Low prevalence of antifungal resistant Candida africana, in the C. albicans complex causing vulvovaginal candidiasis

Abstract

The <i>Candida</i> (<i>C</i>.) <i>albicans</i> complex includes <i>C. albicans</i>, <i>C. dubliniensis</i>, <i>C. stellatoidea,</i> and <i>C. africana</i>, with the last mentioned as an important emerging agent of vulvovaginal candidiasis (VVC). The aim of the study was to identify <i>C. africana</i> and <i>C. dubliniensis</i> and assess their drug susceptibility in vaginitis. One-hundred <i>Candida</i> isolates of the <i>C. albicans</i> complex from women diagnosed with vaginitis and from vaginal samples in the culture collection of a medical mycology laboratory were examined. Species of the <i>C. albicans</i> complex were identified with conventional and molecular methods using polymerase chain reaction (PCR) for amplification and sequencing of the internal transcribed spacer (ITS) region, PCR for partial amplification of hyphal wall protein 1 (<i>HWP1</i>) gene and duplex PCR. The effects of antifungal drugs were evaluated according to standard broth microdilution protocols. Ninety-<i>seven C. albicans</i> (97%) and three <i>C. africana</i> (3%) isolates were identified. Results of susceptibility testing revealed one isolate of <i>C. africana</i> to be resistant to both clotrimazole and fluconazole, and one showed reduced susceptibility to itraconazole. Identification of <i>Candida</i> species especially <i>C. africana</i> in vaginitis is crucial, there are varying levels of resistance to antifungal drugs.