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OBJECTIVE: Vulvovaginal Candidiasis (VVC) is a prevalent genital infection in women of reproductive age and requires effective non-drug therapies. Therefore, this study aimed to investigate the effect of blue light emitting diode (LED) therapy as an alternative treatment for recurrent VVC due to its proven antimicrobial properties. The safety and non-invasiveness of LED therapy make it a promising option for sensitive tissue applications. MATERIALS AND METHODS: This randomized controlled trial recruited 60 women with culture-confirmed VVC. Participants were randomly allocated to two groups. Group A (control group) received standard antifungal treatment with Gynoconazol 0.8% vaginal cream for three consecutive nights (n = 30). Group B (study group) received the same antifungal treatment plus two 60-min sessions of blue LED therapy directed at the vagina and vulva, with the sessions separated by two days (n = 30). Candida count (via CHROMagar™ Candida) and vaginal pH (via AD110-AD111 m) were assessed at baseline and one week after initiating treatment. RESULTS: Post-treatment, group (B) demonstrated a significantly greater reduction in Candida count compared to group (A) (mean difference (MD) 8.267; 95% Confidence Interval (CI) 6.723-9.811; p = 0.0001). However, there was no statistically significant difference in vaginal pH between the groups (MD -0.03; 95% CI -0.244-0.178; p = 0.749). CONCLUSION: Blue LED therapy effectively reduces Candida count in women with recurrent VVC without adversely affecting the vaginal pH, highlighting its safety and efficacy as a treatment modality.
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Candidiasis Vulvovaginal , Humanos , Femenino , Candidiasis Vulvovaginal/terapia , Candidiasis Vulvovaginal/tratamiento farmacológico , Adulto , Fototerapia/métodos , Antifúngicos/uso terapéutico , Recurrencia , Adulto Joven , Método Simple Ciego , Resultado del Tratamiento , Luz AzulRESUMEN
BACKGROUND: Saccharomyces cerevisiae has been considered a harmless yeast, but in recent years, increasing evidence has shown that it can cause disease in humans, especially invasive infections in infants/children and vulvovaginal infections in women. This study aimed to investigate the clinical information and antifungal susceptibility of clinical cases with S. cerevisiae and establish a foundation for the prevention and treatment of fungal infections. METHODS: This study was conducted from May 2018 to May 2023 at a national regional medical center in Southwest China for women and children. The demographic and clinical characteristics of patients isolated with S. cerevisiae were collected and analyzed. All the isolates were cultured on Sabouraud medium plates and identified by MALDI-TOF MS. The antifungal susceptibility of S. cerevisiae to 10 agents (amphotericin B, fluconazole, itraconazole, voriconazole, micafungin, caspofungin, terbinafine and 5-flucytosine) was determined via the microdilution broth method to determine the minimum inhibitory concentrations (MICs). RESULTS: A total of 75 cases of S. cerevisiae isolated from patients with vulvovaginal candidiasis (VVC, 44 cases), pneumonia (13 cases), or diarrhea (18 cases) were included after data review. The MICs of voriconazole and flucytosine for S. cerevisiae isolated from different body sites differed, with higher resistance in intestinal isolates. In this study, S. cerevisiae caused VVC, but there was no clear evidence that it was involved in pneumonia or diarrhea. Compared with those of Candida albicans, the primary pathogen of VVC, the MICs of fluconazole (11.96 ± 5.78 µg/mL vs. 67.64 ± 16.62 µg/mL, p = 0.002), itraconazole (0.77 ± 0.19 µg/mL vs. 2.31 ± 0.53 µg/mL, p = 0.008), voriconazole (0.22 ± 0.09 µg/mL vs. 5.02 ± 1.09 µg/mL, p < 0.001), and terbinafine (10.41 ± 0.84 µg/mL vs. 14.93 ± 4.77 µg/mL, p < 0.001) for S. cerevisiae (isolated from the genital tract) were significantly lower, while those of micafungin (0.14 ± 0.01 µg/mL vs. 0.06 ± 0.01 µg/mL, p < 0.001) and caspofungin (0.27 ± 0.04 µg/mL vs. 0.06 ± 0.01 µg/mL, p < 0.001) were significantly greater. CONCLUSION: Azoles remain the recommended regimen for S. cerevisiae-related VVC, and the use of amphotericin B vaginal effervescent tablets could be considered for the treatment of azole-resistant isolates. The antifungal susceptibility of S. cerevisiae varies according to the isolated source, and the pathogenicity trend of S. cerevisiae should be studied.
