الفهرس | Only 14 pages are availabe for public view |
Abstract Vulvovaginal Candidiasis (VVC) is a female genital system infection that occurs due to Candida species. There are many risk factors for development of vulvovaginal candidiasis like advanced reproductive age, pregnancy, diabetes, hormonal contraception, recent antibiotic use. Elevated serum glucose may lead to impaired neutrophil and monocyte adherence, chemotaxis, phagocytosis, pathogen killing, and respiratory burst. Also elevated glucose level in infected tissue increase candidia adherence and invasion. Several characteristics of Candida have been shown to be important for its pathogenicity, especially adherence to host surfaces and medical devices, Reversible morphogenetic transitions between yeast and filamentous growth, secreted hydrolytic enzymes as aspartyl proteinases, phospholipases. So we conducted this study to determine the prevalence of vaginal carriage of Candida, species level and its phospholipase activity among diabetic and non diabetic women, at Fayoum University Hospital by conventional microbiological methods and on molecular basis. Vaginal samples were collected from 80 diabetics and 100 non diabetics. It is found that the prevalence of vaginal candidiasis among diabetics was 40 (50%) against 20 (20%) in non diabetics. Species detection by API system revealed that C. albicans was the predominant species among both diabetics and non diabetics. The prevalence of C. albicans was as follows: 11(55%) in symptomatic diabetics, 11 (40%) in non symptomatic diabetics and 15 (75%) in non diabetics. Phenotypic screening for phospholipase enzyme detection by measuring PZ value on egg yolk media found that 100 % of Candida was phospholipase producers. C. glabrata in diabetics was more phospholipase producer than in non diabetics. PZ value of 3 (15.8%) C. glabrata in diabetics was (+ +) against 2 (50%) in non diabetics. 11 (57.9%) against 1 (25%) C. glabrata had PZ value of (+ + +) in diabetics and non diabetics respectively. Among diabetics PZ value of 5 (26.3%) C. glabrata was (+ + + +) versus 0% in non diabetic patients. Molecular analysis revealed that; the prevalence of gene encoding phospholipase among diabetic patients was as follows: 19 (95%) symptomatic diabetic patients, 17 (85%) non symptomatic diabetic patients and 19 (95%) non diabetics had PLB1 gene. PLB2 gene was found in 3 (15%) symptomatic diabetics, 3 (15%) non symptomatic diabetic patients and in 7 (35%) non diabetics. ACT1gene which used for identification of Candida cell wall actin was found in 10 (50%) of symptomatic diabetics but in non symptomatic diabetics it was found in 4 (20%). 9 (45%) non diabetics were ACT1 positive. We recommended detection of species by CHROM agar media which is simple and any microbiology laboratory can use it. We also recommended phenotypic and genotypic detection of other secreted enzymes. Finally, the results imply that vaginal candidiasis is present in alarming prevalence in diabetic patients. This requires blood glucose level control, improving hygienic habits and regular detection of causative species. |