagnóstico de agentes etiológicos / Antifungal resistance profile in the treatment of vaginal candidiasis: A diagnosis of etiologic agents

Introducción: En las micosis, la resistencia a los antifúngicos aumenta debido a los diagnósticos y tratamientos incorrectos. Por tanto, se ha sugerido la vigilancia y el seguimiento de las cepas resistentes para garantizar una terapia adecuada. Objetivo: Determinar las especies de Candida y el perfil de resistencia a fluconazol y voriconazol, que presentan los aislados obtenidos de muestras almacenadas durante los meses diciembre 2017 y marzo 2018 de pacientes provenientes del Laboratorio del Hospital Regional "Miguel Ángel Mariscal Llerena" del departamento de Ayacucho, Perú. Material y Métodos: Estudio descriptivo transversal, en el cual se aislaron 110 cepas de Candida sp almacenadas por un período de cuatro meses, y procesadas por métodos estandarizados y aprobados por el Ministerio de Salud (MINSA) y el Instituto Nacional de Salud (INS) del Perú relacionados con el diagnóstico de agentes etiológicos de micosis humanas y la sensibilidad antifúngica con los métodos estandarizados de Clinical Laboratory Standard Institute (CLSI). Resultados: Se observó C. albicans en 86,4 % de los aislados seguida por C. glabrata con 9,1 %, C. parapsilosis 2,7 % y 0,9 % de C. tropicalis y C. krusei. El 10,5 % de C. albicans fue resistente al fluconazol y voriconazol con CMI ≥ 128 μg/mL y ≥ 16 μg/mL respectivamente, mientras que 20 % de C. glabrata mostró sensibilidad dosis dependiente y 10 % de resistencia al fluconazol. Conclusiones: Existe una gran variedad de especies de Candida, siendo la C. albicans la más común, seguida por C. glabrata, con un mayor porcentaje de aislamiento en comparación con otras especies. Se puede observar que estas especies poseen grados de vulnerabilidad considerables a la aplicación de fármacos como el fluconazol y voriconazo(AU)

Introduction: In mycoses, resistance to antifungals increases due to incorrect diagnosis and treatment. Therefore, surveillance and monitoring of resistant strains has been suggested to ensure adequate therapy. Objective: To determine the Candida species and the resistance profile to fluconazole and voriconazole presented by the isolates obtained from samples stored during the months of December 2017 and March 2018 from patients coming from the Laboratory of the Regional Hospital "Miguel Ángel Mariscal Llerena" in the department of Ayacucho, Peru. Material and Methods: Cross-sectional descriptive study in which 110 strains of Candida sp were isolated and stored for a period of four (04) months, and processed by standardized methods approved by the Ministry of Health (MINSA) and the National Institute of Health (INS) of Peru related to the diagnosis of etiological agents of human mycosis and antifungal sensitivity with the standardized methods of the Clinical Laboratory Standard Institute (CLSI). Results: C. albicans was observed in 86,4 % of isolates, followed by C. glabrata (9,1 %), C. parapsilosis (2,7 %), and 0,9 % of C. tropicalis and C. krusei; 10,5 % of C. albicans was resistant to fluconazole and voriconazole with MIC ≥ 128 μg/mL and ≥ 16 μg/mL respectively, while 20 % of C. glabrata showed dose dependent sensitivity and 10 % resistance to fluconazole. Conclusions: There is a wide variety of Candida species, with C. albicans being the most common, followed by C. glabrata, with a higher percentage of isolation compared to other species. It can be seen that these species have considerable degrees of vulnerability to the application of drugs such as fluconazole and voriconazole(AU)

Phospholipase and proteinase activities of isolates of colonizing Candida spp. causing vulvovaginitis in pregnant women / Actividad de fosfolipasas y proteasas en aislamientos de especies de Candida colonizadoras y causantes de vulvovaginitis en mujeres gestantes

Introduction: Proteases and phospholipases are virulence factors of Candida spp. that play an important role in tissue invasion. Among the factors related to the host some are associated with environmental characteristics and others with Candida colonization. Objectives: To determine phospholipase and protease activities in colonizing and pathogenic strains, isolated from pregnant women in Cartagena de Indias. Materials and methods: Phospholipase and protease activity was determined in 56 isolates, evaluating substrate degradation and calculating the enzyme activity coefficient. Phospholipase and protease activities were compared between colonizing and pathogenic strains. Results: "Very high" (<0.69) phospholipase and protease activity was found in 34 and 14 isolates, respectively. There was no significant difference when comparing phospholipase and protease activities between colonizing and pathogenic isolates. Conclusions: Phospholipase activity predominated as a virulence factor in the studied strains, but no significant difference found between colonizing and pathogenic strains for phospholipase and protease activities.

