Recurrent vulvovaginal candidiasis: different aspects of Candida-host interaction

MIRÓ MS, ABIEGA C, ICELY PA, RIERA F, ARBACH F, GRUTADAURIA MG, VIGEZZI C, RODRIGUEZ E, CAEIRO JP Y SOTOMAYOR CE

Curitiba

Congreso; INFOCUS; 2014

Asociación Latinoamericana de Infectologia

Vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC) are two forms of a disease that affects a large number of otherwise healthy women caused by Candida species. Up to 8% of all VVC patients suffer from RVVC characterized by more than three episodes each year. The factors that determine which women will undergo the transition from sporadic VVC to RVVC are still undefined. Resistance to antifungal agents and varied virulence factors contribute to fungal pathogenicity. The aim of this study was to evaluate different aspects of this pathology such as: predisposing factors, Candida species, fungal susceptibility, production of virulence factors and in vitro response of genital tract epithelial cells against clinical isolates. The study was performed in 29 patients with RVVC, 66% didn?t have any risk factors, 21% contraceptive usage, 3% antibiotics therapy, 7% mixed factors and 3% other factors. Yeast identification by Maldi-Tof revealed that from all isolated strains 93% were C. albicans and 7% C. guilliermondii. All strains were sensitive to Amphotericin B and Fluocytosine, 94% to Voriconazole and 89% to Fluconazole (Vitek2 Compact). Relevant virulence factors during Candida infection are the secretion of hydrolytic enzymes as lipase (LIP) and the ability to form biofilm. As the role of LIP remains unexplored in CVVR, we studied LIP transcriptional profile (RT-PCR) and biofilm formation (XTT assay), in clinical isolates compared with C. albicans-ATCC 36801. All strains amplified transcripts of LIP4, 6 and 9, meanwhile LIP 5 and 7 are not expressed in all isolates. Reactive Oxygen Species (ROS) are fungicidal metabolites produced by the host cells against fungus. In address to evaluate the response of genital tract cells against clinical strains, a cervicovaginal human epithelial cell line (Hela) was incubated with C. albicans at a fungus:cell ratio of 5:1 during 4 and 24h. All isolates stimulated ROS production (NBT assay) with increased level after 24h of culture (p