ISOLATION AND SPECIATION OF CANDIDA FROM LEUCORRHOEA SAMPLES OF REPRODUCTIVE AGE WOMEN WITH ANTIFUNGAL SUSCEPTIBILITY OF THE ISOLATES
DOI:
https://doi.org/10.22159/ajpcr.2025v18i5.54204Keywords:
Candida, Leucorrhoea, Antifungal Susceptibility, Non-albicans Candida, Vulvovaginal candidiasisAbstract
Objectives: (1) To isolate and identify Candida species from leucorrhoea samples of women aged 15–45 years. (2) To determine the distribution of Candida species. (3) To evaluate the antifungal susceptibility of the isolates.
Methods: A cross-sectional, descriptive study was conducted from October 2018 to January 2020 at King George Hospital and Andhra Medical College, Visakhapatnam. 259 high vaginal swab samples were collected from women with leucorrhoea symptoms. Direct microscopy and culture on Sabouraud’s dextrose agar were used for Candida isolation. Species identification involved standard biochemical tests, including the germ tube test, cornmeal agar, HICHROME agar, and sugar assimilation/fermentation tests. Antifungal susceptibility was assessed using the disc diffusion method for six antifungals: amphotericin B, clotrimazole, fluconazole, itraconazole, ketoconazole, and nystatin.
Results: Out of 259 samples, 100 Candida isolates (38.6% prevalence) were obtained. The most affected age group was 31–35 years (34%), followed by 21–25 years (27%). Non-albicans Candida (NAC) species (59%) were more prevalent than Candida albicans (41%). Among NAC species, Candida glabrata (23%) and Candida tropicalis (19%) predominated. All Candida isolates were 100% susceptible to amphotericin B and nystatin. C. albicans demonstrated the highest resistance to fluconazole (26.9%). Among NAC species, Candida krusei exhibited 100% resistance to fluconazole and significant resistance to other azoles.
Conclusion: The study reveals a rising trend in NAC infections with higher antifungal resistance. Amphotericin B and nystatin remain the most effective treatments. Early species-specific identification and antifungal susceptibility testing are essential to guide appropriate therapy and curb emerging antifungal resistance. Further research is required to establish regional Candida epidemiology and optimize empirical treatment guidelines.
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References
Jeffcoate T, Tindall V. Jeffcoate’s Principles of Gynaecology. 9th ed. Delhi: Jaypee Brothers; 2019.
Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clin Microbiol Rev. 2010 Apr;23(2):253-73. doi: 10.1128/CMR.00076- 09, PMID 20375352
Sasikala G, Udayasri B. Speciation and antifungal susceptibility profiles of Candida isolates from vaginitis patients attending STD clinic at a tertiary care hospital. J NTR Univ Health Sci. 2018;7(2):94- 7. doi: 10.4103/jdrntruhs.jdrntruhs_33_17
Chander J. Textbook of Mycology. 3rd ed. Maharashtra: Mehta Publishers; 2009. p. 9-20, 35-56, 266-90.
Jawetz M. Adelbergs Textbook of Medical Microbiology. 25th ed., Ch. 45., Sec. 4. United States: McGraw-Hill Lange; 2010. p. 632-43.
Koneman E, Roberts GD, Wright SE. Practical Laboratory Mycology. 2nd ed., Ch. 6: Williams and Wilkins; 1997. p. 103-17.
Merz WG, Hay RJ. Topley and Wilson’s Medical Microbiology and Microbial Infections, Medical Mycology. 10th ed., Vol. 15, 30., Ch. 1. London: Edward Arnold Publishers Limited; 2005. p. 11, 256, 579-620.
Parija SC, Sujatha S, Dhodapkar R. Standard Operating Procedure Manual. Pondicherry: Department of Microbiology, JIPMER; 2011. p. 37-42.
