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. 2021 Aug;40(8):1681-1693.
doi: 10.1007/s10096-021-04199-1. Epub 2021 Mar 13.

Vulvovaginal candidiasis and current perspectives: new risk factors and laboratory diagnosis by using MALDI TOF for identifying species in primary infection and recurrence

Lívia Custódio Pereira  1   2 , Amabel Fernandes Correia  3 , Zita Dinis Lopes da Silva  2 , Ceres Nunes de Resende  1 , Fabiana Brandão  2 , Rosane Mansan Almeida  2 , Yanna Karla de Medeiros Nóbrega  4
Affiliations

Vulvovaginal candidiasis and current perspectives: new risk factors and laboratory diagnosis by using MALDI TOF for identifying species in primary infection and recurrence

Lívia Custódio Pereira et al. Eur J Clin Microbiol Infect Dis. 2021 Aug.

Abstract

Vulvovaginal candidiasis (VVC), considered the second cause of genital infection among women, has pathogenic mechanisms still to be elucidated and unknown risk factors. Prevalence studies with laboratory diagnosis (at first diagnosis and recurrence) are uncommon, especially using MALDI TOF, used in this clinical, epidemiological, and laboratory study for evaluating candidiasis, and identifying unknown risk factors. To obtain clinical and epidemiological data, patients were questioned, and there was material collection. Samples collected were identified by using phenotypic and presumptive methods and confirmed by MALDI TOF. This study analyzed 278 patients, divided into symptomatic (n = 173) and asymptomatic (n = 105) groups. Regarding the main candidiasis symptoms (discharge, itching, and burning), only 50.3% of patients described these concomitant symptoms, showing a positive predictive value of 67.8%. Regarding the risk factors investigated, there was a statistical correlation between candidiasis and dairy products, gut transit, contraceptive use, respiratory allergy, and panty liners, describing new risk factors related to intestinal and vaginal dysbiosis. After Candida species analysis and confirmation, the primary prevalence was 80.9% (Candida albicans), 15.2% (non-albicans), 1% (Rhodotorula mucilaginosa), and 1.9% (unidentified species). In recurrence, the prevalence was 66.7% (C. albicans) and 33.3% (non-albicans). The presence of symptoms has low positive predictive value for the diagnosis of candidiasis, even when considering the classic triad of symptoms. Laboratory identification of yeast species is essential for correct treatment, preventing the resistance to antifungals and the high recurrence. In addition, dairy products and bowel habits, both related to intestinal and vaginal dysbiosis, may be associated with VVC.

Keywords: Candida; Candidiasis; Intestinal dysbiosis; Non-albicans; Recurrence; Vaginal dysbiosis; Vaginal vulvovaginitis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Venn diagram in symptomatic patients
Fig. 2
Fig. 2
a–h Analyzed risk factors of vulvovaginal candidiasis. Symptomatic patients showing positive laboratory diagnosis (VVC group) were compared with asymptomatic patients, with negative laboratory tests (control group)
Fig. 3
Fig. 3
Identification of yeasts species by MALDI TOF
Fig. 4
Fig. 4
Laboratory assessment of RVVC in symptomatic patients
See this image and copyright information in PMC

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