Introducción: Las proteasas y las fosfolipasas son factores de virulencia de Candida spp. que cumplen un papel importante en la invasión de los tejidos. Entre los factores relacionados con el huésped, se encuentran algunos asociados con las características ambientales y otros con la colonización. Objetivo: Determinar la actividad de fosfolipasas y proteasas en aislamientos de especies colonizadoras y patógenas de Candida spp., aisladas de mujeres gestantes de Cartagena de Indias. Materiales y métodos. Se determinó la actividad de fosfolipasas y proteasas en 56 aislamientos mediante degradación del sustrato y cálculo del coeficiente de actividad enzimática. Se compararon las actividades de fosfolipasas y proteasas, entre los aislamientos colonizadores y los patógenos. Resultados: La actividad de la fosfolipasa fue "muy alta" (< 0,69) en 34 aislamientos e, igualmente, la de la proteasa en 14. No hubo diferencias significativas al comparar las actividades de las fosfolipasas y de las de las proteasas, entre los aislamientos colonizadores y los patógenos. Conclusiones: La actividad de las fosfolipasas predominó como factor de virulencia en los aislamientos estudiados. No obstante, no se encontró una diferencia significativa entre los grupos de aislamientos colonizadores y los patógenos, en cuanto a las actividades de fosfolipasas y proteasas.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecções que causam corrimento vaginal / Brazilian Protocol for Sexually Transmitted Infections 2020: infections causing vaginal discharge / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infecciones que causan flujo vaginal

O tema corrimento vaginal é um dos capítulos que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Neste artigo, são apresentados aspectos epidemiológicos e clínicos relacionados às situações de corrimento vaginal, bem como orientações aos gestores e profissionais de saúde na triagem, diagnóstico e tratamento desses agravos, que constituem uma das principais queixas entre mulheres que procuram serviços de saúde e que podem ser causados por fatores infecciosos ou não infecciosos. Além disso, são apresentadas informações sobre estratégias para as ações de vigilância, prevenção e controle, a fim de promover o conhecimento do problema e a oferta de assistência de qualidade e tratamento efetivo.

The topic of vaginal discharge is one of the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The chapter has been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects related to vaginal discharge conditions, as well as guidelines for health service managers and health professionals about screening, diagnosing and treating these conditions, which are one of the main complaints among women seeking health services, and which may be caused by infectious or non-infectious factors. In addition, information is presented on strategies for surveillance, prevention and control actions, in order to promote knowledge of the problem and provision of quality care and effective treatment.

El tema del flujo vaginal es uno de los capítulos del Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. El documento fue desarrollado en base a evidencia científica y validado en discusiones con especialistas. En este artículo se presentan aspectos epidemiológicos y clínicos relacionados a las situaciones de flujo vaginal, así como pautas para gestores y profesionales de la salud en el cribado, diagnóstico y tratamiento de esas complicaciones, que son una de las principales quejas entre las mujeres que buscan servicios de salud y que pueden ser causadas por factores infecciosos o no infecciosos. Además, se presenta información sobre estrategias para acciones de vigilancia, prevención y control, con el fin de promover la comprensión del problema y la oferta de asistencia de calidad y tratamiento eficaz.

Infecciones cervicovaginales en exudados vaginales / Cervicovaginal infections in vaginal exudates

Introducción: Se desconocen las características de las infecciones cervicovaginales, diagnosticadas mediante el exudado vaginal, sobre todo en mujeres cubanas de mediana edad. En otras etapas del ciclo vital femenino, sí se han realizado estos estudios. Esta información es importante, fundamentalmente para realizar acciones de promoción de salud. Objetivo: Determinar las características de las infecciones cervicovaginales más frecuentes diagnosticadas mediante el exudado vaginal. Método: Se realizó un estudio transversal en 1118 mujeres. Se recogió la edad (agrupada en 20 - 44 años y 45 y más años), los resultados del exudado vaginal, la percepción de secreción vaginal o la ausencia de esta (asintomáticas) y los microorganismos identificados en el exudado. Resultados: El 49,9 por ciento de exudados vaginales fueron positivos a vaginosis bacteriana, Cándidas albicans, Trichomonas vaginalis y desequilibro en la ecología vaginal. El 45 por ciento de las pacientes no tenían secreción vaginal, es decir, estaban asintomáticas. Conclusión: Las infecciones cervicovaginales se caracterizaron por ser de elevada frecuencia, usualmente asintomáticas, con predominio de vaginosis bacteriana, candidiasis y trichomoniasis(AU)

