Prevalence & susceptibility to fluconazole of Candida species causing vulvovaginitis

Background & objectives: Vulvovaginal candidiasis is an important cause of morbidity in women of reproductive age. This study was carried out to determine the species prevalence and susceptibility pattern to fluconazole of yeasts isolated from the vagina of symptomatic women. Methods: This prospective study was conducted in a rural primary health care center of north India from May 2003 to April 2004 and included 601 married, sexually active women (18-49 yr) with the self reported symptoms of vaginal discharge and/or genital itching and/or genital burning. Specific aetiology of the genitourinary symptoms including candidal infection were determined. Specimens from the lateral wall of vagina were subjected to direct wet mount microscopy and fungal culture on Sabouraud's dextrose agar. Susceptibility testing to fluconazole was carried out using broth microdilution method. Results: Yeasts were isolated in 111 (18.5%) women and these consisted of Candida glabrata (56, 50.4%), C albicans (39, 35.1%), C. tropicalis (12,10.8%), C. krusei (3, 2.7%) and C parapsilosis (1, 0.9%). Susceptibility testing carried out on 30 representative isolates (15 C glabrata, 10 C albicans, 4 C. tropicalis and 1 C. parapsilosis) revealed that 21 isolates (70%) were susceptible (MIC, <= 8 mu g/ ml) to fluconazole while 9 (30%) were susceptible-dose dependent (S-DD, MIC 16-32 mu g/ml). Interpretation & conclusion: Our findings suggest a low prevalence of fluconazole resistance in vaginal candida isolates in our population. However, a high prevalence of non-albicans candida species and increased dose-dependent resistance in these isolates necessitates vigilance since this may warrant a change in the optimal therapy of non-albicans candida vaginitis.