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Antifúngicos , Pruebas de Sensibilidad Microbiana , Saccharomyces cerevisiae , Antifúngicos/farmacología , Humanos , Femenino , China , Saccharomyces cerevisiae/efectos de los fármacos , Saccharomyces cerevisiae/aislamiento & purificación , Niño , Preescolar , Lactante , Adulto , Candidiasis Vulvovaginal/microbiología , Masculino , Adolescente , Farmacorresistencia Fúngica , Persona de Mediana Edad , Adulto Joven , Micosis/microbiologíaRESUMEN
The immunopathogenesis of recurrent vulvovaginal candidiasis (RVVC) is poorly understood. Recently, it was reported that patients with RVVC present a decrease in both the fungicidal capacity of neutrophils and the proliferative capability of peripheral blood mononuclear cells in response to Candida albicans infection, suggesting an alteration in the innate and adaptive immune response. The aim of this study was to determine the in-situ expression, in the vaginal mucosa, of genes associated with the immune response, as well as the serum concentrations of dectin-1, mannose-binding lectin (MBL), and vitamin D in patients with RVVC. A study was carried out on 40 patients with a diagnosis of RVVC and 26 healthy women. Vaginal scrapings were obtained, and the expression of genes that encode cytokines and transcription factors specific for Th1, Th2, Th17, Treg, pro-inflammatory profiles, and enzymes related to oxidative/microbicidal mechanisms was evaluated by quantitiative polymerase chain reaction (qPCR). Additionally, serum levels of vitamin D and the soluble receptors dectin-1 and MBL were determined by enzyme-linked immunosorbent assay (ELISA). In patients with RVVC, a decreased expression of T-bet, RORγ-T, IL-1ß, and IL-17, and an increase in the expression of FOXP3, IL-4, IL-8, IL-10, and IL-18 were observed when compared to healthy women: moreover, decreased levels of MBL were also observed in these patients. These results confirm that patients with RVVC present in-situ alterations in both the specific and adaptive immune response against Candida spp., a fact that could be associated with the exaggerated vaginal inflammatory response.
The study concerns the immune response of women with recurrent vulvovaginal candidiasis; we observed an alteration in the expression of genes that participate in the control of infection, a fact that could be associated with the exaggerated vaginal inflammatory response observed in those patients.
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Candidiasis Vulvovaginal , Citocinas , Lectinas Tipo C , Vagina , Vitamina D , Humanos , Candidiasis Vulvovaginal/inmunología , Candidiasis Vulvovaginal/microbiología , Femenino , Lectinas Tipo C/genética , Adulto , Citocinas/sangre , Vagina/microbiología , Vagina/inmunología , Vitamina D/sangre , Adulto Joven , Recurrencia , Lectina de Unión a Manosa/sangre , Lectina de Unión a Manosa/genética , Membrana Mucosa/inmunología , Membrana Mucosa/microbiología , Candida albicans/inmunologíaRESUMEN
Candida species are common human pathogens that cause a wide range of diseases ranging from superficial to invasive candidiasis. However, basic studies focusing on the mechanisms underlying these diseases are limited. This article reviews our previous research on the mechanisms of superficial and invasive candidiasis, the virulence of Candida species, and Candida species fitness to hosts. Regarding invasive candidiasis, we focused on two types of infections: ocular candidiasis and endogenous candidiasis from the gastrointestinal tract. Using an established ocular candidiasis mouse model, along with retrospective epidemiological research, we found a strong association between Candida albicans and ocular candidiasis. Regarding endogenous candidiasis, research using Candida auris indicated that invasive strains had a higher capability for gastrointestinal tract colonization and showed greater dissemination compared with non-invasive strains. In terms of superficial candidiasis, we focused on the defense mechanism in vulvovaginal candidiasis. The results suggested that stimulated invariant natural killer T cells played a protective role against C. albicans vaginal infection and might be a therapeutic target for vulvovaginal candidiasis. Concerning Candida species fitness, we focused on environmental factors, particularly oxygen concentration, and evaluated biofilm formation under various oxygen concentrations, revealing that each Candida species favored different oxygen concentrations. In particular, Candida tropicalis showed greater biofilm formation under hypoxic conditions. Our research revealed several insights for understanding the exact mechanisms of candidiasis, which might lead to better control of Candida species infections and appropriate treatment.
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Biopelículas , Candida , Candidiasis , Modelos Animales de Enfermedad , Animales , Ratones , Candida/patogenicidad , Candidiasis/microbiología , Humanos , Biopelículas/crecimiento & desarrollo , Virulencia , Femenino , Candidiasis Vulvovaginal/microbiología , Infecciones Fúngicas del Ojo/microbiología , Candida albicans/patogenicidad , Candidiasis Invasiva/microbiologíaRESUMEN
Significant increases in rates of sexually transmitted infections (STIs) caused by Trichomonas vaginalis (TV), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG) are occurring in the United States. We present results of a U.S. study examining the intersection of STIs and vaginitis. Among 1,051 women with diagnoses for the presence or absence of bacterial vaginosis (BV) and/or symptomatic vulvovaginal candidiasis (VVC), 195 (18.5%) had one or more STIs, including 101 (9.6%) with TV, 24 (2.3%) with CT, 9 (0.8%) with NG, and 93 (8.8%) with MG. STI prevalence in BV-positive women was 26.3% (136/518), significantly higher than STI prevalence of 12.5% (59/474) in BV-negative women (P < 0.0002). Unlike infections with CT or NG, solo infections of MG or TV were each significantly associated with a diagnosis of BV-positive/VVC-negative (OR 3.0751; 95% CI 1.5797-5.9858, P = 0.0113, and OR 2.873; 95% CI 1.5687-5.2619, P = 0.0017, respectively) and with mixed infections containing MG and TV (OR 3.4886; 95% CI 1.8901-6.439, P = 0.0042, and OR 3.1858; 95% CI 1.809-5.6103, P = 0.0014, respectively). TV and MG infection rates were higher in all Nugent score (NS) categories than CT and NG infection rates; however, both STIs had similar comparative prevalence ratios to CT in NS 6-10 vs NS 0-5 (CT: 3.06% vs 1.4%, 2.2-fold; MG: 10.7% vs 6.1%, 1.8-fold; TV: 14.5% vs 7.0%, 2.1-fold). NG prevalence was relatively invariant by the NS category. These results highlight the complexity of associations of STIs with two major causes of vaginitis and underscore the importance of STI testing in women seeking care for abnormal vaginal discharge and inflammation. IMPORTANCE: This study reports high rates for sexually transmitted infections (STIs) in women seeking care for symptoms of vaginitis and bacterial vaginosis, revealing highly complex associations of STIs with two of the major causes of vaginal dysbiosis. These results underscore the importance of STI testing in women seeking care for abnormal vaginal discharge and inflammation.
