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A High Rate of Recurrent Vulvovaginal Candidiasis and Therapeutic Failure of Azole Derivatives Among Iranian Women

Recurrent vulvovaginal candidiasis (RVVC) is one of the most prevalent fungal infections in humans, especially in developing countries; however, it is underestimated and regarded as an easy-to-treat condition. RVVC may be caused by dysbiosis of the microbiome and other host-, pathogen-, and antifung...

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Autores principales: Arastehfar, Amir, Kargar, Melika Laal, Mohammadi, Shahla Roudbar, Roudbary, Maryam, Ghods, Nayereh, Haghighi, Ladan, Daneshnia, Farnaz, Tavakoli, Mahin, Jafarzadeh, Jalal, Hedayati, Mohammad Taghi, Wang, Huiwei, Fang, Wenjie, Carvalho, Agostinho, Ilkit, Macit, Perlin, David S., Lass-Flörl, Cornelia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8113757/
https://www.ncbi.nlm.nih.gov/pubmed/33995315
http://dx.doi.org/10.3389/fmicb.2021.655069
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author Arastehfar, Amir
Kargar, Melika Laal
Mohammadi, Shahla Roudbar
Roudbary, Maryam
Ghods, Nayereh
Haghighi, Ladan
Daneshnia, Farnaz
Tavakoli, Mahin
Jafarzadeh, Jalal
Hedayati, Mohammad Taghi
Wang, Huiwei
Fang, Wenjie
Carvalho, Agostinho
Ilkit, Macit
Perlin, David S.
Lass-Flörl, Cornelia
author_facet Arastehfar, Amir
Kargar, Melika Laal
Mohammadi, Shahla Roudbar
Roudbary, Maryam
Ghods, Nayereh
Haghighi, Ladan
Daneshnia, Farnaz
Tavakoli, Mahin
Jafarzadeh, Jalal
Hedayati, Mohammad Taghi
Wang, Huiwei
Fang, Wenjie
Carvalho, Agostinho
Ilkit, Macit
Perlin, David S.
Lass-Flörl, Cornelia
author_sort Arastehfar, Amir
collection PubMed
description Recurrent vulvovaginal candidiasis (RVVC) is one of the most prevalent fungal infections in humans, especially in developing countries; however, it is underestimated and regarded as an easy-to-treat condition. RVVC may be caused by dysbiosis of the microbiome and other host-, pathogen-, and antifungal drug-related factors. Although multiple studies on host-related factors affecting the outcome have been conducted, such studies on Candida-derived factors and their association with RVVC are lacking. Thus, fluconazole-tolerant (FLZT) isolates may cause fluconazole therapeutic failure (FTF), but this concept has not been assessed in the context of Candida-associated vaginitis. Iran is among the countries with the highest burden of RVVC; however, comprehensive studies detailing the clinical and microbiological features of this complication are scarce. Therefore, we conducted a 1-year prospective study with the aim to determine the RVVC burden among women referred to a gynecology hospital in Tehran, the association of the previous exposure to clotrimazole and fluconazole with the emergence of FLZT and fluconazole-resistant (FLZR) Candida isolates, and the relevance of these phenotypes to FTF. The results indicated that about 53% of the patients (43/81) experienced RVVC. Candida albicans and C. glabrata constituted approximately 90% of the yeast isolates (72 patients). Except for one FLZT C. tropicalis isolate, FLZR and FLZT phenotypes were detected exclusively in patients with RVVC; among them, 27.9% (12/43) harbored FLZR strains. C. albicans constituted 81.2% of FLZR (13/16) and 100% of the FLZT (13/13) isolates, respectively, and both phenotypes were likely responsible for FTF, which was also observed among patients with RVVC infected with fluconazole-susceptible isolates. Thus, FTF could be due to host-, drug-, and pathogen-related characteristics. Our study indicates that FLZT and FLZR isolates may arise following the exposure to over-the-counter (OTC) topical azole (clotrimazole) and that both phenotypes can cause FTF. Therefore, the widespread use of OTC azoles can influence fluconazole therapeutic success, highlighting the necessity of controlling the use of weak topical antifungals among Iranian women.