ABSTRACT Introduction: The characteristics of cervicovaginal infections diagnosed by vaginal exudate are unknown, especially in middle-aged Cuban women. At other stages of the female life cycle, these studies have been done. Due to the importance of this information, to carry out health promotion actions, this research was carried out. Objective: To determine the characteristics of the most frequent cervicovaginal infections diagnosed by vaginal exudate. Method: A cross-sectional study was conducted in 1118 women. Age (grouped into 20-44 years and 45 and over), the results of positive vaginal discharge, the perception of presence or not of vaginal discharge (asymptomatic) and the microorganisms identified in the discharge were collected. Results: 49.9 percent of vaginal exudates were positive for bacterial vaginosis, Candidas albicans, Trichomonas vaginalis and imbalance in vaginal ecology. 45 percent of the patients had no vaginal discharge, that is, they were asymptomatic. Conclusion: Cervicovaginal infections were characterized by being of high frequency, usually asymptomatic, with prevalence of bacterial vaginosis, candidiasis and trichomoniasis(AU)

Efficacy of curcumin in the treatment of experimental vulvovaginal candidiasis.

BACKGROUND: Candida albicans is the main agent that causes vulvovaginal candidiasis. Resistance among isolates to azole antifungal agents has been reported. AIMS: Due to the well-known antifungal potential of curcumin, the purpose of this work was to evaluate the in vitro anticandidal activity of curcumin and its effect in the treatment of experimental vulvovaginal candidiasis. METHODS: The anticandidal activity of curcumin was investigated against eight Candida strains by the broth microdilution assay, and its mechanism of action was evaluated by testing the binding to ergosterol. Then, the effect of curcumin in the treatment of vulvovaginal candidiasis was evaluated in an immunosuppressed, estrogen treated rat model. RESULTS: Curcumin showed minimum inhibitory concentration values of 125-1000µg/ml, and the best result was observed against Candida glabrata. The compound was shown to be able to bind to the ergosterol present in the membrane, event that may be the mechanism of action. In addition, in the in vivo model of vulvovaginal candidiasis with C. albicans, treatments reduced the vaginal fungal burden in infected rats after seven days of treatment with different doses. CONCLUSIONS: Curcumin could be considered a promising effective antifungal agent in the treatment of vulvovaginal candidiasis.

Factores de riesgo asociados a infección vaginal en mujeres embarazadas / Risk factors associated to vaginal infections in pregnant women / Fatores de risco associados à infecção vaginal em gestantes

RESUMEN La infección vaginal constituye una de las complicaciones médicas más frecuentes asociadas al embarazo. Se realizó un estudio epidemiológico, observacional, analítico, longitudinal de casos y controles con mujeres embarazadas atendidas en el Policlínico Jimmy Hirzel, Bayamo, Granma, período junio 2016 - diciembre 2017, con el objetivo de identificar factores de riesgo hipotéticamente relacionados con la aparición de infección vaginal. Los datos se obtuvieron a partir de una encuesta aplicada a las pacientes y su historia clínica, previo consentimiento informado. Se aplicó modelo de riesgo proporcional de Cox para análisis univariado y multivariado, y el Chi cuadrado, con una confiabilidad del 95% y una probabilidad menor de 0.05. La historia previa de infección de transmisión sexual (OR 2,25), más de tres gestaciones (OR 3,20), los abortos previos (9,88) y el no empleo de preservativos en las relaciones sexuales (OR 5, 35) se constituyeron en los antecedentes gineco-obstétricos relacionados con la aparición de infección vaginal en mujeres embarazadas. El inicio precoz de la vida sexual (OR 2, 25) se constituyó en un factor demográfico y de conducta sexual relacionado con la aparición de infección vaginal en mujeres embarazadas. Haber recibido algún tipo de tratamiento vaginal previo al estudio (OR 1,26), constituyó un factor de riesgo relacionado con los procedimientos externos, aunque no de forma significativa. La presencia de infección de vías urinarias y de diabetes mellitus se constituyeron en factores de riesgo relacionados con la aparición de infección vaginal en mujeres embarazadas.

ABSTRACT Vaginal infection is one of the most frequent medical complications associated with pregnancy. An epidemiological, observational, analytical, longitudinal study of cases and controls was carried out with pregnant women attended at the Jimmy Hirzel Polyclinic, Bayamo, Granma, June 2016 - December 2017, with the objective of identifying risk factors hypothetically related to the appearance of vaginal infection. The data was obtained from a survey applied to patients and their clinical history, with prior informed consent. Cox proportional risk model was applied for univariate and multivariate analysis, and Chi square, with a 95% reliability and a probability lower than 0.05. The previous history of sexually transmitted infection (OR 2.25), more than three pregnancies (OR 3.20), previous abortions (9.88) and the non-use of condoms in sexual relations (OR 5, 35) were constituted in the gynecological-obstetric history related to the appearance of vaginal infection in pregnant women. The early onset of sexual life (OR 2, 25) became a demographic and sexual behavior factor related to the appearance of vaginal infection in pregnant women. Having received some type of vaginal treatment prior to the study (OR 1.26), constituted a risk factor related to external procedures, although not in a significant way. The presence of urinary tract infection and diabetes mellitus constituted risk factors related to the appearance of vaginal infection in pregnant women.