Krishnasamy L, Krishnakumar S, Santharam P, Saikumar C. Isolation and identification of Candida species in patients with vulvovaginal candidiasis. J Pure Appl Microbiol. 2018;12(4):2269-73. doi: 10.22207/ JPAM.12.4.67
Bitew A, Abebaw Y. Vulvovaginal candidiasis: Species distribution of Candida and their antifungal susceptibility pattern. BMC Womens Health. 2018 Jun 15;18(1):94. doi: 10.1186/s12905-018-0607-z, PMID 29902998
Panda S, Nagamanasa P, Panda SS, Raman TV. Incidence of candidiasis and trichomoniasis in leucorrhoea patients. Int J Curr Res Rev. 2013;5(3):95.
Ragunathan L, Poongothai GK, Sinazer AR, Kannaiyan K, Gurumurthy H, Jaget N, et al. Phenotypic characterization and antifungal susceptibility pattern to fluconazole in Candida species isolated from vulvovaginal candidiasis in a tertiary care hospital. J Clin Diagn Res. 2014 May;8(5):DC01-4. doi: 10.7860/JCDR/2014/7434.4311, PMID 24995172
Kalaiarasan K, Singh R, Chaturvedula L. Fungal profile of vulvovaginal candidiasis in a tertiary care hospital. J Clin Diagn Res. 2017 Mar;11(3):DC06-9. doi: 10.7860/JCDR/2017/23578.9475, PMID 28511380
Lakshmi N, Ratna Kumari G, Purushottham MD, Krishna PB. Isolation and speciation of Candida from vulvovaginitis and their antifungal susceptibility. Int J Curr Microbiol Appl Sci. 2015;4(12):121-9.
Verghese S, Padmaja P, Asha M, Elizabeth SJ, Anitha A, Kundavi KM, et al. Prevalence, species distribution and antifungal sensitivity of vaginal yeasts in infertile women. Indian J Pathol Microbiol. 2001;44(3):313-4. PMID 12024920
Fathima K, Rajendran R. A study of isolation and identification of non-albicans Candida species from clinically suspected cases of vulvovaginitis. Int J Curr Microbiol Appl Sci. 2014;3(12):147-59.
Vijaya D, Santhya ST, Shakthi R. Speciation and biofilm formation in Candida species isolated from various clinical samples. Int J Curr Res. 2016;8(5):31332-5.
Mahadevaiah P, Yoganand R, Rudresh SM, Ravi GS. Speciation of Candida isolates from vulvovaginal candidiasis cases, detection of virulence markers of Candida and antifungal susceptibility by disc diffusion method. Indian J Microbiol Res. 2022;9(4):287-95. doi: 10.18231/j.ijmr.2022.052
Lavanya V, Pavani P, Reddy BK. Speciation and antifungal susceptibility pattern of Candida isolates from vulvovaginitis patients attending a tertiary care hospital in South India. Int Arch Integr Med. 2019;6(2):62-8.
Vijaya D, Harsha TR, Nagaratnamma T. Candida speciation using Chrom Agar. J Clin Diagn Res. 2011 Aug;5(4):755-7. doi: 10.7860/ JCDR/2011/1630.1482
Richter SS, Galask RP, Messer SA, Hollis RJ, Diekema DJ, Pfaller MA. Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases. J Clin Microbiol. 2005 May;43(5):2155-62. doi: 10.1128/JCM.43.5.2155-2162.2005, PMID 15872235
Mohanty S, Xess I, Hasan F, Kapil A, Mittal S, Tolosa JE. Prevalence and susceptibility to fluconazole of Candida species causing vulvovaginitis. Indian J Med Res. 2007 Sep;126(3):216-9. PMID 18037716
Garg S, Malhotra A, Oberoi L, Batra S, Singh K. Emergence of non-albicans Candida and use of CHROMagar for speciation of Candida in a resource-limited setting. Asian J Pharm Clin Res. 2024;17(8):61-6. doi: 10.22159/ajpcr.2024v17i8.51488
Shukla R, Reddy SG, Bilolikar AK. A study of Candida albicans and
non-albicans Candida species isolated from various clinical samples and their antifungal susceptibility pattern. J Med Sci Res. 2020;8(1):1- 11. doi: 10.17727/JMSR.2020/8-1
Deepthi KN, Menon AR, Nair PK. Identification of Candida species from clinical isolates and their antifungal susceptibility pattern. J Evol Med Dent Sci. 2020;9(24):1813-7. doi: 10.14260/jemds/2020/396
Parameshwaran SP, Kannan S, Nagarajan D, Pichaivel M, Samundi SP, Parameswaran S, et al. A comprehensive review of candidiasis. Innovare J Med Sci. 2022;10(6):1-6. doi: 10.22159/ijms.2022.v10i6.45111
Rajeshkumar SR, Parsana HN, Mehta M, Mehta SH, Patel B, Dave M. Candidiasis-review of risk factors and diagnostic approaches. Int J Curr Res. 2018;10(4):67838-40.
