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Candida parapsilosis Sensu Stricto and the Closely Related Species Candida orthopsilosis and Candida metapsilosis in Vulvovaginal Candidiasis

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Abstract

This study aimed to determine the clinical characteristics and in vitro susceptibilities of Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis isolates from patients with vulvovaginal candidiasis (VVC). We analysed 63 vaginal C. parapsilosis specimens. After the molecular analyses, the isolates were characterised as C. parapsilosis sensu stricto (77.8 %), C. orthopsilosis (7.9 %) and C. metapsilosis (14.3 %). The signs and symptoms of VVC caused by C. parapsilosis sensu lato, including itching, erythema and abnormal discharge, were milder than those caused by C. albicans. None of the C. parapsilosis sensu lato isolates were resistant to fluconazole, miconazole or itraconazole. The resistance rates of C. albicans to fluconazole, itraconazole, miconazole and clotrimazole were 2.3, 1.5, 3.1 and 0.8 %, respectively. Both C. parapsilosis sensu lato and C. albicans were susceptible to nystatin. The mycological eradication rate at follow-up days 7–14 and 30–35 were 77.8 % (49/63) and 76.2 % (48/63), respectively, when treated with various antifungal agents and regimens. We conclude that C. parapsilosis sensu stricto and the closely related species C. orthopsilosis and C. metapsilosis were present in the vaginal samples of VVC patients. The symptoms and signs of VVC caused by C. parapsilosis are milder than those caused by C. albicans. The antifungal susceptibility and therapeutic efficacy in patients colonised by C. parapsilosis sensu lato were similar to those observed in C. albicans-colonised patients.

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References

  1. Richter SS, Galask RP, Messer SA, Hollis RJ, Diekema DJ, Pfaller MA. Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases. J Clin Microbiol. 2005;43:2155–62.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Sobel JD. Vulvovaginal candidosis. Lancet. 2007;369:1961–71.

    Article  PubMed  Google Scholar 

  3. Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59:1–110.

    PubMed  Google Scholar 

  4. Trama JP, Adelson ME, Raphaelli I, Stemmer SM, Mordechai E. Detection of Candida species in vaginal samples in a clinical laboratory setting. Infect Dis Obstet Gynecol. 2005;13:63–7.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Gross NT, Arias ML, Moraga M, Baddasarow Y, Jarstrand C. Species distribution and susceptibility to azoles of vaginal yeasts isolated prostitutes. Infect Dis Obstet Gynecol. 2007:82412.

  6. Silva S, Negri M, Henriques M, Oliveira R, Williams DW, Azeredo J. Candida glabrata, Candida parapsilosis and Candida tropicalis: biology, epidemiology, pathogenicity and antifungal resistance. FEMS Microbiol Rev. 2012;36:288–305.

    Article  CAS  PubMed  Google Scholar 

  7. Miranda-Zapico I, Eraso E, Hernández-Almaraz JL, López-Soria LM, Carrillo-Muñoz AJ, Hernández-Molina JM, Quindós G. Prevalence and antifungal susceptibility patterns of new cryptic species inside the species complexes Candida parapsilosis and Candida glabrata among blood isolates from a Spanish tertiary hospital. J Antimicrob Chemother. 2011;66:2315–22.

    Article  CAS  PubMed  Google Scholar 

  8. Goswami D, Goswami R, Banerjee U, Dadhwal V, Miglani S, Lattif AA, Kochupillai N. Pattern of Candida species isolated from patients with diabetes mellitus and vulvovaginal candidiasis and their response to single dose oral fluconazole therapy. J Infect. 2006;52:111–7.

    Article  PubMed  Google Scholar 

  9. Paulitsch A, Weger W, Ginter-Hanselmayer G, Marth E, Buzina W. A 5-year (2000–2004) epidemiological survey of Candida and non-Candida yeast species causing vulvovaginal candidiasis in Graz, Austria. Mycoses. 2006;49:471–5.

    Article  CAS  PubMed  Google Scholar 

  10. Rad MM, Zafarghandi S, Abbasabadi B, Tavallaee M. The epidemiology of Candida species associated with vulvovaginal candidiasis in an Iranian patient population. Eur J Obstet Gynecol Reprod Biol. 2011;155:199–203.

    Article  Google Scholar 

  11. Pemán J, Cantón E, Quindós G, Eraso E, Alcoba J, Guinea J, Merino P, Ruiz-Pérez-de-Pipaon MT, Pérez-del-Molino L, Linares-Sicilia MJ, Marco F, García J, Roselló EM, Gómez-G-de-la-Pedrosa E, Borrell N, Porras A, Yagüe G, FUNGEMYCA Study Group. Epidemiology, species distribution and in vitro antifungal susceptibility of fungaemia in a Spanish multicentre prospective survey. J Antimicrob Chemother. 2012;67:1181–7.