RESUMO A infecção vaginal é uma das complicações médicas mais frequentes associadas à gravidez. Dezembro de 2017, com o objetivo de identificar fatores de risco hipoteticamente relacionados ao aparecimento de - uma epidemiológica,,, estudos de caso-controle observacionais analíticos longitudinais com mulheres grávidas que frequentam Policlínica Jimmy Hirzel, Bayamo, Granma, período de junho de estudo 2016 foi realizado infecção vaginal. Os dados foram obtidos a partir de uma pesquisa aplicada aos pacientes e sua história clínica, com consentimento prévio informado. O modelo de risco proporcional de Cox foi aplicado para análise univariada e multivariada, e o qui quadrado, com 95% de confiabilidade e probabilidade menor que 0,05. história prévia de doença sexualmente transmissível (OR 2,25), mais de três gestações (OR 3,20), abortos anteriores (9,88) e não-uso de preservativos durante as relações sexuais (OR 5, 35) foram constituídos na história gineco-obstétrica relacionada ao aparecimento de infecção vaginal em gestantes. O início precoce da vida sexual (OR 2, 25) tornou-se um fator de comportamento demográfico e sexual relacionado ao aparecimento de infecção vaginal em gestantes. Ter recebido algum tipo de tratamento vaginal antes do estudo (OR 1,26), constituiu um fator de risco relacionado aos procedimentos externos, embora não de forma significativa. A presença de infecção do trato urinário e diabetes mellitus constituiu fatores de risco relacionados ao aparecimento de infecção vaginal em gestantes.

Meningoencefalitis criptocóccica refractaria en una mujer joven

RESUMEN Mujer de 23 años presenta hace 2 meses cefalea que se acompaña de visión borrosa, disartria y pérdida de la conciencia. Por líquido cefalorraquídeo se confirma meningitis a criptococo. A pesar del tratamiento con anfotericina B y fluconazol presenta empeoramiento general. Durante su evolución presentó paracoccidioidomicosis pulmonar y candidiasis vaginal. A pesar de la terapia dirigida, la paciente fallece con la tardía confirmación de una inmunodeficiencia variable común.

ABSTRACT A 23-year-old woman has been presenting headache for two months that is accompanied by blurred vision, dysarthria and loss of consciousness. Cerebrospinal fluid confirms meningitis to Cryptococcus. In spite of the treatment with amphotericin B and fluconazole she presents a general deterioration. During her evolution she presented pulmonary paracoccidiomycosis and vaginal candidiasis. Despite specific therapy, the patient dies with the late confirmation of a common variable immunodeficiency.

Vaginal colonization and vulvovaginitis by Candida species in pregnant women from Northern of Colombia / Vulvovaginitis y colonización vaginal por especies de Candida en gestantes del norte de Colombia

Objective: identify the vaginal colonizing Candida species and VVC species, predisposing factors and susceptibility against fluconazole in pregnant women attending gynecological outpatient of a maternal clinic in Cartagena (Colombia). Vulvovaginal candidiasis (VVC) is a common infection that affects a large proportion of women of childbearing age. It is estimated that about 75% of healthy women have had at least one episode of VVC in her life. Vaginal colonization by Candida spp. can vary from 10 to 17% and this is increased by 35% during pregnancy. The epidemiological behavior of Candida in VVC tends to be variable and this will depend on the level of vaginal estrogens, conditions of immunosuppression or chronicity of the process. Materials and Methods: the laboratory study included the direct examination of vaginal swabs, by fresh and differential staining of smears and cultures. The isolated species were identified by phenotypic tests and by multiplex PCR and CLSI M27-A3 microdilution method was used to evaluate susceptibility to fluconazole. Results: the frequent clinical diagnosis of bacterial vaginosis, did not correspond with the laboratory diagnosis in which predominated the intermediate biota. The results showed Candida albicans as the most common isolated species, followed by Candida tropicalis and Candida krusei.Candida colonization occurred in 71.4% and 28.6% of the population was diagnosed with vaginal candidiasis. All isolates were susceptible to fluconazole. Conclusion:The most common factors for colonization were related to clothing and for vaginal candidiasis to the use of vaginal lubricants..(AU)