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Técnicas de Amplificación de Ácido Nucleico , Enfermedades de Transmisión Sexual , Humanos , Femenino , Estados Unidos/epidemiología , Adulto , Adulto Joven , Prevalencia , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/microbiología , Técnicas de Amplificación de Ácido Nucleico/métodos , Adolescente , Persona de Mediana Edad , Mycoplasma genitalium/genética , Mycoplasma genitalium/aislamiento & purificación , Vaginitis/epidemiología , Vaginitis/microbiología , Trichomonas vaginalis/genética , Trichomonas vaginalis/aislamiento & purificación , Vaginosis Bacteriana/epidemiología , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/microbiología , Chlamydia trachomatis/genética , Chlamydia trachomatis/aislamiento & purificación , Candidiasis Vulvovaginal/epidemiología , Candidiasis Vulvovaginal/diagnóstico , Candidiasis Vulvovaginal/microbiología , Infecciones por Mycoplasma/epidemiología , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/microbiología , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/aislamiento & purificaciónRESUMEN
Excessive local accumulation of reactive oxygen species (ROS) in vulvovaginal candidiasis (VVC) leads to oxidative stress and aggravates inflammation. This study aimed to optimize and synthesize four ROS-sensitive polyethylene glycol (PEG)-boride polymers (PB, PCB, BPB, and BCPCB). A nanomicelle (BCPCB-K) was constructed using BCPCB-encapsulated ketoconazole (KTZ). Finally, the depolymerization principle and ROS-sensitive drug release of BCPCB-K as well as its anti-Candida albicans (CA) and therapeutic effects on mice with VVC were explored through in vitro and in vivo experiments. BCPCB-K exhibited low toxicity to mammalian cells in vitro and good biocompatibility in vivo. It also improved the dispersion and solubility of the hydrophobic drug KTZ. Furthermore, BCPCB-K simultaneously scavenged ROS and released the drug, thus facilitating the antifungal and VVC-treating effects of KTZ. Overall, the findings of this study broadened the application of ROS-sensitive materials in the drug-loading and antifungal fields and provided a strategy for VVC treatment.
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Antifúngicos , Candida albicans , Candidiasis Vulvovaginal , Cetoconazol , Pruebas de Sensibilidad Microbiana , Especies Reactivas de Oxígeno , Candida albicans/efectos de los fármacos , Antifúngicos/farmacología , Antifúngicos/química , Especies Reactivas de Oxígeno/metabolismo , Candidiasis Vulvovaginal/tratamiento farmacológico , Candidiasis Vulvovaginal/microbiología , Cetoconazol/farmacología , Cetoconazol/administración & dosificación , Femenino , Animales , Ratones , Micelas , Nanopartículas/química , Humanos , Liberación de Fármacos , Polietilenglicoles/química , Polietilenglicoles/farmacología , Tamaño de la PartículaRESUMEN
Introduction: Candida species, opportunistic yeast, are the second most common cause of female vulvovaginal candidiasis. This study aimed to evaluate the antifungal susceptibility profile of the isolated Candida species in pregnant women in Hajjah governorate, Yemen. Methods: A hospital-based cross-sectional study was conducted among 396 pregnant women attending Authority AL-Gumhorri Hospital Hajjah between February and July 2023. Vaginal swabs were collected, and Candida species were isolated and identified based on the standard laboratory method. Furthermore, the antifungal drug susceptibility of Candida species was determined by the Kirby-Bauer technique. Results and discussion: The prevalence of vaginal Candida infection among pregnant women was 61.4%. Candida albicans was the most predominant species (59.26%), followed by Candida krusei(13.58%), Candida Tropicalis (11.12%), Candida Grabata (9.87%), and Candida dubliniensis (6.17%). The highest rate of Candida infections was among women aged 24-30 years (71.9%) who finished primary school (77.8%), with the third trimester (80%), multigravida (66.1%), and recurrent infection (67.7%) showing significant differences (P < 0.05). The Candida albicans isolates were resistant to clotrimazole and itraconazole at 34.7% and 23.6%, respectively.In addition, the resistance of Candida krusei, Candida tropicalis, Candida glabrata, and Candida dublinensis isolates to fluconazole, voriconazole, voriconazole, and nystatin was 57.6%, 63%, 43.8%, and 60%, respectively. Additionally, approximately 46.2% of isolated Candida albicans exhibited one kind of antifungal drug resistance, whereas 38.7% of isolated non-albicans exhibited resistance to three different antifungal agents. According to the above findings, Candida infection is highly prevalent in Yemen and quite widespread. Interventions in health education are advised to increase women's knowledge of vaginitis and its prevention. The antifungal susceptibility test may also be helpful in determining the best medication for each patient.
