الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Vulvovaginal Candidiasis or Candida vaginitis is a common fungal infection among adult women during reproductive ages. It has been estimated that 75 % of all adult women experience at least one period of vulvovaginal candidiasis in their lifetime. Fortunately the infection is rarely life threatening, whereas it is usually associated with such morbidities like pruritis, burning irritation, soreness, dyspareunia and whitish cheesy discharge. Known predisposing host factors, which include pregnancy, uncontrolled diabetes mellitus, using contraceptive, compromised immune system, broad spectrum antibiotics are risk factors for VVC.
Diagnosis cannot be made solely on clinical basis and should be confirmed by laboratory diagnosis. The latter include direct microscopic examination, culture and antifungal susceptibility testing.
The present study extended from December 2014 until July 2015. Three-hundred and fifty clinically diagnosed female patients were microbiologically tested for VVC. Patients were attending the outpatient clinic of EL Shatby Obstetrics and Gynecology Hospital aged from18 to 29 years old. All patients were subjected to the following tests: Direct microscopic examination, Culture on SDA agar & BDTM chrOMagar Candida, Germ tube test and Vitek 2 Compact system if needed. Samples that were positive by chrOMagar Candida were then subjected to AST by disk diffusion method. This was to determine the appropriate antifungal treatment.
There is a clear correlation between the frequency of positive microscopic findings and positive cultures in vaginal swabs. Greater frequency of positive cultures was established in pregnant women compared to non-pregnant women. Also women with uncontrolled diabetes mellitus, using antibiotics and oral contraceptive showed significantly higher rate of Candida culture positivity.
Identification of species showed that the most common isolated Candida was C.albicans followed by C.glabrata, C.tropicalis, C.krusei and C.parapsilosis respectively as NAC species.
Along with the increase in the incidence of VVC , there has been an important shift away from C.albicans towards NAC spp. , Many species from NAC group exhibit varying degrees of resistance, either intrinsic or acquired or both, to commonly used antifungal drugs.
In the present study, susceptibility testing was performed using disk diffusion methods for the following antifungal drugs: Fluconazole (25μg), Voriconazole(1μg) and Nystatin (100 units).
The results of the present study suggest that patients with VVC caused by C. albicans had higher total severity scores than those with VVC caused by NAC species. C.albicans was the predominant Candida species isolated from cases of VVC. Vaginal C.albicans isolates were found to be resistant to antifungal agents only in few cases; isolates of C.albicans were more susceptible to nystatin, voriconazole and fluconazole on basis of the in vitro data. Nystatin can represent a possible alternative for the treatment of refractory cases of R/VVC.
Summary & Conclusion
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Conclusion
from this study, it could be concluded that VVC is a common clinical problem that affects most adult women at least once during their lifetime.
Factors known to impact the vaginal environment and contribute to VVC like pregnancy, antibiotic therapy, hormone therapy and uncontrolled diabetes mellitus were present in a majority of the patients with multiple positive cultures in the current study.
The culture of vaginal discharge should be warranted because culture technique is more sensitive than direct smear.
The use of BDTM chrOMagar Candida for the vaginal swab demonstrate that BDTM chrOMagar Candida has several advantages over SDA which offer a reliable and rapid identification of Candida spp. , allowing recognition of mixed cultures.
C.albicans followed by C.glabrata are the most leading pathogens causing VVC.
Antifungal susceptibility testing should be performed before prescribing treatment to provide effective therapy.
Disk diffusion method has been adapted for sensitivity testing of Candida spp. because its simplicity comparable to other methods.
Both Azoles (Fluconazole, Voriconazole) and Nystatin are efficient in women with VVC but Nystatin is more susceptible than azoles antifungal agent in the current study.