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spelling pubmed-81137572021-05-13 A High Rate of Recurrent Vulvovaginal Candidiasis and Therapeutic Failure of Azole Derivatives Among Iranian Women Arastehfar, Amir Kargar, Melika Laal Mohammadi, Shahla Roudbar Roudbary, Maryam Ghods, Nayereh Haghighi, Ladan Daneshnia, Farnaz Tavakoli, Mahin Jafarzadeh, Jalal Hedayati, Mohammad Taghi Wang, Huiwei Fang, Wenjie Carvalho, Agostinho Ilkit, Macit Perlin, David S. Lass-Flörl, Cornelia Front Microbiol Microbiology Recurrent vulvovaginal candidiasis (RVVC) is one of the most prevalent fungal infections in humans, especially in developing countries; however, it is underestimated and regarded as an easy-to-treat condition. RVVC may be caused by dysbiosis of the microbiome and other host-, pathogen-, and antifungal drug-related factors. Although multiple studies on host-related factors affecting the outcome have been conducted, such studies on Candida-derived factors and their association with RVVC are lacking. Thus, fluconazole-tolerant (FLZT) isolates may cause fluconazole therapeutic failure (FTF), but this concept has not been assessed in the context of Candida-associated vaginitis. Iran is among the countries with the highest burden of RVVC; however, comprehensive studies detailing the clinical and microbiological features of this complication are scarce. Therefore, we conducted a 1-year prospective study with the aim to determine the RVVC burden among women referred to a gynecology hospital in Tehran, the association of the previous exposure to clotrimazole and fluconazole with the emergence of FLZT and fluconazole-resistant (FLZR) Candida isolates, and the relevance of these phenotypes to FTF. The results indicated that about 53% of the patients (43/81) experienced RVVC. Candida albicans and C. glabrata constituted approximately 90% of the yeast isolates (72 patients). Except for one FLZT C. tropicalis isolate, FLZR and FLZT phenotypes were detected exclusively in patients with RVVC; among them, 27.9% (12/43) harbored FLZR strains. C. albicans constituted 81.2% of FLZR (13/16) and 100% of the FLZT (13/13) isolates, respectively, and both phenotypes were likely responsible for FTF, which was also observed among patients with RVVC infected with fluconazole-susceptible isolates. Thus, FTF could be due to host-, drug-, and pathogen-related characteristics. Our study indicates that FLZT and FLZR isolates may arise following the exposure to over-the-counter (OTC) topical azole (clotrimazole) and that both phenotypes can cause FTF. Therefore, the widespread use of OTC azoles can influence fluconazole therapeutic success, highlighting the necessity of controlling the use of weak topical antifungals among Iranian women. Frontiers Media S.A. 2021-04-28 /pmc/articles/PMC8113757/ /pubmed/33995315 http://dx.doi.org/10.3389/fmicb.2021.655069 Text en Copyright © 2021 Arastehfar, Kargar, Mohammadi, Roudbary, Ghods, Haghighi, Daneshnia, Tavakoli, Jafarzadeh, Hedayati, Wang, Fang, Carvalho, Ilkit, Perlin and Lass-Flörl. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Microbiology
Arastehfar, Amir
Kargar, Melika Laal
Mohammadi, Shahla Roudbar
Roudbary, Maryam
Ghods, Nayereh
Haghighi, Ladan
Daneshnia, Farnaz
Tavakoli, Mahin
Jafarzadeh, Jalal
Hedayati, Mohammad Taghi
Wang, Huiwei
Fang, Wenjie
Carvalho, Agostinho
Ilkit, Macit
Perlin, David S.
Lass-Flörl, Cornelia
A High Rate of Recurrent Vulvovaginal Candidiasis and Therapeutic Failure of Azole Derivatives Among Iranian Women
title A High Rate of Recurrent Vulvovaginal Candidiasis and Therapeutic Failure of Azole Derivatives Among Iranian Women
title_full A High Rate of Recurrent Vulvovaginal Candidiasis and Therapeutic Failure of Azole Derivatives Among Iranian Women
title_fullStr A High Rate of Recurrent Vulvovaginal Candidiasis and Therapeutic Failure of Azole Derivatives Among Iranian Women
title_full_unstemmed A High Rate of Recurrent Vulvovaginal Candidiasis and Therapeutic Failure of Azole Derivatives Among Iranian Women
title_short A High Rate of Recurrent Vulvovaginal Candidiasis and Therapeutic Failure of Azole Derivatives Among Iranian Women
title_sort high rate of recurrent vulvovaginal candidiasis and therapeutic failure of azole derivatives among iranian women
topic Microbiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8113757/
https://www.ncbi.nlm.nih.gov/pubmed/33995315
http://dx.doi.org/10.3389/fmicb.2021.655069
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