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. 2020 Nov 26:2020:7042490.
doi: 10.1155/2020/7042490. eCollection 2020.

Prevalence and Antifungal Susceptibility Profile of Clinically Relevant Candida Species in Postmenopausal Women with Diabetes

Sarah Al Halteet  1 , Ahmed Abdel-Hadi  2   3 , Mohamed Hassan  1   4 , Mohamed Awad  1   2
Affiliations

Prevalence and Antifungal Susceptibility Profile of Clinically Relevant Candida Species in Postmenopausal Women with Diabetes

Sarah Al Halteet et al. Biomed Res Int. .

Abstract

The incidence of diabetes mellitus has increased in Saudi Arabia, which has raised the risk of vulvovaginal candidiasis (VVC). This study highlights the prevalence and antifungal susceptibility of Candida species among postmenopausal women with diabetes with symptoms of VVC in Taif, a city in Saudi Arabia. Several diagnostic tools were used to differentiate the yeast isolates, including microscopic examination, culture morphology on CHROM agar, further confirmation with the VITEK 2 system, and ITS1 and ITS4 region sequencing. Antifungal susceptibility of the selected Candida species was determined using the VITEK 2 system (bioMérieux Inc., USA). Out of the 550 high vaginal swabs investigated, 86 specimens were Candida species positive (15.6%) with a significant difference according to age; the positivity in the 45-50 years' age group (12%) was higher than that in the 51-55 years' age group (3.6%). Candida albicans was the most common causative agent in 51 samples (59.3%), followed by C. glabrata in 21 samples (24.41%) and C. krusei in 14 samples (16.27%), with no significant differences between the age groups. Three isolates, including two C. albicans and one C. krusei, exhibited resistance against all the tested antifungal agents. CHROM agar and VITEK 2 were accurate phenotypic tools to identify Candida species with 100% sensitivity and specificity and were consistent with the phylogenetic characterization. The data emphasized the importance of identifying Candida species and their antifungal susceptibility among postmenopausal women with diabetes, highlighting the potential risk posed by diabetes in this age group.

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Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1
Appearance of yeast colonies on CHROM Agar Candida: (a) Candida albicans, (b) Saccharomyces cerevisiae, (c) Candida krusei, and (d) Candida glabrata.
Figure 2
Figure 2
Frequency of Candida albicans and nonalbicans Candida species isolated from postmenopausal women with diabetes with vulvovaginal candidiasis based on VITEK 2 characterization.
Figure 3
Figure 3
Neighbor-joining tree showing genetic diversity of Candida isolates based on the sequence analysis of the ITS region.
Figure 4
Figure 4
Antifungal susceptibility pattern of Candida species associated with postmenopausal women with diabetes (Candida albicans = 18; Candida glabrata = 4; Candida krusei = 2), where S = susceptible, I = intermediate, and R = resistance.
Figure 5
Figure 5
Flow diagram for the identification of Candida species associated with postmenopausal women with diabetes.
See this image and copyright information in PMC

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