Vulvovaginal Candidiasis - Speciation and Antifungal Susceptibility Pattern in a Tertiary Care Hospital, Tirunelveli

Introduction: Vulvovaginal candidiasis (VVC) refers to a disorder characterized by signs and symptoms of vulvovaginal inflammation due to Candida species. Gram’s staining is performed to see the presence of yeast and pseudohyphae of Candida species. For systemic infection like candidemia, blood culture is done in a biphasic medium like brain-heart infusion agar-broth and incubated at both the temperatures. As drug resistance in Candida species is now very common, therefore, antifungal susceptibility testing should be performed. This study aims to determine the prevalence of various Candida species among vaginal candidiasis and to determine the antifungal susceptibility pattern of the isolates. Methodology: This is a prospective study with Candida isolates from high-vaginal swabs. The samples were screened for Candida by microscopy and culture. Speciation of the Candida isolates was done on Hi-CHROM Candida agar and susceptibility pattern was determined. All the swabs received were subject to microscopy with Gram staining. All the isolates were subjected to antifungal susceptibility testing on Modified Mueller-Hinton agar as per CLSI guidelines. The antifungal agents used were fluconazole, itraconazole, clotrimazole, nystatin and amphotericin-B. The susceptibility pattern was observed by the Kirby-Bauer disk diffusion method. Results: Of all the samples received at the laboratory of the Department of Microbiology, 63 showed Candida morphology and were plated on Hi-CHROM agar and their species was noted. Of the 63 Candida isolates, 27 were C. albicans (42.9%), 14 were C. glabrata (22.2%), 15 were C. dubliniensis (23.8%), 5 were C. parapsilosis (7.9%), C. krusei and C. tropicalis were 1 each (1.6%). Drug resistance was the most commonly noted in Candida albicans (14.8% of all C. albicans samples) than in other species. Conclusion: In our study, most drug resistant strains were of Candida albicans species, which poses a great threat of recurrences. Moreover, multi-drug resistance patterns have been noted to most commonly use antifungal drugs in Candida albicans strains than non-albicans species. This makes speciation and antifungal susceptibility a must in treatment of vulvovaginal candidiasis. Doing so will provide proper and complete cure to patients without recurrence due to ineffective antibiotic treatment.