MYCOTIC INFECTIONS OF THE VAGINA: VULVOVAGINAL CANDIDIASIS AS A CASE STUDY By AKINWALE, A.A

 MYCOTIC INFECTIONS OF THE VAGINA: VULVOVAGINAL CANDIDIASIS AS A CASE STUDY By AKINWALE, A.A

  Fungi make up nearly 7% (611,000 species) of the 8.7 million Eukaryotic species on Earth. A notable fungi of interest, Candida albicans, causes two major types of infections in humans. Vulvovaginal candidiasis (VVC) happens to be the second most documented form of infectious vaginitis. Candida albicans is a known inhabitant of the oral and vaginal mucosa as well as the GIT of man. Between 30-70% healthy individuals carry at least one Candida species commensally. It causes superficial infections such as oral or vaginal candidiasis, and grave systemic infections.

     Various studies have confirmed that over 70-80% of females will experience an episode of yeast infection at least once in their lifetime. Less than 15% of females however are very likely to experience recurring yeast infection caused by Candida albicans. In a research study carried out by a team of five students including myself, vaginal swab samples of 116 students from Obafemi Awolowo University, Ile Ife, Osun State were screened. 11.2% were infected with Vulvovaginal Candidiasis but were asymptomatic, while 9.6% were symptomatic and have the vagina infection. 

Many might ask, what are the risk factors of developing Vulvovaginal Candidiasis? A number of them include but are not limited to:

i.    Douching 

ii.   Habits such as smoking, staying in wet clothes for long periods, use of scented feminine products and certain diet, 

iii.  Sexual encounter with an infected person (oral-genital sex) 

iv.   Improper antibiotic use which could cause an imbalance in natural vaginal flora

v.    Pregnancy

vi.   Uncontrolled diabetes

vii.  Oral contraceptives and hormone therapy which increases estrogen levels and

viii. Immunocompromised immune system which predisposes persons with immune disorders like HIV/AIDS to VVC

In our study, we gave out questionnaires to all screened students to discover the how these risk factors affected outcomes. It was discovered that all infected persons (11.2%) engaged in at least two factors that increased their risk of developing yeast infection. 

  Candida albicans is the species most commonly implicated in mycotic vaginal infections in humans. Like all human commensals and pathogens, it requires iron as a necessary nutrient for growth. One of the key factors for its survival in its commensal microenvironment are the proteins found at the yeast cell surface. The ability of Candida albicans to infect a wide array of host niches is due to a wide range of virulence factors and fitness attributes. A number of characters including the morphological transition between yeast and hyphal forms, thigmotropism, the formation of biofilms, phenotypic switching and the secretion of hydrolytic enzymes are considered pathogens.

 

  Diagnosis of Candida is complicated because circulating antibodies to Candida species could be present in normal subjects as an outcome of commensal colonization of mucosal surfaces. Non-culture diagnostic methods, such as detection assays for antibody, antigen, and polymerase chain reaction, are recently introduced to clinical practice. Preventive strategies are far more effective than the Cure of Candida infections using antifungal agents. Lactobacillus brevis isolate could inhibit Candida albicans adhesion and biofilm formation on medical-grade silicone disks. Trypsin inhibitor from Tecoma stans (yellow elder) was recently investigated for anti-Candida activity.

 Fluconazole was found to be effective and safe in preventing oropharyngeal and vaginal candidiasis, but not in esophageal candidiasis. A minimum 2 weeks duration of therapy is recommended to eliminate the fungal infection from the blood stream (Schoch et al., 2012). The swab tip is inserted into the vagina and then rotated for 10-15 seconds. It is important to keep the swab stick sterile by not touching the surface or turning the tip downwards. After collection, the student washes her hands with soap and water, rinse, and dry.

 The basic culture media used in isolating clinical Candida species are blood agar, Potato Dextrose Agar (PDA) or broth (PDB) and Sabouraud brain heart infusion agar. Vaginal swab specimens must be transported to the laboratory in the swab tube provided. The Potato Dextrose Agar (PDA) is allowed to solidify for ten to fifteen minutes. 23g of Nutrient Agar was also weighed and dissolved in one liter of distilled water. All the activities were carried out close to the flame from the Bunsen burner.

 Yeasts can be characterized by observing their morphology. Microscopes can be used for fast identification and detection of possible yeasts in a clinical sample. Lactophenol cotton blue was used for better observation of yeast under the microscope. The distinct morphological features were observed such as budding yeast, hyphae, pseudohyphae and chlamydospores.