Distinct host immune responses in recurrent vulvovaginal candidiasis and vulvovaginal candidiasis

Abstract

Recurrent vulvovaginal candidiasis (RVVC) and vulvovaginal candidiasis (RVVC) are one of the most common gynecological infections, primarily caused by Candida species. Although risk factors of RVVC and VVC have been identified in many studies, antifungal immunological mechanisms are still not fully understood. We performed a 1-year prospective study in a local hospital to monitor 98 patients clinically diagnosed with gynecological Candida infection. The results showed that 20.41% (20/98) are with RVVC, and 79.59% (78/98) patients have VVC. C. albicans accounts for 90% and 96.1% of all strains isolated collected from RVVC and VVC patients, respectively. Antifungal susceptibility testing showed no significant difference in Candida species between RVVC and VVC patients. However, the serum levels of IFN-γ, TNF-α, and IL-17F in the RVVC group were significantly lower than those of the VVC group, while IL-4, IL-6, and IL-10 were higher in the RVVC patients than VVC patients. IL-17A and IL-2 levels were comparable between the two groups. Taken together, our results suggest that the host-immune responses, especially Th1/2 immunity, may play important roles in prognosis of RVVC and VVC.

Keywords: T helper cells (Th); anti-fungal susceptibility; host-immune responses; recurrent vulvovaginal candidiasis (RVVC); vulvovaginal candidiasis (VVC).

Figure 1

Flowchart of the study.

Figure 2

Age distribution of women with recurrent vulvovaginal candidiasis (RVVC) and vulvovaginal candidiasis (VVC).

Figure 3

The isolates from vaginal secretion were identified by ITS sequencing. The Candida spp. distributed in both Vulvovaginal candidiasis (VVC) patients and Recurrent vulvovaginal candidiasis (RVVC) patients (A), in VVC patients (B) and in RVVC patients (C).

Figure 4

The serum was collected from the VVC and RVVC patients before the initiation of treatment to analyze the cytokines in the serum by LEGENDplex™. (A-C) represent the serum level of IFN-γ, IL-2 and TNF-α (Th1 associated cytokines) of the patients with Recurrent vulvovaginal candidiasis (RVVC) and Vulvovaginal candidiasis (VVC), respectively. (D, E) represent the serum level of IL-4 and IL-10 (Th2 associated cytokines) of the patients with RVVC and VVC, respectively. (F-H) represent the serum level of IL-6, IL-17A and IL-17F (Th17 associated cytokines) of the patients with RVVC and VVC, respectively. Data are representative of three independent experiments. P value < 0.05 is regarded as a significant enrichment. Error bars represent SD, *p < 0.05, **p < 0.01, ***p < 0.001. ns, No significance.