    Article  PubMed  Google Scholar 

  12. Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Ellis D, Tullio V, Rodloff A, Fu W, Ling TA, Global Antifungal Surveillance Group. Results from the ARTEMIS DISK global antifungal surveillance study, 1997 to 2007: a 10.5-year analysis of susceptibilities of Candida Species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion. J Clin Microbiol. 2010;48:1366–77.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Nyirjesy P, Alexander AB, Weitz MV. Vaginal Candida parapsilosis: pathogen or bystander? Infect Dis Obstet Gynecol. 2005;13:37–41.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Trofa D, Gácser A, Nosanchuk JD. Candida parapsilosis, an emerging fungal pathogen. Clin Microbiol Rev. 2008;21:606–25.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Tavanti A, Davidson AD, Gow NA, Maiden MC, Odds FC. Candida orthopsilosis and Candida metapsilosis spp. nov. to replace Candida parapsilosis groups II and III. J Clin Microbiol. 2005;43:284–92.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Tavanti A, Hensgens LA, Ghelardi E, Campa M, Senesi S. Genotyping of Candida orthopsilosis clinical isolates by amplification fragment length polymorphism reveals genetic diversity among independent isolates and strain maintenance within patients. J Clin Microbiol. 2007;45:1455–62.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. van Asbeck E, Clemons KV, Stevens DA. Candida parapsilosis: a review of its epidemiology, pathogenesis, clinical aspects, typing and antimicrobial susceptibility. Crit Rev Microbiol. 2009;35:283–309.

    Article  PubMed  Google Scholar 

  18. Lin D, Wu LC, Rinaldi MG, Lehmann PF. Three distinct genotypes within Candida parapsilosis from clinical sources. J Clin Microbiol. 1995;33:1815–21.

    CAS  PubMed Central  PubMed  Google Scholar 

  19. Feng X, Ling B, Yang G, Yu X, Ren D, Yao Z. Prevalence and distribution profiles of Candida parapsilosis, Candida orthopsilosis and Candida metapsilosis responsible for superficial candidiasis in a Chinese university hospital. Mycopathologia. 2012;173:229–34.

    Article  PubMed  Google Scholar 

  20. Ge YP, Boekhout T, Zhan P, Lu GX, Shen YN, Li M, Shao HF, Liu WD. Characterization of the Candida parapsilosis complex in East China: species distribution differs among cities. Med Mycol. 2012;50:56–66.

    Article  CAS  PubMed  Google Scholar 

  21. Bertini A, De Bernardis F, Hensgens LA, Sandini S, Senesi S, Tavanti A. Comparison of Candida parapsilosis, Candida orthopsilosis, and Candida metapsilosis adhesive properties and pathogenicity. Int J Med Microbiol. 2013;303:98–103.

    Article  CAS  PubMed  Google Scholar 

  22. Lockhart SR, Messer SA, Pfaller MA, Diekema DJ. Geographic distribution and antifungal susceptibility of the newly described species Candida orthopsilosis and Candida metapsilosis in comparison to the closely related species Candida parapsilosis. J Clin Microbiol. 2008;46:2659–64.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Singaravelu K, Gácser A, Nosanchuk JD. Genetic determinants of virulence-Candida parapsilosis. Rev Iberoam Micol. 2014;31(1):16–21.

  24. Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Ng KP, Colombo A, Finquelievich J, Barnes R, Wadula J, Global Antifungal Surveillance Group. Geographic and temporal trends in isolation and antifungal susceptibility of Candida parapsilosis: a global assessment from the ARTEMIS DISK Antifungal Surveillance Program 2001 to 2005. J Clin Microbiol. 2008;46:842–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Gomez-Lopez A, Alastruey-Izquierdo A, Rodriguez D, Almirante B, Pahissa A, Rodriguez-Tudela JL, Cuenca-Estrella M, Barcelona Candidemia Project Study Group. Prevalence and susceptibility profile of Candida metapsilosis and Candida orthopsilosis: results from population-based surveillance of candidemia in Spain. Antimicrob Agents Chemother. 2008;52:1506–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Gonçalves SS, Amorim CS, Nucci M, Padovan AC, Briones MR, Melo AS, Colombo AL. Prevalence rates and antifungal susceptibility profiles of the Candida parapsilosis species complex: results from a nationwide surveillance of candidaemia in Brazil. Clin Microbiol Infect. 2010;16:885–7.

    Article  PubMed  Google Scholar 

  27. Chen YC, Lin YH, Chen KW, Lii J, Teng HJ, Li SY. Molecular epidemiology and antifungal susceptibility of Candida parapsilosis sensu stricto, Candida orthopsilosis, and Candida metapsilosis in Taiwan. Diagn Microbiol Infect Dis. 2010;68:284–92.

    Article  CAS  PubMed  Google Scholar 

  28. van Asbeck E, Clemons KV, Martinez M, Tong AJ, Stevens DA. Significant differences in drug susceptibility among species in the Candida parapsilosis group. Diagn Microbiol Infect Dis. 2008;62:106–9.

    Article  PubMed  Google Scholar 

  29. Fan SR, Liu XP. In vitro fluconazole and nystatin susceptibility and clinical outcome in complicated vulvovaginal candidosis. Mycoses. 2011;54(6):501–5.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This research was supported by Shenzhen Science and Technology Grants 200702108, 200703031 and 20120320020.

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Authors have no conflicts of interest with the content of this article.

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Correspondence to Shangrong Fan.

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Yuxia Zhu and Yingying Shan have contributed equally to this study.

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Zhu, Y., Shan, Y., Fan, S. et al. Candida parapsilosis Sensu Stricto and the Closely Related Species Candida orthopsilosis and Candida metapsilosis in Vulvovaginal Candidiasis. Mycopathologia 179, 111–118 (2015). https://doi.org/10.1007/s11046-014-9821-x

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  • DOI: https://doi.org/10.1007/s11046-014-9821-x

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