Investigation of virulence factors and fluconazole resistance in strains isolated from candidal vaginitis in physiological menopausal and hysterectomized women: Candidal vaginitis and fluconazole resistance

Ertan Özyurt; Nil Türkölmez; Nilgün  Çerikçioğlu

doi:10.5281/zenodo.8151896

Authors

Ertan Özyurt Marmara University Faculty of Medicine, Department of Medical Microbiology Istanbul, Turkey https://orcid.org/0000-0002-5832-4652
Nil Türkölmez Gebze Technical University Department of Molecular Biology and Genetics, İzmit, Turkey https://orcid.org/0000-0001-9377-3747
Nilgün Çerikçioğlu Marmara University Faculty of Medicine, Department of Medical Microbiology, İstanbul, Turkey https://orcid.org/0000-0002-7554-4366

DOI:

https://doi.org/10.5281/zenodo.8151896

Keywords:

Fluconazole, menopause, phenotypic switching, vulvovaginal candidiasis

Abstract

Objective: This research aims to evaluate the role of virulence factors of Candida species in vulvovaginal candidiasis (VVC).

Methods: In this research, Candida isolates obtained from physiological menopausal (n=30) and hysterectomized (n=30) women who were prediagnosed with VVC were collected for two years and identified according to conventional methods and API ID 32C assimilation profiles. The study examined the secreted acid proteinase (SAP) and phospholipase activities, slime production and phenotypic switching properties of these strains. In addition, the associations between these factors and possible resistance against fluconazole were investigated.

Results: The most commonly observed phenotypic switching pattern of strains was the “dwarf smooth” (DO) phenotype. Six strains (20%) in the physiological menopausal group and 13 in the hysterectomized group (43.3%) formed DO colonies. SAP activities, slime production of Candida isolates and phenotypic switching did not show statistically significant differences (p>0.05). The relationship between the number and production levels of phospholipase-producing strains and the phenotypic switching frequency was significant in the hysterectomized group compared to the physiological menopause group (p<0.05). All five strains with DO-forming ratios of ≤90% expressed at least one of the other virulence factors, whereas half of the 14 strains forming DO colonies at high ratios (91-100%) produced none of the other virulence factors. With an increase in the DO phenotypic switching ratio, the fluconazole MIC values (≥4 µg/mL) were also increased (p<0.001).

Conclusion: The phenotypic switching ability of Candida sp. may be an important factor in the pathogenesis of VVC and may lead to unresponsiveness to treatment.

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