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Antifúngicos , Candida , Candidiasis Vulvovaginal , Pruebas de Sensibilidad Microbiana , Humanos , Femenino , Candida/efectos de los fármacos , Candida/aislamiento & purificación , Candida/clasificación , Antifúngicos/farmacología , Embarazo , Adulto , Estudios Transversales , Adulto Joven , Candidiasis Vulvovaginal/microbiología , Candidiasis Vulvovaginal/epidemiología , Yemen/epidemiología , Prevalencia , Farmacorresistencia Fúngica , Complicaciones Infecciosas del Embarazo/microbiología , Complicaciones Infecciosas del Embarazo/epidemiología , Adolescente , Vagina/microbiologíaRESUMEN
Vulvovaginal candidiasis (VVC) alters the innate cervicovaginal immunity, which provides an important barrier against viruses and other infections. The incidence of this disease has not decreased in the last 30 years, so effective treatments are still needed. Nanoparticles (NPs) of cellulose acetate phthalate (CAP) and clotrimazole (CLZ) were prepared by the emulsification-diffusion method. NPs were characterized using dynamic light scattering, atomic force microscopy and differential scanning calorimetry; their release profile was determined by the dialysis bag technique and mucoadhesion was evaluated with the mucin-particle method. The growth inhibition study of Candida albicans was carried out using the plate counting technique. Finally, accelerated physical stability tests of NPs were carried out, both in water and in SVF. The CAP-CLZ NPs had an average diameter of 273.4 nm, a PDI of 0.284, smooth surfaces and spherical shapes. In vitro release of CLZ from the CAP NPs was categorized with the Weibull model as a matrix system in which initial release was rapid and subsequently sustained. The inhibition of C. albicans growth by the CAP-CLZ NPs was greater than that of free CLZ, and the CAP-only NPs had a microbicidal effect on C. albicans. The NPs showed poor mucoadhesiveness, which could lead to studies of their mucopenetration capacities. An accelerated physical stability test revealed the erosion of CAP in aqueous media. A nanoparticulate system was developed and provided sustained release of CLZ, and it combined an antifungal agent with a microbial polymer that exhibited antifungal activity against C. albicans.
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Antifúngicos , Candida albicans , Candidiasis Vulvovaginal , Celulosa , Clotrimazol , Nanopartículas , Clotrimazol/administración & dosificación , Clotrimazol/farmacología , Candidiasis Vulvovaginal/tratamiento farmacológico , Nanopartículas/química , Candida albicans/efectos de los fármacos , Femenino , Celulosa/química , Celulosa/análogos & derivados , Antifúngicos/farmacología , Antifúngicos/administración & dosificación , Polímeros/química , Tamaño de la Partícula , Pruebas de Sensibilidad Microbiana/métodos , Liberación de FármacosRESUMEN
Vulvovaginal candidiasis (VVC) is characterized as a very common fungal infection that significantly affects women's health worldwide. Essential oils (EOs) are currently being evaluated as an alternative therapy. The development of efficient techniques such as micro- or nanoencapsulation for protecting and controlling release is essential to overcome the limitations of EO applications. Therefore, the aim of this study was to develop and characterize oregano EO-loaded keratin microparticles (OEO-KMPs) as a potential treatment for VVC. OEO-KMPs were produced using high-intensity ultrasonic cycles and characterized in terms of morphological and physicochemical parameters. In vitro evaluation included assessing the toxicity of the OEO-KMPs and their effect against Candida albicans using microdilution and agar diffusion, while the activity against biofilm was quantified using colony forming units (CFU). The efficacy of the OEO-KMPs in an in vivo VVC mouse model was also studied. Female BALB/c mice were intravaginally infected with C. albicans, 24 h postinfection animals were treated intravaginally with 15 µL of OEO-KMPs and 24 h later vaginal fluid was analyzed for C. albicans and Lactobacillus growth (CFU mL-1). The results showed the stability of the OEO-KMPs over time, with high encapsulation efficiency and controlled release. This nanoparticle size facilitated penetration and completely inhibited the planktonic growth of C. albicans. In addition, an in vitro application of 2.5% of the OEO-KMPs eradicated mature C. albicans biofilms while preserving Lactobacillus species. In in vivo, a single intravaginal application of OEO-KMPs induced a reduction in C. albicans growth, while maintaining Lactobacillus species. In conclusion, this therapeutic approach with OEO-KMPs is promising as a potential alternative or complementary therapy for VVC while preserving vaginal microflora.
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Antifúngicos , Candida albicans , Candidiasis Vulvovaginal , Ratones Endogámicos BALB C , Aceites Volátiles , Origanum , Candida albicans/efectos de los fármacos , Candida albicans/fisiología , Animales , Femenino , Aceites Volátiles/química , Aceites Volátiles/farmacología , Candidiasis Vulvovaginal/tratamiento farmacológico , Candidiasis Vulvovaginal/microbiología , Ratones , Antifúngicos/farmacología , Antifúngicos/química , Origanum/química , Biopelículas/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , HumanosRESUMEN
Natural polyphenols are promising alternatives to antifungals for novel treatments of vulvovaginal candidiasis (VVC) in an era of antimicrobial resistance. However, polyphenols are poorly soluble and prone to degradation. To overcome their limitations, we propose incorporation in liposomes. The study aimed to develop chitosan and liposome comprising delivery systems for epicatechin (EC) or propyl gallate (PG) as treatment of VVC. EC was selected for its antioxidative properties and PG as an ester of antifungal gallic acid. To improve formulation retention at vaginal site, mucoadhesive chitosan was introduced into formulation as liposomal surface coating or hydrogel due to intrinsic antifungal properties. These polyphenol-loaded liposomes exhibited an average size of 125 nm with a 64 % entrapment efficiency (for both polyphenols). A sustained in vitro polyphenol release was seen from liposomes, particularly in chitosan hydrogel (p < 0.01 or lower). Viscosity was evaluated since increased viscosity upon mucin contact indicated adhesive bond formation between chitosan and mucin confirming mucoadhesiveness of formulations. Antifungal activity was evaluated by the broth microdilution method on Candida albicans CRM-10231. Unlike PG, incorporation of EC in liposomes enabled antifungal activity. Fungicidal activity of chitosan was confirmed both when used as liposomal coating material and as hydrogel vehicle.