Objetivo: identificar las especies colonizantes y asocidadas a CVV, factores predisponentes y sensibilidad a fluconazol en gestantes que asistieron a la consulta externa ginecológica de una clínica materna de Cartagena (Colombia). La candidiasis vulvovaginal (CVV) es una infección común que afecta una gran proporción de mujeres en edad fértil. Se estima que un 75% de las mujeres sanas han tenido al menos un episodio de CVV en su vida. La colonización vaginal por Candida spp. varía del 10 al 17% y esta alcanza un 35% durante el embarazo. El comportamiento epidemiológico del género Candida en la VVC es variable y dependerá del nivel de estrógenos de la vagina, inmunosupresión o cronicidad del proceso. Materiales y métodos: el estudio de laboratorio comprendió, examen directo de exudados vaginales, mediante fresco y tinciones diferenciales. Los aislamientos se identificaron por pruebas fenotípicas y PCR múltiple y se utilizó el método M27-A3 del CLSI por microdilución para la evaluación de la sensibilidad a fluconazol. Resultados: el diagnóstico médico frecuente de vaginosis bacteriana no correspondió con el de laboratorio en el que predominó la biota intermedia. Los resultados revelaron a Candida albicans como la especie más frecuente, seguida por Candida tropicalis y Candida krusei. La colonización por Candida fue del 71,4% y la candidiasis vaginal del 28,6%. Los aislamientos resultaron sensibles a fluconazol. Conclusión: los factores más frecuentes para colonización se relacionaron con la ropa y para candidiasis vaginal, con el uso de lubricantes vaginales..(AU)

Prevalencia y factores asociados con vaginosis bacterianas, candidiasis y tricomoniasis en dos hospitales de los municipios de Apartadó y Rionegro -Antioquia, 2014 / Prevalence of bacterial vaginosis, candidiasis, trichomoniasis, and associated factors in two hospitals of Apartadó and Rionegro - Antioquia, 2014

RESUMEN Objetivo: determinar la prevalencia de vaginosis bacteriana (VB), candidiasis, tricomoniasis y sus factores asociados, en las mujeres que consultan al servicio de citología de dos empresas sociales del estado (ESEs) de los municipios de Apartadó y Rionegro, año 2014. Metodología: estudio descriptivo de corte transversal. Fuente de información secundaria: base de datos del Laboratorio de Citología de la Escuela de Microbiología. Población: 6447 registros de mujeres del servicio de citología de los municipios de Apartadó y Rionegro. 3.762 registros de Apartadó y 2.685 registros de Rionegro año 2014. Se calcularon frecuencias absolutas, relativas e intervalos de confianza. Se exploró la asociación entre las variables independientes con relación significativa con los microorganismos estudiados, luego se ingresaron a un modelo de ajuste multivariado de regresión logística binaria. Nivel de significación estadística del 0,05. Los datos se almacenaron y analizaron en SPSS 20,1®. Resultados: la prevalencia de vaginosis bacteriana fue 29,9 %, candidiasis del 10,7 %, y tricomoniasis del 3,2 %. No hubo diferencias significativas en las infecciones en ambos municipios. No se encontró asociación estadística significativa con los factores de riesgo estudiados. Conclusiones: el comportamiento de las VB, cándida y trichomona fue muy similar al reportado en otras investigaciones y no se encontró diferencia en el comportamiento en los municipios estudiados, a pesar de ser contextos socioeconómicos y culturales diferentes.

SUMMARY Objective: To determine the prevalence of bacterial vaginosis, candidiasis, trichomoniasis, and associated factors in women who use the cytology service of two hospitals in Apartadó and Rionegro in 2014. Methodology: Descriptive cross-sectional study. Data source: the cytology laboratory database of the School of Microbiology. Study population: 6447 samples from women who attended the cytology service in Apartadó hospital with 3,762 records and Rionegro hospital with 2,685 records. Absolute and relative frequencies with confidence intervals were calculated, the association between the independent variables that showed significant association with the microorganisms studied were explored, and then, entered in a multivariate binary logistic regression model. In all analyzes statistical significance level of 0.05 was accepted and data were stored and analyzed with SPSS 20,1®. Results: The prevalence of bacterial vaginosis was 29.9 %, candidiasis 10.7% and trichomoniasis 3.2 %. No significant differences between municipalities were observed nor statistically significant association with any of the risk factors studied. Conclusions: The behavior of BV, candida and trichomona were very similar to those reported in other researches and no difference was found between the studied municipalities, despite the differences in socioeconomic and cultural contexts.

Prevalence of Candida albicans, Candida dubliniensis and Candida africana in pregnant women suffering from vulvovaginal candidiasis in Argentina.

