Species-specific prevalence of vaginal candidiasis among patients with diabetes mellitus and its relation to their glycaemic status

Objectives: Non-C. albicans Candida species are increasingly being recognized as the cause of vulvo-vaginal candidiasis. These species are often less susceptible to antifungal agents. Patients with diabetes mellitus are at risk for vulvovaginal candidasis. We assessed the species-specific prevalence rate and risk of candidiasis in patients with diabetes mellitus and healthy controls. Methods: Genital tract examination, direct microscopy and fungal cultures of discharge collected by high vaginal swab were undertaken among 78 consecutive patients with diabetes mellitus (mean ( +/- SD) age 32 +/- 12 years and body mass index (BMI) 22.3 +/- 5.5 kg/m(2)) and 88 age- and BMI-matched healthy females. Glycaemic control in the diabetic cohort was assessed by measuring total glycosylated haemoglobin. Results: Candida species were isolated in 36 of 78 (46%) subjects with diabetes mellitus and in 21 of 88 (23%) healthy subjects (Chi-squared 9.11, P = 0.0025), The predominant Candida species isolated in diabetics with vulvo-vaginal candidiasis were Candida glabrata (39%), C. albicans (26%) and C, tropicalis (17%), In contrast, in the control group, C. albicans, C, glabrata and C. hemulonii comprised 30% each, with none having C. tropicalis infection (for C. tropicalis: diabetic vs, control; 17% vs. nil, P < 0.05). Among the diabetic group, subjects with vulvo-vaginal candidiasis had significantly higher mean HbA1 when compared to those who had no such infection (12.8 +/- 2.6% vs, 9.7 +/- 1.7% respectively, P = 0.001). The overall accuracy of direct microscopy and clinical examination for predicting vulvo-vaginal candidiasis was only 77% and 51%, respectively, in the diabetic group, and 83% and 65% in the control group. Conclusions: Patients with diabetes mellitus had a high prevalence rate (46%) of vul co-vaginal candidiasis with relative risk: of 2.45. The non-C. albicans species such as C, glabrata and C. tropicalis were the predominant species isolated among them. There seems to be a significant link between hyperglycaemia and vulvo-vaginal candidiasis. (C) 2000 The British Infection Society.