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Antifúngicos , Candida albicans , Candidiasis Vulvovaginal , Catequina , Quitosano , Liposomas , Galato de Propilo , Quitosano/química , Quitosano/administración & dosificación , Antifúngicos/administración & dosificación , Antifúngicos/farmacología , Antifúngicos/química , Candidiasis Vulvovaginal/tratamiento farmacológico , Femenino , Candida albicans/efectos de los fármacos , Catequina/análogos & derivados , Catequina/administración & dosificación , Catequina/química , Catequina/farmacología , Galato de Propilo/administración & dosificación , Galato de Propilo/química , Sistemas de Liberación de Medicamentos , Liberación de Fármacos , Hidrogeles/química , Hidrogeles/administración & dosificación , Mucinas/química , Viscosidad , Pruebas de Sensibilidad MicrobianaRESUMEN
PROBLEM: Vulvovaginal candidiasis (VVC) is a common mucosal fungal infection, and Candida albicans is the main causative agent. The NLRP3 inflammasome plays an important role in VVC, but the underlying mechanism is unknown. METHOD OF STUDY: Vaginal epithelial cells were divided into three groups: control, C. albicans strain SC5314 (wild-type, WT), and WT+ Matt Cooper Compound 950 (MCC950, a specific NLRP3 inhibitor). After human vaginal epithelial cells were pretreated with 1 µmol/L MCC950 for 2 h, C. albicans (MOI = 1) was cocultured with the human vaginal epithelial cells for 12 h. The cell supernatants were collected, LDH was detected, and the IL-1ß and IL-18 levels were determined by ELISA. The expression of the pyroptosis-related proteins NLRP3, Caspase-1 p20 and GSDMD was measured by Western blotting analysis. The protein expression of the pyroptosis-related N-terminus of GSDMD (GSDMD-N) was detected by immunofluorescence. RESULTS: In this study, we showed that the WT C. albicans strain induced pyroptosis in vaginal epithelial cells, as indicated by the LDH and proinflammatory cytokine levels and the upregulated levels of the pyroptosis-related proteins NLRP3, Caspase-1 p20, and GSDMD-N. MCC950 reversed the changes in the expression of these proteins and proinflammatory cytokines in vaginal epithelial cells. CONCLUSION: C. albicans activated the NLRP3 inflammasome to induce vaginal epithelial cell pyroptosis. MCC950 inhibited the NLRP3 inflammasome, reduced vaginal epithelial cell pyroptosis, and decreased the release of inflammatory cytokines.
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Candida albicans , Candidiasis Vulvovaginal , Células Epiteliales , Inflamasomas , Proteína con Dominio Pirina 3 de la Familia NLR , Piroptosis , Vagina , Femenino , Humanos , Proteína con Dominio Pirina 3 de la Familia NLR/metabolismo , Candidiasis Vulvovaginal/inmunología , Candidiasis Vulvovaginal/microbiología , Candidiasis Vulvovaginal/metabolismo , Células Epiteliales/inmunología , Células Epiteliales/metabolismo , Inflamasomas/metabolismo , Inflamasomas/inmunología , Candida albicans/inmunología , Vagina/microbiología , Vagina/inmunología , Vagina/patología , Interleucina-18/metabolismo , Interleucina-1beta/metabolismo , Indenos , Furanos/farmacología , Caspasa 1/metabolismo , Compuestos Heterocíclicos de 4 o más Anillos/farmacología , Proteínas de Unión a Fosfato/metabolismo , Células Cultivadas , SulfonamidasAsunto(s)
Antifúngicos , Candidiasis Vulvovaginal , Candidiasis Vulvovaginal/diagnóstico , Candidiasis Vulvovaginal/tratamiento farmacológico , Candidiasis Vulvovaginal/microbiología , Humanos , Femenino , Antifúngicos/uso terapéutico , Antifúngicos/administración & dosificación , Candida albicans/aislamiento & purificación , China , Candida/aislamiento & purificación , Candida/efectos de los fármacosRESUMEN
BACKGROUND: Vulvovaginal candidiasis is a common fungal infection that affects the female lower genital tract. This study determined the major risk factors associated with vulvovaginal infection (VVI) in the Ashanti region of Ghana and also determined the antifungal resistance patterns of Candida albicans isolates to some antifungals. METHODS: Three hundred and fifty (350) high vaginal swab (HVS) samples were collected from women who presented with signs and symptoms of VVI. A structured questionnaire was administered to one hundred and seventy-two (172) of the women. HVS samples were cultured on Sabouraud dextrose agar with 2% chloramphenicol. The polymerase chain reaction was employed to confirm C. albicans. Antifungal susceptibility testing was performed and the susceptibility of C. albicans isolates to fluconazole, clotrimazole, amphotericin B, nystatin, miconazole and 5-flurocytosine were assessed. RESULTS: Vaginal infection was most prevalent amongst females in their reproductive age (21 to 30 years; 63.0%). The study found a significant association between vaginal infections and some risk factors such as sexual practices (p < 0.001), antibiotic misuse (p < 0.05), poor personal hygiene (p < 0.005) and birth control methods (p < 0.049). Out of the 350 HVS samples collected, 112 yielded yeast cells with 65 (58%) identified as C. albicans. The C. albicans isolates were resistant to 5' flucytosine (100%), fluconazole (70%), voriconazole (69.2%), miconazole (58.5%) and nystatin (49.2%). C. albicans isolates were more susceptible to amphotericin B (53.8%) and clotrimazole (45.1%), although an appreciable number of isolates showed resistance (46.1% and 52.3%, respectively). CONCLUSION: There should be nationwide education on all associated risk factors of VVI. Also, use of the various antifungal agents in vaginal candidiasis should proceed after antifungal susceptibility testing to ensure efficacious use of these agents.