Jithendra K, Madhavulu B, Rama Mohan P, Munilakshmi P, Avinash G. Candida speciation from vaginal candidiasis and its antifungal susceptibility. Int J Curr Med Appl Sci. 2015;5(3):144-8.
Vignan N, Tiwari V, Kharat A, Kumari R. Antifungal stewardship: Mitigating inappropriate prescriptions in vulvovaginal candidiasis in tertiary care hospital, Central India. Int J Pharm Pharm Sci. 2024;16(4):61-3. doi: 10.22159/ijpps.2024v16i4.50496
Chakraborty M, Banu H, Gupta MK. Epidemiology and antifungal susceptibility of Candida species causing blood stream infections: An Eastern India perspective. J Assoc Physicians India. 2021;69(8):11-2. PMID 34472809
Shaik N, Penmetcha U, Myneni RB, Yarlagadda P, Singamsetty S. A study of identification and antifungal susceptibility pattern of Candida species isolated from various clinical specimens in a tertiary care teaching hospital, Chinakakani, Guntur, Andhra Pradesh, South India. Int J Curr Microbiol Appl Sci. 2016;5(7):71-91. doi: 10.20546/ ijcmas.2016.507.006
Jayalakshmi L, RatnaKumari G, Samson SH. Isolation, speciation and antifungal susceptibility testing of Candida from clinical specimens at a tertiary care hospital. Appl Med Sci. 2014;2(6E):3193-8.
Kamel R, Abbas H. Rationale for the use of coconut oil-based antimycotic pessaries to combat recurrent vaginal infection: In vitro/in vivo evaluation and preliminary prospective clinical investigation. Int J Appl Pharm. 2018;10(5):159-66. doi: 10.22159/ijap.2018v10i5.28199
Lestari AD, Puspitawati R, Djais AA. The potency of Javanese turmeric (Curcuma Xanthorrhiza roxb.) ethanol extract to eradicate wild strain Candida albicans biofilm. Int J Appl Pharm. 2019;11(Special Issue 1):5-9. doi: 10.22159/ijap.2019.v11s1.150
Verma S, Patil E, Nerurkar V. Speciation and antifungal susceptibility profile of Candida species-a study from a private diagnostic reference lab in Mumbai. IAR J Med Sci. 2021;2(4):48-55.
Kumar NA. Clinico-etiologic and pathological profile of fungal keratitis: A retrospective research. Int J Curr Pharm Rev Res. 2024;16(3):345-8.
Khan M, Ahmed J, Gul A, Ikram A, Lalani FK. Antifungal susceptibility testing of vulvovaginal Candida species among women attending antenatal clinic in tertiary care hospitals of Peshawar. Infect Drug Resist. 2018;11:447-56. doi: 10.2147/IDR.S153116, PMID 29628769
Khadka S, Sherchand JB, Pokhrel BM, Parajuli K, Mishra SK, Sharma S, et al. Isolation, speciation and antifungal susceptibility testing of Candida isolates from various clinical specimens at a tertiary care hospital, Nepal. BMC Res Notes. 2017;10(1):218. doi: 10.1186/ s13104-017-2547-3, PMID 28646915
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