BACKGROUND: Vulvovaginal candidiasis (VVC) is a vulvovaginitis commonly diagnosed in gynecology care. In recent years, the taxonomy of the most important pathogenic Candida species, such as Candida albicans have undergone significant changes. AIMS: This study examined the prevalence of C. albicans, Candida africana, and Candida dubliniensis in vaginal specimens from 210 pregnant women suffering from vulvovaginitis or having asymptomatic colonization. METHODS: Phenotypic and molecular methods were used for the identification of the species. RESULTS: During the studied period, 55 isolates of Candida or other yeasts were obtained from specimens collected from 52 patients suffering from vulvovaginitis (24.8%). C. albicans was the predominant Candida species in 42 isolates (80.7%), either alone or in combination with other species of the genus (5.7%, n=3). Additionally, nine isolates of C. albicans (50%) were obtained from asymptomatic patients (n=18). C. dubliniensis was the causative agent in 2 (3.8%) cases of VVC, and was also isolated in one asymptomatic patient. Molecular assays were carried out using specific PCR to amplify the ACT1-associated intron sequence of C. dubliniensis. The amplification of the HWP1 gene also correctly identified isolates of the species C. albicans and C. dubliniensis. No C. africana was isolated in this work. Some C. albicans isolates were either homozygous or heterozygous at the HWP1 locus. The distribution of heterozygous and homozygous C. albicans isolates at the HWP1 locus was very similar among patients suffering from VVC and asymptomatic patients (p=0.897). CONCLUSIONS: The presence of C. albicans and C. dubliniensis, and the absence of C. africana in pregnant is noteworthy.

Detección de Candida glabrata en mujeres mexicanas sanas y con candidiasis vulvovaginal recurrente / Candida glabrata detection in healthy Mexican women with recurrent vulvovaginal candidiasis

Resumen OBJETIVO: determinar, mediante reacción en cadena de la polimerasa (PCR), si C. albicans y C. glabrata son causantes de las recurrencias de candidiasis vulvovaginal y si suelen colonizar la vagina de mujeres mexicanas asintomáticas en edad reproductiva. MATERIALES Y MÉTODOS: estudio analítico, transversal, prospectivo, experimental, de casos y controles, efectuado en mujeres de 18 a 45 años de edad, atendidas en el servicio de Ginecología del Centro Médico ABC de la Ciudad de México y el Cinvestav del Instituto Politécnico Nacional. Identificar C. albicans y C. glabrata en muestras vaginales por medio de reacción en cadena de la polimerasa con iniciadores específicos para cada especie. RESULTADOS: se estudiaron 93 pacientes: 46 casos y 47 controles. En los casos se encontraron: 2.17% con C. albicans, 80.4% con C. glabrata y 17.3% con coinfección por ambas especies. En los controles se encontraron: 61.7% con C. albicans, 4.2% con C. glabrata, 19.1% con coinfección por ambas especies y 14.8% con ausencia de Candida spp. CONCLUSIONES: el agente causal de la mayor parte de las candidiasis vulvovaginales recurrentes es C. glabrata. La colonización por esta especie y por C. albicans es común y no provoca síntoma alguno, por lo que para su identificación es importante utilizar métodos de diagnóstico como la reacción en cadena de la polimerasa.

Abstract BACKGROUND: 75% of women are affected with vulvovaginal candidiasis and 10% of them will have at least 4 episodes during one year. The most common etiological agents are C. albicans and C. glabrata, which is usually the responsible of the recurrent cases when the patients have received inadequate treatment. Up to 55% of asymptomatic women can have different species of Candida spp. as vaginal commensals, but there are no recent studies that identify this yeast through molecular techniques in healthy women and with history of vulvovaginal candidiasis. OBJECTIVE: Determine using polymerase chain reaction if C. albicans and C. glabrata are responsible of recurrent vulvovaginal candidiasis and if they usually colonize Mexican asymptomatic women in reproductive age. MATERIAL AND METHODS: An analytical, transversal, prospective, experimental, case control study was carried out in women age 18 to 45 in the Gynecology Service of ABC Medical Centre of México City and IPN Cinvestav. C. albicans and C. glabrata were identified in vaginal samples using polymerase chain reaction with specific primers for each specie. RESULTS: A total of 93 patients were studied, 46 cases and 47 controls. 2.17% of the case patients were positive C. albicans, 80.43% for C. glabrata, and 17.39% for both species. 61.70% of the control patients were positive for C. albicans, 4.20% for C. glabrata, 19.14% for both species, and 14.89% were negative for Candida. CONCLUSIONS: The main etiological agent of recurrent vulvovaginal candidiasis is C. glabrata. The vaginal colonization of this specie and C. albicans is common and causes no symptoms, thus, it is important to use diagnostic tools such as polymerase chain reaction to identify them. It is relevant to investigate the factors that help this yeast to cause a symptomatic infection and stop being just a vaginal commensal.