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Antifúngicos , Candida albicans , Candidiasis Vulvovaginal , Farmacorresistencia Fúngica , Pruebas de Sensibilidad Microbiana , Humanos , Femenino , Candidiasis Vulvovaginal/microbiología , Candidiasis Vulvovaginal/epidemiología , Candidiasis Vulvovaginal/tratamiento farmacológico , Ghana/epidemiología , Candida albicans/aislamiento & purificación , Candida albicans/efectos de los fármacos , Adulto , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Adulto Joven , Factores de Riesgo , Adolescente , Vagina/microbiología , Recurrencia , Centros de Atención Terciaria/estadística & datos numéricos , Anfotericina B/uso terapéutico , Anfotericina B/farmacología , Persona de Mediana EdadRESUMEN
This article summarizes the situation with public health threats for primary care patients as of early 2024 and provides updates on strategies for the prevention, diagnosis, and treatment of common infections where new treatments and vaccines are available. For flu and COVID, an update on treatment is also provided-along with pearls useful for the busy primary care provider. The authors also discuss a new treatment option for drug-resistant vulvovaginal candidiasis and provide a balanced view of the increasingly popular technique of preventing bacterial sexually transmitted infections using doxycycline after condomless sex among men who have sex with men.
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Atención Primaria de Salud , Humanos , COVID-19/epidemiología , COVID-19/prevención & control , Femenino , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/prevención & control , Enfermedades de Transmisión Sexual/terapia , Masculino , Candidiasis Vulvovaginal/tratamiento farmacológico , Candidiasis Vulvovaginal/diagnóstico , Gripe Humana/epidemiología , Gripe Humana/prevención & control , SARS-CoV-2 , Enfermedades Transmisibles/epidemiología , Enfermedades Transmisibles/tratamiento farmacológicoRESUMEN
AIMS: To examine whether vulvovaginal candidiasis (VVC) precedes type 2 diabetes and to quantify the possible time period between VVC and subsequent diabetes. MATERIAL AND METHODS: We conducted a nationwide retrospective primary healthcare study including 1 838 929 women aged 35-65 years in Sweden (2007-2018). Cox regression models were used to examine associations between VVC and type 2 diabetes, while controlling for possible confounders. Propensity-score-weighted analysis was also conducted. RESULTS: The incidence rate of diabetes per 1000 person-years was 3.06 (95% confidence interval [CI] 3.05-3.08) in women without preceding VVC and 4.05 (95% CI 3.86-4.24) in women with preceding VVC. The incidence rate was particularly high in women aged 55 years and older with VVC: 9.56 (95% CI 8.01-11.11). Women with VVC had a hazard ratio (HR) of 1.41 (95% CI 1.28-1.55) for diabetes compared to women without VVC in the multivariable-adjusted model. The corresponding HR was 1.63 (95% CI 1.53-1.74) in propensity-score-weighted analysis. Women with prior VVC also seemed to have a stronger risk of diabetes with older age, particularly after the age of 55 years. The mean (range) time between VVC and subsequent diabetes was 0.57 (0-2) years, depending on the age of the woman. CONCLUSION: We found temporal associations between VVC and diabetes. The findings demonstrate that the presence of VVC may indicate a future diagnosis of diabetes, especially in women aged 55 years and older. This knowledge could be valuable for clinicians when treating women with VVC.
