Genotype Analysis of Vaginal Candida albicans Isolates and Fluconazole Susceptibility in Tunisia
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Abstract
Background: Vulvovaginal candidiasis (VVC) is a common fungal infection caused mainly by Candida albicans. This study aimed to determine the genotypes and subtypes of C. albicans responsible for VVC and to assess their susceptibility to fluconazole.
Methods: A total of 103 females referred to the Laboratory of Parasitology at the Military Hospital of Tunis for vaginal sampling were included. C. albicans isolates were identified using phenotypic and molecular methods. Genotyping and subtyping were performed using 25S rDNA–based and ALT-RPS–based primers, respectively. The susceptibility to fluconazole using E-test technique was made for 60 strains.
Results: Genotype B was the most prevalent (46%), predominantly subtype B2/3/4 (51%), followed by genotype A (34%) with subtype A2/3/4 (49%), and genotype C (20%) with a single subtype C3. The mean age of patients was 31 years (range: 13–74). The most common clinical sign was white leucorrhea, observed in 80% of cases. Significant correlations were found between genotypes and age group, pregnancy status, trimester, clinical signs, and culture abundance (p < 0.05). Additionally, sub-genotype distribution was significantly associated with pregnancy, parity, and trimester (p < 0.05). Fluconazole susceptibility testing revealed that 57% of strains were resistant.
Conclusion: This study identified three major C. albicans genotypes (A, B, and C) and ten RPS subtypes among Tunisian VVC isolates. A high rate of fluconazole resistance was observed, highlighting the need for antifungal susceptibility testing to guide effective treatment.
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References
I. L. MTIBAA, et al., Vulvovaginal candidiasis: Etiology, symptomatology and risk factors. Journal de mycologie medicale. 2017 ; 27 (2) :153-158.
II. S. ANANE, et al., Les candidoses vulvovaginales: facteurs de risque et particularités cliniques et mycologiques. Journal de mycologie médicale. 2010 ; 20 (1) :36-41.
III. Eschenbach, Chronic vulvovaginal candidiasis. N Engl J Med. 2004; 351:851–2.
IV. J. Sardi, et al., Vulvovaginal candidiasis: epidemiology and risk factors, pathogenesis, resistance, and new therapeutic options. Curr Fungal Infect Rep. 2021; 15:32–40.
V. M. SHEKHANY, Isolation and genotyping of Candida albicans involved in vaginal candidiasis among pregnant women in Sulaymaniyah and Erbil cities. Zanco Journal of Medical Sciences (Zanco J Med Sci).2021; 25 (1):493-502.
VI. T. Iwata et al., Genotyping of Candida albicans on the basis of polymorphisms of ALT repeats in the repetitive sequence (RPS). J Dermatol Sci 41 (2006) 43–54.
VII. C. Bii, et al., Genotypes of Candida albicans from clinical sources in Nairobi Kenya. African Journal of Microbiology Research. 2009;3: 475-477.
VIII. D. Shivanand, et al., Species Identification of Candida Isolates in Various Clinical Specimens with Their Antifungal Susceptibility Patterns. Journal of Clinical and Diagnostic Research. 2011; 5(6): 1177-1181.
IX. P. Haddadi, et al. Yeast colonization and drug susceptibility pattern in the pediatric patients with neutropenia. Jundishapur J Microbiol. 2014; 7(9):11858.
X. S Hana, et al., Characterization of the ‘Candida albicans Complex’: first report of Candida africana in Tunisia. J Med Microb Diagn. 2020; 9 (307): 2.
XI. P. SAWADOGO, et al., Genotype analysis of clinical Candida albicans isolates using PCRs targeting 25S rDNA and ALT repeat sequences of the RPS and antifungal susceptibility in Ouagadougou (Burkina Faso). Infection and Drug Resistance. 2019: 3859-3866.
XII. T. Ji-yun, et al., Genetic diversity and molecular epidemiology of Candida albicans from vulvovaginal candidiasis patients. Infection, Genetics and Evolution. 2021; 92:104893.
XIII. M. BIGNOUMBA, et al., High diversity of yeast species and strains responsible for vulvovaginal candidiasis in South-East Gabon. Journal of Medical Mycology 33 (2) (2023) 101354.
XIV. N. HONG, et al. Genotyping and drug resistance profile of clinical isolates of Candida albicans from vulvovaginal candidiasis in the Eastern China. Mycopathologia. 2022;187 (2-3): 217-224.
XV. Fornari, et al., Susceptibility and molecular characterization of Candida species from patients with vulvovaginitis. Braz J Microbiol. 2016; 47(2): 373-380.
XVI. S. Amanloo, et al., Genotyping of candida albicans strains obtained from oropharyngeal candidiasis patients based on abc and rps typing systems. Jundishapur J Microbiol. 2020; 13(5)103592.
XVII. M. GHARAGHANI, et al., ABC typing and extracellular enzyme production of Candida albicans isolated from Candida vulvovaginitis. Journal of Clinical Laboratory Analysis. 2022; 36 (1):24117.
XVIII. M. TAMURA, et al., Molecular characterization of new clinical isolates of Candida albicans and C. dubliniensis in Japan: analysis reveals a new genotype of C. albicans with group I intron. Journal of clinical microbiology. 2001; 39 (12): 4309-4315.
XIX. Dalvand, et al., Genotyping of Candida albicans isolated from animals using 25S ribosomal DNA and ALT repeats polymorphism in repetitive sequence. Curr Med Mycol. 2018; 4(4): 12–9.
XX. T. AHMED, et al., Genotyping of Candida albicans by polymerase chain reaction isolated from women in diala province. Biochemical and Cellular Archives. 2019; 19 (1):1803-1809.
XXI. S. Xiao-dong, et al., Genotype comparisons of strains of Candida albicans from patients with cutaneous candidiasis and vaginal candidiasis Chin Med J.2008; 121(15): 1450-1455.
XXII. M. Abu Baker, Genotype comparisons of strain of Candida albicans from patients with vaginal candidiasis. MSC. Thesis, Faculty of Graduate Studies at AL-Najah National university, Nabuls, Palestine. 2012.
XXIII. C. Lian, et al., Genotype of Candida species associated with different conditions of vulvovaginal candidosis. Mycoses.2004; 47:495-502.
XXIV. GUZEL, et al., Evaluation of risk factors in patients with vulvovaginal candidiasis and the value of chromID Candida agar versus CHROMagar Candida for recovery and presumptive identification of vaginal yeast species. Medical Mycology.2011; 49(1):16-25.