Increasing rate of non-Candida albicans yeasts and fluconazole resistance in yeast isolates from women with recurrent vulvovaginal candidiasis in Leeds, United Kingdom.

Azoles have been the mainstay of recurrent vulvovaginal candidiasis (RVVC) for many years. Because of a recent anecdotal increase in non-Candida albicans yeasts (NCAY) and azole-resistant C. albicans cases, their prevalence was calculated from cultures for yeasts in women with complicated/RVVC over 3 years. Retrospective data search of vaginal cultures from adult women in Leeds, UK between April 2018 and March 2021 was conducted. Samples with clinical details of complicated/RVVC had full yeast identification and antifungal susceptibility performed. Differences in prevalence between 12-month periods were determined using χ2 tests. Over the 3 years, cultures were performed on 5461 vaginal samples from women with clinical information indicating they had complicated/RVVC, RVVC, with 1828 (33.5%) growing yeasts.Over 85% of yeasts each year were C. albicans, however the proportion declined yearly with an increase in NCAY species. Nakaseomyces glabrata was the most frequent NCAY species isolated, increasing from 2.8% in 2018-19 to 6.8% in 2020-21. Total NCAY species increased from 6.0% in 2018-19 to 12.6% in 2020-21. Fluconazole-sensitive dose-dependant (SDD) and resistant isolates increased from 3.5% in 2018-19 to 7.7% in 2019-20 and 9.6% in 2020-21. Most resistance was in C. albicans and the majority of cases were seen in primary care. Most fluconazole non-sensitive isolates were either SDD or resistant to itraconazole (77% and 23%, respectively) and were intermediate or resistant to voriconazole (36.4% and 60%, respectively). There was a significant increase in the prevalence of NCAY and fluconazole-resistant C. albicans in complicated/RVVC cultures over these 3 years. Successful treatment of such cases can be very challenging. The exact reasons for this increase remain unclear but it follows a policy change that encouraged a clinical diagnosis and empirical treatment of vulvovaginal candidiasis, rather than fungal culture, in primary care.

Ratner JC ，Wilson J ，Roberts K ，Armitage C ，Barton RC ... -  《-》

Epidemiology of Vulvovaginal Candidiasis in Greece: A 2-Year Single-Centre Study.

The epidemiology of vulvovaginal candidiasis (VVC) in Greece remains poorly reported and outdated. We therefore conducted a 2-year retrospective survey to assess the epidemiological aspects of the infection among symptomatic Greek patients. High vaginal swab samples were collected from adult women with clinically suspected VVC attending a private diagnostic laboratory in Athens. VVC was confirmed through microscopic examination of a wet mount preparation revealing yeasts and Candida-positive culture. Species were identified by MALDI-ToF MS, and in vitro susceptibility was determined according to the EUCAST-E.Def 7.4. Predisposing host factors were associated with the occurrence of the infection and isolated Candida spp. using Fisher's exact test, and epidemiological changes over time were analysed with the χ2 test for trend. Among 1300 women screened, 283 VVC episodes were recorded among 233 (18%) patients, whereof 11 (5%) had recurrent VVC (RVVC) and 19 (8%) had mixed Candida infections. Coinfection with other pathogens and recent prior use of antifungals were associated with RVVC. Candida albicans was the most prevalent pathogen (50%), followed by Candida parapsilosis sensu stricto (SS) (35%), Nakaseomyces glabratus (former Candida glabrata) (10%), Pichia kudriavzevii (former Candida krusei) (3%), Candida orthopsilosis (1.5%) and Clavispora lusitaniae (former Candida lusitaniae) (0.5%). Regarding the RVVC cases, 54% were attributed to C. albicans, 37% to N. glabratus and 9% to C. parapsilosis SS. Resistance to fluconazole was found in 4% of C. albicans and 23% of N. glabratus strains with cross-resistance to other azoles. Fluconazole-resistant isolates were recovered from 5 of 11 RVVC patients, whereof 4 of 5 had previous exposure to azoles. During the study period, an increase in N. glabratus VVC and fluconazole resistance was noted. VVC is common in our region, with C. albicans as the predominant species, followed by C. parapsilosis SS and N. glabratus. Fluconazole resistance is low in C. albicans but high in N. glabratus, emphasising the need for targeted antifungal strategies.

Kroustali V ，Resoulai E ，Kanioura L ，Siopi M ，Meletiadis J ，Antonopoulou S ... -  《-》

Vulvovaginal candidiasis, an increasing burden to women in the tropical regions attending Bharatpur Hospital, Chitwan.

Subedi A ，Upreti MK ，Rana JC ，Sapkota RP ，Thapa Shrestha U ... -  《-》

The impact of fluconazole use on the fungal and bacterial microbiomes in recurrent Vulvovaginal Candidiasis (RVVC): a pilot study of vaginal and gastrointestinal site interplay.

Recurrent Vulvovaginal Candidiasis (RVVC) is a problematic clinical condition for which fluconazole treatment is commonly prescribed. This study investigated the interkingdom vaginal and gastrointestinal microbiomes of RVVC patients who use fluconazole intermittently or as longer-term maintenance therapy for symptom management and compared them to healthy controls. Vaginal swabs and fecal samples were collected. A novel interkingdom analysis was performed using 16 S rRNA and ITS1 gene sequencing to compare the diversity and taxonomic composition of vaginal microbiome (VMB) and gastrointestinal microbiome (GIMB). Twenty-seven women participated: 10 intermittent users and healthy controls and 7 maintenance therapy. The study revealed that microbiomes of fluconazole users do not differ in diversity metrics from healthy controls. RVVC patients using intermittent fluconazole displayed a higher abundance of vaginal C. albicans than healthy controls. Candida species pairings were not commonly observed between sites in individuals and, as such a fecal reservoir is unlikely to be implicated in recurrent symptomatology. In many of the RVVC non-Candida fungal spp. were identified in the vaginal microbiome. Users of fluconazole displayed elevations of the CST-I (Community State Type 1) associated bacterium L. crispatus. All participants displaying vaginal Candida spp. belonged to either bacterial CST-I or CST-III (Community State Type 3- L. iners associated). To our knowledge, this is the first study to compare the interkingdom VMB-GIMB of women with RVVC using oral fluconazole. As fluconazole users in this study represent a typical RVVC population, trends observed in microbial abundance require further analysis to establish fluconazole's long-term microbiome safety. Examining the microbiome at both sites adds to the current understanding of microbial associated with the condition.

Bradfield Strydom M ，Nelson TM ，Khan S ，Walpola RL ，Ware RS ，Tiralongo E ... -  《-》

Erratum: Eyestalk Ablation to Increase Ovarian Maturation in Mud Crabs.

《Jove-Journal of Visualized Experiments》