Infecciones vaginales en pacientes gestantes de una clínica de alta complejidad de Medellín-Colombia / Vaginal infections in pregnant patients of a high complexity clinic from Medellín-Colombia

Objetivo: describir características de las infecciones vaginales en pacientes gestantes.La gestación constituye un factor predisponente para infecciones vaginales, las cuales pueden generar consecuencias deletéreas para la madre y el feto. Materiales y métodos: estudio transversal, descriptivo. Población compuesta por gestantes condiagnóstico de infección vaginal en una clínica de alta complejidad durante enero de 2011 a junio de 2012. Se recolectó información sociodemográfica, clínica, microbiológica y terapéutica de las historias clínicas de las pacientes. Resultados: se incluyeron 67 pacientes, con una mediana de edad de 23 (RIQ 21-29) años; el 40% era primigestante y el 66% nulípara. Únicamente el 15% de las infecciones vaginales se presentaron en el primer trimestre gestacional. Los síntomas más frecuentemente referidos fueron: flujo vaginal (59.7%), síntomas urinarios bajos (26.9%) y prurito vulvar (23.9%); los principales hallazgos al examen físico fueron flujo (79.1%) y fetidez (16.4%) vaginal. En el 67,2% de los casos fue ordenada la realización del directo y gram de flujo vaginal, de los cuales, el 64,4% se realizó intrahospitalariamente. La reacción leucocitaria estuvo presente en la totalidad de las pacientes y en el 90% fue de moderada a abundante.Ocho de cada 10 pacientes presentó blastoconidias y pseudomicelios. El diagnóstico microbiológico más frecuente fue Candidiasis vulvovaginal (41.4%), seguido por Vaginosis bacteriana (24.1%). Conclusión: las infecciones vaginales constituyen una patología con sintomatología frecuente, la cual se presenta generalmente en la segunda mitad del embarazo, siendo Candida spp. el agente etiológico más común.

Objective: to describe the characteristics of vaginal infections in pregnant patients. Pregnancy is a predisposing factor for vaginal infections, which can lead to deleterious consequences for mother and fetus. Materials and methods: a cross-sectional study. Population consists in pregnant patients diagnosed with vaginal infection in a high complexity clinic, January 2011 to June 2012. Sociodemographic, clinical, microbiologicaland therapeutic information were collected from the clinical histories of the patients. Results: 67 patients were included, with a median age of 23 (IQR 21-29) years; 40%were in their first pregnancy and 66% were nulliparous. Only 15% of vaginal infectionsoccurred in the first trimester of pregnancy. The most frequently reported symptomswere vaginal discharge (59.7 %), lower urinary tract symptoms (26.9 %) and vulvarpruritus (23.9 %); the main physical findings were vaginal discharge (79.1 %) and vaginalstench (16.4 %). In 67.2% of cases were ordered the direct and gram of vaginaldischarge, of which 64.4% were performed during hospitalization. Leukocyte reactionwas present in all patients and in 90 % was moderate to abundant. 8 out of 10 patientshad blastoconidia and pseudomycelia. The most common microbiological diagnose was vulvovaginal candidiasis (41.4 %), followed by bacterial vaginosis (24.1 %). Conclusion: vaginal infections are a condition with frequent symptoms, which usually occursin the second half of pregnancy, being the Candida spp. the most common etiology.

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.

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.

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.

Efectividad y seguridad de la combinación fluconazol más secnidazol para el tratamiento de flujo vaginal sintomático: Bogotá, Colombia / Effectiveness and safety of the combination of fluconazole and secnidazole for the treatment of symptomatic vaginal discharge: Bogotá, Colombia

Objectives: To describe the safety and the clinical and microbiological efficacy of a single oral dose of a combined treatment with secnidazole plus fluconazole for the syndromic management of symptomatic vaginal discharge.Materials and methods: A clinical trial without control group study was conducted including women with symptomatic vaginal discharge who assisted to a secondary level hospital in Bogota, Colombia. 118 women were included in a consecutive convenience sample who received the study treatment according to syndromic diagnosis approach. Microbiological diagnosis of bacterial vaginosis (BV) was confirmed by Nugent score, yeast infection by candida culture and trichomoniasis by wet mount. Prevalence, clinical and microbioogical efficacy and safety of the secnidazole and fluconazole combination pill was determined and a sensitivity analysis for treatment efficacy was performed.Results: The following infections were found: BV in 57.1%, candidiasis in 28.8%, and mixed infections in 10.8%. In 8.5% of the patients, the microbiology tests were negative. No trichomonas were found. The clinical cure rate was 90.4%, and the microbiological cure rate was 94.1% with the study medication. Twelve cases (12.90%) presented drug-related non serious adverse events.Conclusion: The most prevalent infection was BV, followed by candidiasis and mixed infection. The combination of a single dose of secnidazole plus fluconazole combined pill had an efficacy rate over 90% and was safe for the treatment of symptomatic women with vaginal discharge.

