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Published on: July 6, 2016
Vaginal Candida parapsilosis: pathogen or bystander?
Paul Nyirjesy1, Alynn B Alexander, M Velma Weitz
1Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA. pn35@drexel.edu
Objective:
Candida parapsilosis is an infrequent isolate on vaginal cultures; its role as a vaginal pathogen remains unstudied. This retrospective study of women with positive culture for C. parapsilosis sought to characterize the significance of this finding and its response to antifungal therapy.
Methods:
From February 2001 to August 2002, we identified all individuals with positive fungal isolates among a population of women with chronic vulvovaginal symptoms. Charts of women with C. parapsilosis cultures were reviewed with regard to patient demographics, clinical presentation and therapeutic response. Mycological cure, defined as a negative fungal culture at the next office visit, and clinical cure, i.e. symptom resolution, were determined for each subject.
Results:
A total of 582 women had positive vaginal cultures for 635 isolates, of which 54 (8.5%) were C. parapsilosis. The charts of 51 subjects with C. parapsilosis were available for review and follow-up cultures and clinical information were available for 39 (76.5%). Microscopy was positive in 9 (17.6%). Antifungal treatment resulted in mycological cure in 17/19 patients with fluconazole, 7/7 with butoconazole, 6/6 with boric acid, 1/1 with miconazole and occurred spontaneously in 6/7: 24/37 (64.9%) patients with a mycological cure experienced clinical cure.
Conclusions:
Although C. parapsilosis is often a cause of vaginal symptoms, it seems to respond to a variety of antifungal agents and may even be a transient vaginal colonizer.
Insights
Candida parapsilosis vaginal infections are uncommon but can cause symptoms. Most cases respond well to various antifungal treatments, suggesting it may be a transient colonizer.
Area of Science:
- Medical Mycology
- Vaginal Microbiome Research
- Infectious Diseases
Background:
- Candida parapsilosis is rarely identified in vaginal cultures.
- Its role in causing vaginal conditions is not well understood.
- Previous studies have not focused on its clinical significance or treatment outcomes.
Purpose of the Study:
- To investigate the clinical significance of Candida parapsilosis vaginal isolates.
- To evaluate the response of C. parapsilosis vaginal infections to antifungal therapy.
- To characterize patient demographics and clinical presentation associated with C. parapsilosis.
Main Methods:
- Retrospective chart review of women with positive vaginal cultures for C. parapsilosis (February 2001-August 2002).
- Analysis of patient demographics, clinical symptoms, and treatment responses.
- Determination of mycological cure (negative fungal culture) and clinical cure (symptom resolution).
Main Results:
- Candida parapsilosis accounted for 8.5% of positive fungal isolates (54/635).
- Antifungal treatment achieved mycological cure with fluconazole (17/19), butoconazole (7/7), boric acid (6/6), and miconazole (1/1).
- Spontaneous mycological cure occurred in 6/7 patients, and 64.9% of those with mycological cure also achieved clinical cure.
Conclusions:
- Candida parapsilosis can cause vaginal symptoms.
- It appears to be susceptible to a range of antifungal agents.
- The yeast may act as a transient vaginal colonizer rather than a persistent pathogen.
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