Associação de cultura e diversidade genética de Candida com características clínicas e epidemiológicas de pacientes com diagnóstico de candidíase vulvovaginal

Abstract

The vulvovaginal candidiases (VVC) is one of the most frequent diagnosed disease in gynecological practice and its incidence has increased drastically. Therefore, regional prospective studies become necessary to better address epidemiological issues. It has been recognized the emergence of other yeast species, besides Candida albicans, as VVC in mono or polymicrobial infections, with direct reflex in antifungal therapy, often empirical. This study was focused on the etiology investigation, the epidemiological profile of patients with vulvovaginal candidiasis (VVC) and predisposing factors, addition to the genetic diversity of yeasts. Vaginal secretions were streaked in Sabouraud agar and yeast samples were isolated and identified by PCR. Demographic and clinical data were obtained by questionnaire. For statistical analysis the Student t test, chi-square and Fischer, were applied as needed using the software Statistical Package for Social Sciences (SPSS) with a significance level of 5 %. Yeast genotyping was performed by the RAPD approach, and a similarity matrix was obtained to evaluate C. albicans diversity and their relationships with clinical and epidemiological data. Sixty nine patients were evaluated between 15 and 52 years, predominantly white (79.7 %), with higher education (58 %), married (56.5 %) and sexually active (97.1 %). Among them, 34.8 % were pregnant, 7.2% diabetic, 1.4 % seropositive for HIV and 36.2 % using oral contraceptives. Recent antibiotic therapy was mentioned by 13 % of patients, and antifungal or anti-trichomonas therapy were mentioned by 5.8% and 1.4 % of the patients. Corticosteroid use was reported by 2.9 % and antineoplastic by 1.4 %. Vaginal discharge and itching were the main complaints (97.1 % and 73.9 %), followed by burning (63.8 %) and erythema (63.8 %). When present, the vaginal flow was predominantly white (88.1 %) or lumpy (86.6 %). The diagnosis was confirmed by culture in 55 (79.7 %) patients, with mixed infections in four patients. The most prevalent species was C. albicans, followed by C. glabrata (one monoinfection and two mixed infections with C. albicans). C. lusitaniae and C. albicans were also identified in mixed infections (two patients). The analysis of data generated by yeasts genotyping allowed discriminating different C. albicans strains in the sampled population. It was identified seven electrophoretic types (ET) classified within groups I to VII. The groups I, II, III, IV, V and VI included yeast strains with of 100% genetic similarity. In group VII were included the yeast strains highly polymorphic that present less than 80% of similarity. Despite the high culture positivity and clinical data being characteristic of VVC, the symptoms are not pathognomonic. C. albicans is the most prevalent species, but other species are also involved in the VVC etiology, as the emergence of C. lusitaniae. It is suggested the diagnosis and identification of microbial species involved including detection of mixed infections before antimicrobial chemotherapy.