Journal
MEDICAL MYCOLOGY
Volume 60, Issue 5, Pages -Publisher
OXFORD UNIV PRESS
DOI: 10.1093/mmy/myac029
Keywords
antifungal resistance; Candida spp; epidemiology; vaginal environment; vulvovaginal candidiasis
Categories
Funding
- Portuguese Foundation for Science and Technology (FCT) [UID/BIO/04469/2019]
- European Regional Development Fund [NORTE-010145-FEDER-000004]
- FCT [FRH/BD/111645/2015, UIDB/50026/2020, UIDP/50026/2020]
- Projetos de Investigacao Cientifica e Desenvolvimento Tecnologico (ICDT) [02/SAICT/2017, POCI-01-0145-FEDER-028893]
- Competitiveness and Internationalization Operational Program [030881, PTDC/EMD-EMD/30881/2017, POCI-01-0145-FEDER030881]
- ICVS Scientific Microscopy Platform, member of the national infrastructure PPBI - Portuguese Platform of Bioimaging [PPBI-POCI-01-0145-FEDER-022122]
- Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF) [NORTE-01-0145-FEDER-000039]
- Fundação para a Ciência e a Tecnologia [PTDC/EMD-EMD/30881/2017] Funding Source: FCT
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This study highlights the importance of understanding the epidemiology, microbiology, antifungal susceptibility, and risk factors of VVC, in order to improve prevention and treatment strategies for this globally significant infection.
Vulvovaginal candidiasis (VVC) has been identified as a global issue of concern due to its clinical, social and economic implications. The emerging relevance of VVC makes it crucial to increase the knowledge on its epidemiological and etiological features in order to improve its prevention and treatment. Thus, this study aimed to reveal the incidence, microbiology, antifungal pattern and risk factors of VVC in Portugal. For that, high vaginal samples were collected from 470 symptomatic and asymptomatic participants; Candida spp. were identified with molecular techniques and their antifungal susceptibility was analyzed with E-tests. The results revealed an incidence of VVC among women with vulvovaginitis of 74.4%. Furthermore, 63.7% of asymptomatic women were colonized with Candida spp. Importantly, women with history of recurrent vaginal infections, those who use over-the-counter antifungals, oral contraceptive pills and non-cotton underwear were found to be at significantly higher risk of developing VVC. Candida albicans was the most common species (59%), followed by Candida glabrata (27%), in a total of eight distinct species, with similar distribution among colonized and infected participants. Of note, various isolates, especially of the most common species, showed low susceptibility towards fluconazole. In contrast, only few isolates showed low susceptibility towards caspofungin. Overall, this study suggests that the identification of species causing VVC and their antifungal susceptibility are urgently needed in clinical practice in order to improve the decision for the most adequate treatment. It also suggests that avoiding certain risk behaviors may prevent the development of VVC. Lay Summary Vaginal candidiasis (VVC) is a relevant infection worldwide. In this study, we identified several risk behaviors that may promote VVC and concluded that vaginal microbiologic analyses are urgently required in clinical practice in order to improve the prevention and treatment of this disease.
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