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Candidiasis Vulvovaginal , Diabetes Mellitus Tipo 2 , Humanos , Femenino , Persona de Mediana Edad , Candidiasis Vulvovaginal/epidemiología , Candidiasis Vulvovaginal/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Estudios Retrospectivos , Adulto , Suecia/epidemiología , Anciano , Incidencia , Factores de Riesgo , Estudios de CohortesRESUMEN
This study aimed to investigate the protective effect and its underlying mechanism of n-butanol extract of Pulsatilla Decoction(BEPD) containing medicinal serum on vaginal epithelial cells under Candida glabrata stimulation via the epidermal growth factor receptor/mitogen activated protein kinase( EGFR/MAPK) pathway based on transcriptomics. A vulvovaginal candidiasis(VVC) mouse model was established first and transcriptome sequencing was performed for the vaginal mucosa tissues to analyze the gene expression differences among the control, VVC model, and BEPD intervention groups. Simultaneously, BEPD-containing serum and fluconazole-containing serum were prepared. A431 cells were divided into the control, model, blank serum, fluconazole-containing serum, BEPD-containing serum, EGFR agonist and EGFR inhibitor groups. Additionally, in vitro experiments were conducted using BEPD-containing serum, fluconazole-containing serum, and an EGFR agonist and inhibitor to investigate the intervention mechanisms of BEPD on C. glabrata-induced vaginal epithelial cell damage. Cell counting kit-8(CCK-8) assay was utilized to determine the safe concentrations of C. glabrata, drug-containing serum, and compounds on A431 cells. Enzyme-linked immunosorbent assay(ELISA)was employed to measure the expression levels of interleukin(IL)-1ß, IL-6, granulocyte-macrophage colony-stimulating factor(GMCSF), granulocyte CSF(G-CSF), chemokine(C-X-C motif) ligand 20(CCL20), and lactate dehydrogenase(LDH). Gram staining was used to evaluate the adhesion of C. glabrata to vaginal epithelial cells. Flow cytometry was utilized to assess the effect of C.glabrata on A431 cell apoptosis. Based on the transcriptomics results, immunofluorescence was performed to measure the expressions of p-EGFR and p-ERK1/2 proteins, while Western blot validated the expressions of p-EGFR, p-ERK1/2, p-C-Fos, p-P38, Bax and Bcl-2 proteins. Sequencing results showed that compared with the VVC model, BEPD treatment up-regulated 1 075 genes and downregulated 927 genes, mainly enriched in immune-inflammatory pathways, including MAPK. Mechanistically, BEPD significantly reduced the expression of p-EGFR, p-ERK1/2, p-C-Fos and p-P38, as well as the secretion of IL-1ß, IL-6, GM-CSF, G-CSF and CCL20, LDH release induced by C. glabrata, and the adhesion of C. glabrata to A431 cells, suggesting that BEPD exerts a protective effect on vaginal epithelial cells damaged by C. glabrata infection by modulating the EGFR/MAPK axis. In addition, BEPD downregulated the pro-apoptotic protein Bax expression and up-regulated the anti-apoptotic protein Bcl-2 expression, leading to a reduction in C. glabrata-induced cell apoptosis. In conclusion, this study reveals that the intervention of BEPD in C. glabrata-induced VVC may be attributed to its regulation of the EGFR/MAPK pathway, which protects vaginal epithelial cells.
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Candida albicans , Células Epiteliales , Receptores ErbB , Pulsatilla , Vagina , Femenino , Receptores ErbB/genética , Receptores ErbB/metabolismo , Células Epiteliales/efectos de los fármacos , Células Epiteliales/metabolismo , Vagina/microbiología , Vagina/efectos de los fármacos , Candida albicans/efectos de los fármacos , Ratones , Humanos , Animales , Pulsatilla/química , Transcriptoma/efectos de los fármacos , 1-Butanol/química , Medicamentos Herbarios Chinos/farmacología , Sistema de Señalización de MAP Quinasas/efectos de los fármacos , Candidiasis Vulvovaginal/tratamiento farmacológico , Candidiasis Vulvovaginal/microbiología , Sustancias Protectoras/farmacología , Sustancias Protectoras/química , Proteínas Quinasas Activadas por Mitógenos/metabolismo , Proteínas Quinasas Activadas por Mitógenos/genética , Candida glabrata/efectos de los fármacos , Candida glabrata/genéticaRESUMEN
Aim: Our investigation aims to estimate the antifungal effect of propranolol hydrochloride (PNL). Methods: Oleosomes (OLs) were fabricated by thin-film hydration and evaluated for entrapment efficiency (EE%), particle size (PS), polydispersity index (PDI), zeta potential (ZP), and amount of drug released after 6 h Q6h (%). Results: The optimal OL showed a rounded shape with optimum characteristics. The ex-vivo permeation and confocal laser scanning microscopy verified the prolonged release and well deposition of PNL-loaded OLs-gel. The in-silico assessment demonstrated the good stability of PNL with OLs' ingredients. In vivo evaluations for PNL-loaded OLs-gel showed a good antifungal impact against Candida albicans with good safety. Conclusion: This work highlights the potential of PNL-loaded OLs-gel as a potential treatment for candida vaginal infection.
[Box: see text].
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Antifúngicos , Candida albicans , Quitosano , Hidrogeles , Propranolol , Candida albicans/efectos de los fármacos , Propranolol/química , Propranolol/farmacología , Propranolol/administración & dosificación , Antifúngicos/farmacología , Antifúngicos/química , Antifúngicos/administración & dosificación , Femenino , Animales , Quitosano/química , Hidrogeles/química , Tamaño de la Partícula , Humanos , Liberación de Fármacos , Liposomas/química , Candidiasis Vulvovaginal/tratamiento farmacológico , Candidiasis Vulvovaginal/microbiología , Portadores de Fármacos/química , Vagina/microbiología , Vagina/efectos de los fármacosRESUMEN
Aim: To explore the antifungal potential of Sanghuang mushroom, a traditional Chinese medicine. Materials & methods: The antifungal properties and the potential mechanism of Sanghuang mushroom extracts against Candida albicans were studied in vitro and in vivo. Results: Sanghuang mushroom extracts inhibited the biofilm formation, increased the cell membrane permeability and promoted cell apoptosis of C. albicans in vitro. In a murine model of vulvovaginal candidiasis, Sanghuang mushroom extracts reduced the vaginal fungal load, improved inflammatory cell infiltration and downregulated the expression of TNF-α, IL-1ß and IL-6. Untargeted metabolomic analysis suggested the presence of ten antifungal components in Sanghuang mushroom extracts. Conclusion: Sanghuang mushroom extracts showed promise as antifungal agent against candidiasis, with potential therapeutic implications.