Objetivos: describir la seguridad y la eficacia clínica y microbiológica del tratamiento combinado de secnidazol mas fluconazol oral, dosis única, para el manejo del flujo vaginal sintomático.Materiales y métodos: ensayo clínico sin grupo control, realizado en mujeres sintomáticas con flujo vaginal en un hospital de mediana complejidad localizado en la ciudad de Bogotá, Colombia. Se incluyeron 118 mujeres por muestreo consecutivo por conveniencia quienes recibieron el tratamiento de acuerdo con el diagnóstico sindrómico. El diagnóstico microbiológico se estableció usando el puntaje de Nugent para vaginosis bacteriana (VB), el cultivo para cándida y el frotis directo en fresco para tricomonas. Se estimaron la prevalencia, la efectividad clínica y microbiológica, y la seguridad del tratamiento combinado de secnidazol con fluconazol en mono dosis, y se realizó un análisis de sensibilidad para la eficacia del tratamiento.Resultados: la prevalencia de VB fue del 57,1%, de candidiasis fue del 28,8% y de la infección mixta 10,8%. No se encontró infección por tricomonas. En 8,5% de las pacientes los resultados microbiológicos fueron negativos. La tasa de curación clínica con secnidazol más fluconazol fue de 90,4%, y la tasa de curación microbiológica fue de 94,1%. Doce pacientes (12,90%) presentaron eventos adversos no serios relacionados con el medicamento.Conclusión: la VB fue la infección más común en este estudio, seguida por la candidiasis y las infecciones mixtas. La combinación secnidazol más fluconazol es una intervención efectiva para alcanzar la cura clínica y microbiológica en las pacientes con síndrome de flujo vaginal, con una baja frecuencia de eventos adversos no serios.

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.

Eosinofilia no sangue periférico de mulheres com candidiase vaginal recorrente / Eosinophilia in peripheral blood of women with recurrent vaginal candidiasis

OBJETIVO: Quantificar o número de células de defesa e os níveis de imunoglobulina E (IgE) no sangue periférico em amostra de mulheres com candidíase vaginal recorrente. MÉTODOS: Estudo de corte transversal com 60 mulheres, 40 com candidíase vulvovaginal e 20 do grupo controle (sem doença). As células de defesa foram identificadas utilizando um sistema de impedância combinada com a citometria de fluxo, os níveis de IgE total e específica foram medidos por meio de técnicas de quimiluminescência, o teste de Mann-Whitney foi utilizado para variáveis nominais e do teste de Spearman para correlações das concentrações de IgE e de eosinófilos no sangue periférico. RESULTADOS: O número de eosinófilos no sangue periférico de pacientes com candidíase vulvovaginal, 302,60 (±253,07), foi significativamente maior do que o grupo controle, 175,75 (±109,24) (p=0,037). Os níveis séricos de IgE total e específica foram semelhantes em ambos os grupos de mulheres com e sem candidíase vulvovaginal recorrente (p=0,361). Entretanto, observou-se uma correlação positiva moderada entre eosinofilia e níveis de IgE total no sangue periférico de mulheres com candidíase vaginal recorrente (r=0,25). CONCLUSÃO: Mulheres com candidíase vaginal recorrente parecem ter maior concentração de eosinófilos no sangue periférico que as assintomáticas.

PURPOSE: To quantify the number of defense cells and immunoglobulin E (IgE) levels in peripheral blood sampled from women with recurrent vulvovaginal candidiasis. METHODS: A cross-sectional study was conducted on 60 women, 40 with vulvovaginal candidiasis and 20 controls. The defense cells were identified using an impedance system combined with flow cytometry and total and specific IgE was measured by chemiluminescence. The Mann-Whitney test was used for nominal variables and the Spearman test was used to determine the correlation of IgE concentration and eosinophils in peripheral blood. RESULTS: The number of eosinophils in peripheral blood from patients with recurrent vulvovaginal candidiasis, 302.60 (±253.07), was significantly higher compared to control, 175.75 (±109.24) (p=0.037). Serum levels of total and specific IgE were similar in the groups of women with and without recurrent vulvovaginal candidiasis (p=0.361). However, there was a moderate positive correlation between eosinophils and total serum IgE in the candidiasis group (r=0.25). CONCLUSION: Women with recurrent vulvovaginal candidiasis are more likely to have eosinophils in peripheral blood.