Phylogenetic characterization of biofilm forming multidrug resistant Candida albicans and Non albicans Candida causing vulvovaginal candidiasis

Introduction: Vulvovaginal candidiasis(VVC) is an important health disorder among women which is caused due to drug resistance in Candida species. C.albicans is the most common pathogenic species among Candida. However, the Non albicans Candida (NAC) species is on the rise, so the appropriate identification of the Candida sp. will pave way for better management and minimising the emergence of drug resistance. The aim of this study is to analyse the species distribution and their antifungal susceptibility pattern of Candida sp. in patients with suspected vaginitis. Materials and methods: A total of 153 women of age 15-40 years with complaints suggestive of vaginitis were clinically examined and high vaginal swabs were taken from them. Samples were inoculated on Sabouraud Dextrose agar and Hi-Crome Candida differential agar. Identification of Candida sp. was performed using conventional methods and with Vitek2 Compact (Biomerieux France) using vitek 2 cards for identification of yeast and yeast like organisms (ID-YST cards). Multidrug resistant Candida isolates were analysed for biofilm forming ability and their identification was confirmed with amplification and sequencing of internal transcribed space regions with specific PCR. Results: In total, 63 Candida isolates were identified from the samples. Candida albicans (59%) was the most common species isolated in the study. The Non albicans Candida species (41%) isolated in the study were C. tropicalis, C. glabrata, C. krusei and C. auris. Discussion: C. albicans is one of the common opportunistic fungal pathogen which causes mucocutaneous infections of genital and non-genital tracts of healthy individuals. It is a polymorphic yeast which exists in different morphologies which facilitates its survival under stress environments by forming biofilms. High prevalence of non albicans Candida sp. in this study indicates the importance of conducting epidemiological surveys to measure the occurrence of NAC. Multiplex PCR is a rapid and reliable method to identify the Candida sp. causing vulvovaginal candidiasis. Although fluconazole still appears to be effective against most of the Candida isolates, resistance rate of this drug to the Candida sp. emphasises the need for performing antifungal susceptibility testing and alternate drug therapy in the routine practice.