[Box: see text].
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Antifúngicos , Biopelículas , Candida albicans , Candidiasis Vulvovaginal , Candida albicans/efectos de los fármacos , Animales , Femenino , Ratones , Antifúngicos/farmacología , Antifúngicos/aislamiento & purificación , Biopelículas/efectos de los fármacos , Candidiasis Vulvovaginal/tratamiento farmacológico , Candidiasis Vulvovaginal/microbiología , Modelos Animales de Enfermedad , Agaricales/química , Pruebas de Sensibilidad Microbiana , Apoptosis/efectos de los fármacos , Humanos , Medicina Tradicional China , Factor de Necrosis Tumoral alfa/metabolismo , Interleucina-1beta/metabolismo , Permeabilidad de la Membrana Celular/efectos de los fármacos , Interleucina-6/metabolismoRESUMEN
Background: Due to its prevalence, recurrence, and the emergence of drug-resistance, Candida vaginitis significantly impacts the well-being of women. Although cinnamon essential oil (CEO) possesses antifungal activity, its hydrophobic properties limit its clinical application. Purpose: To overcome this challenge, a nanoemulsification technology was employed to prepare cinnamon essential oil-nanoemulsion (CEO@NE), and its therapeutic efficacy and action mechanism for Candida vaginitis was investigated in vivo and in vitro. Materials and Methods: CEO@NE, composed of 4% CEO, 78% distilled water, and 18% Tween 80, was prepared by ultrasonic nanoemulsification. The physical properties, anti-Candida activity, cytotoxicity, immunomodulatory potential and storage stability of CEO@NE were explored. Subsequently, the effect of intravaginal CEO@NE treatment on Candida vaginitis was investigated in mice. To comprehend the possible mechanism of CEO@NE, an analysis was conducted to ascertain the production of intracellular reactive oxygen species (ROS) in C. albicans. Results: CEO@NE, with the droplet size less than 100 nm and robust storage stability for up to 8 weeks, exhibited comparable anti-Candida activity with CEO. CEO@NE at the concentration lower than 400 µg/mL had no cytotoxic and immunomodulatory effects on murine splenocytes. Intravaginal treatment of CEO@NE (400 µg/mL, 20 µL/day/mouse for 5 consecutive days) curbed Candida colonization, ameliorated histopathological changes, and suppressed inflammatory cytokine production in mice intravaginally challenged with C. albicans. Notably, this treatment preserved the density of vaginal lactic acid bacteria (LAB) crucial for vaginal health. Co-culturing C. albicans with CEO@NE revealed concentration-dependent augmentation of intracellular ROS generation and ensuing cell death. In addition, co-culturing LPS-stimulated murine splenocytes with CEO@NE yielded a decrease in the generation of cytokines. Conclusion: This discovery provides insight into the conceivable antifungal and anti-inflammatory mechanisms of CEO@NE to tackle Candida vaginitis. CEO@NE offers a promising avenue to address the limitations of current treatments, providing novel strategy for treating Candida vaginitis.
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Antifúngicos , Candida albicans , Candidiasis Vulvovaginal , Cinnamomum zeylanicum , Emulsiones , Aceites Volátiles , Femenino , Animales , Aceites Volátiles/química , Aceites Volátiles/farmacología , Aceites Volátiles/administración & dosificación , Candidiasis Vulvovaginal/tratamiento farmacológico , Candida albicans/efectos de los fármacos , Antifúngicos/farmacología , Antifúngicos/química , Antifúngicos/administración & dosificación , Ratones , Administración Intravaginal , Cinnamomum zeylanicum/química , Emulsiones/química , Especies Reactivas de Oxígeno/metabolismo , Humanos , Nanopartículas/química , Ratones Endogámicos BALB CRESUMEN
BACKGROUND: Vulvovaginal Candidiasis (VVC) is a fungal infection causing inflammation of the vagina and/or the vulva. Symptoms include itching, irritation, and discharge. VVC presents commonly across primary care and, despite its mild symptoms, carries psychological burden and has a significant impact on women's quality of life. UK guidelines support treatment via oral or topical azole antifungal agents. Recent evidence attests to the superiority of novel non-azole antifungals. Thus, rigorous financial assessment of both antifungals is necessary for optimal VVC treatment allocation in UK primary care. AIM: To evaluate the cost-effectiveness of ibrexafungerp against the gold standard fluconazole as first-line treatment of VVC within the NHS. METHOD: A systematic review on the efficacy of ibrexafungerp and fluconazole in acute VVC was conducted. Cost-effectiveness analysis was initiated using health outcome data from the DOVE trial, a Phase 2 RCT. Costs in pound sterling were ascertained in monetary units, and effectiveness determined as reduced need for follow-up medication. RESULTS: An incremental cost-effectiveness ratio of £2185.74 was determined. This suggests oral ibrexafungerp being largely more costly yet slightly more effective than fluconazole, and thus has unfavourable net benefit. Two sensitivity analyses were conducted considering follow-up medication combination and market price, which provided confidence in the calculated cost-effectiveness ratio. CONCLUSION: This analysis highlights fluconazole's cost-effectiveness in current UK guidelines and favourability.