Isolation, molecular identification, and antifungal susceptibility profiles of vaginal isolates of Candida species

BACKGROUND AND OBJECTIVES: Vulvovaginal candidiasis is a common fungal infection among women during reproductive ages. Although, Candida albicans is accounted as the main etiologic agent of vaginitis, non-albicans species have arisen during last years. Resistant to antifungal drugs especially, fluconazole has been more reported by researchers from around the World. The aims of this study were to determine the prevalence of vulvovaginal candidiasis among suspected patients with vaginitis, the frequency of Candida species, and the susceptibility profiles of isolates to caspofungin, fluconazole and clotrimazole. MATERIALS AND METHODS: One hundred and twenty suspected women with vaginitis were examined by specialist physician and sampled using moisture swabs. Swabs were inoculated on CHROMagar Candida plates, incubated at 35°C and detected all isolated Candida species using morphological, microcopy and molecular methods. The antifungal susceptibility tests with caspofungin, fluconazole and clotrimazole were applied using microdilution and Resazurin dye methods against all isolated yeasts. RESULTS: The cultures were positive for 34(28.3%) samples and three Candida species including; C. albicans (88.2%), C. glabrata (8.8%) and C. kefyr (2.9%). Our study shows that only one isolate of C. albicans was resistant to caspofungin at the concentration of 2 μg/ml after 24h incubation that increased to 2 isolates after 48h incubation. All isolates were sensitive to fluconazole at the MIC ranges of 1-0.25 μg/ml, while 88.2% of them were inhibited at 0.25 μg/mL of clotrimazole. Candida albicans remains the most common agent of fungal vaginitis. CONCLUSION: Although all of Candida isolates were susceptible to fluconazole in vitro, it should be used with caution for empirical therapy due to more resistant rates in clinic. In addition, due to valuable sensitivity of all tested strains to caspofungin, it potentially can be presented as the first line therapy for Candida vaginitis.