Immunological investigations in vaginal mycoses

Area of Science:

• Gynecology
• Infectious Diseases
• Immunology

Background:

• Vulvovaginal candidiasis is a common gynecological infection.
• Recurrent and acute forms, caused by Candida albicans and Candida glabrata, present distinct clinical challenges.
• Understanding the local immune response, including protein content, secretory IgA (sIgA), and immune cells in cervicovaginal secretions, is crucial for managing these infections.

Purpose of the Study:

• To investigate and compare the cervicovaginal immune environment in women with acute and chronic Candida albicans vulvovaginitis, Candida glabrata vaginitis, and healthy controls.
• To analyze protein content, sIgA levels, immune cell presence, and IgA binding to yeast cells in relation to different candidiasis types.

Main Methods:

• Analysis of cervicovaginal secretions from 42 women with chronic recurrent Candida albicans, 20 with acute Candida albicans, and 14 with Candida glabrata vaginitis.
• Comparison with 77 healthy pre-menopausal women, 17 pregnant women, and 4 hysterectomized women.
• Utilized ELISA for protein and sIgA, immunofluorescence for immune cells and cell-bound IgA, and nephelometry for serum IgA.

Main Results:

• Women with acute and chronic Candida albicans vaginitis exhibited higher protein content in secretions due to inflammation, but sIgA was not elevated and decreased in chronic cases.
• Immune cell counts (macrophages, granulocytes) were not significantly increased in candidiasis patients compared to healthy controls.
• Candida glabrata vaginitis cases showed lower sIgA levels than healthy women and those with Candida albicans, with some IgA binding to yeast cells observed.

Conclusions:

• Inflammation in Candida albicans vulvovaginitis increases protein but not necessarily protective sIgA or immune cell infiltration.
• Chronic Candida albicans infections are associated with decreased sIgA, and Candida glabrata vaginitis shows a distinct pattern of lower sIgA.
• The findings suggest a complex local immune response in vaginal candidiasis, with reduced sIgA potentially contributing to chronicity or specific pathogen prevalence.