Three cases of vulvovaginal candidiasis due to Candida nivariensis

Area of Science:

• Medical Mycology
• Infectious Diseases
• Antimicrobial Resistance

Background:

• Candida nivariensis is an emerging yeast species within the Candida glabrata complex.
• This species is increasingly recognized for causing difficult-to-treat invasive and mucocutaneous infections.
• High antifungal resistance is a growing concern with this pathogen.

Purpose of the Study:

• To describe clinical cases of vulvovaginal candidiasis caused by Candida nivariensis.
• To evaluate the in vitro antifungal susceptibility profile of Candida nivariensis isolates.
• To report treatment outcomes for patients infected with Candida nivariensis.

Main Methods:

• Identification of Candida nivariensis isolates using Internal Transcribed Spacer 1-2 sequencing.
• In vitro antifungal susceptibility testing against a panel of antifungal agents.
• Clinical case reporting and treatment outcome analysis.

Main Results:

• Three cases of vulvovaginal candidiasis attributed to Candida nivariensis were identified.
• All isolates demonstrated in vitro susceptibility to anidulafungin, micafungin, caspofungin, 5-flucytosine, posaconazole, voriconazole, itraconazole, and amphotericin B.
• Dose-dependent susceptibility to fluconazole was observed, with one patient developing clinical resistance and relapse, which was managed by increasing the fluconazole dose.

Conclusions:

• Candida nivariensis is a significant cause of vulvovaginal candidiasis with a concerning resistance profile.
• While many antifungals are effective, fluconazole susceptibility can be variable.
• Treatment strategies may need to be adjusted, including dose escalation, for resistant cases.