Analysis of Сandida species distribution isolated from women with vulvovaginal candidiasis and their antifungal susceptibility profile


  • O.S. Burduniuc Microbiology Laboratory, National Agency for Public Health, Republic of Moldova; Departament of Microbiology and Immunology, Nicolae Testemitanu State University of Medicine and Pharmacy, Republic of Moldova
  • E.I. Bîrcă Private medical laboratory MedExpert, Republic of Moldova
  • A.M. Burduniuc Faculty of medicine in Hradec Kralove, Charles University in Prague, Czech Republic
  • M.V. Bivol Microbiology Laboratory, National Agency for Public Health, Republic of Moldova
  • O.S. Iacon Microbiology Laboratory, National Agency for Public Health, Republic of Moldova



Candida non-albicans, Candida albicans, VVC, antifungal agents


Background. Candida species is usually a commensal fungus residing in the vagina, in about 30 %–50 % of healthy adults and remains the most common agent isolated from clinical samples of patients diagnosed with vulvovaginal candidiasis (VVC). Culture is not recommended for all patients on a routine basis but is informative for the exclusion of non-albicans infections resistant to azoles, or recurrent VVC. Identification of Candida species and antifungal susceptibility testing are key elements in the correct management of recurrent VVC. The authors of this paper aimed to study the spectrum of pathogenic Candida species. The antifungal sensitivity patterns of the isolated strains during the years 2017-2019 are also presented. Material and methods. A descriptive study of Candida species distribution and antifungal susceptibility profile was performed. Identification of isolated Candida species was performed by the MALDI-TOF MS, bacterial strains by Vitek 2 automated system (BioMérieux) and antifungal susceptibility profiles by Fungitest (Bio-Rad). Results. Of the 1030 recovered strains, C. albicans species predominated - 83.8% and Candida non albicans -16.2%. The most common species of the Candida non-albicans, were C.glabrata (7.5%). Also, it was observed that in 56.6% of the cases C. albicans presented bacterial associations. The most common microbial association was C. albicans and S.aureus (26.6%), followed by C. albicans and E.coli (20.8%). Candida spp. showed moderate antifungal resistance. The resistance rate of C. albicans isolates to miconazole, fluconazole and itraconazole was 25.5%, 17.0% and 11.4% compared to non-albicans Candida strains which showed a resistance rate of 10,8%, 14.4% and 10%, respectively. Conclusions. C. albicans is the most frequently isolated species among patients with VVC, but there is also an increase share of non-albicans Candida species such as C. glabrata. C. albicans isolates showed higher indices of resistance, than Candida non-albicans.


Höfs S, Mogavero S, Hube B. Interaction of Candida albicans with host cells: virulence factors, host defense, escape strategies, and the microbiota. J Microbiol. 2016; 54: 149-169.

Fidel PL. History and new insights into host defense against vaginal candidiasis. Trends Microbiol. 2004 May;12(5):220-7. doi: 10.1016/j.tim.2004.03.006. PMID: 15120141.

Aballéa S, Guelfucci F, Wagner J et al. Subjective health status and health-related quality of life among women with recurrent vulvovaginal candidosis (RVVC) in Europe and the USA. Health Qual Life Outcomes. 2013; 11: 169.

Foxman B, Barlow R, D'Arcy H, Gillespie B, Sobel JD. Candida vaginitis: self-reported incidence and associated costs. Sex Transm Dis. 2000; 27: 230- 235.

Sobel JD. Vulvovaginal candidosis. Lancet. 2007; 369: 1961- 1971.

Jacob L, John M, Kalder M, Kostev K. Prevalence of vulvovaginal candidiasis in gynecological practices in Germany: a retrospective study of 954,186 patients. Curr Med Mycol. 2018; 4: 6- 11.

Geiger AM, Foxman B, Gillespie BW. The epidemiology of vulvovaginal candidiasis among university students. American Journal of Public Health. 1995;85(8):1146–1148.

Chowdhary A, Meis J. Antifungal resistance in clinically significant fungi. Fungal Genetics and Biology 139:103369 DOI: 10.1016/j.fgb.2020.103369.

Fidel PL, Cutright J, Steele C. Effects of reproductive hormones on experimental vaginal candidiasis. Infect Immun 2000;68:651-7.

Gonçalves B, Ferreira C, Alves CT, Henriques M, Aze­redo J, Silva S. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Crit Rev Microbiol. 2016;42(6):905-927. doi:10.3109/1040841X.2015.1091805.

Richter SS, Galask RP, Messer SA, Hollis RJ, Diekema DJ, Pfaller MA. Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases. J Clin Microbiol. 2005; 43: 2155- 2162.

Grigoriou O, Baka S, Makrakis E, Hassiakos D, Kapparos G, Kouskouni E. Prevalence of clinical vaginal candidiasis in a university hospital and possible risk factors. Eur J Obstet Gynecol Reprod Biol. 2006; 126: 121- 125.

Makanjuola O, Bongomin F, Fayemiwo SA. An Update on the Roles of Non-albicans Candida Species in Vulvovaginitis. J Fungi (Basel). 2018 Oct 31;4(4):121. doi: 10.3390/jof4040121. PMID: 30384449; PMCID: PMC6309050.

Ferris DG, Nyirjesy P, Sobel JD, Soper D, Pavletic A, Litaker MS. Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstet Gynecol. 2002; 99: 419- 425.

Mendling W, Brasch J. German Society for Gyneco­logy and Obstetrics. Guideline vulvovaginal candidosis (2010) of the German Society for Gynecology and Obstetrics, the Wor­king Group for Infections and Infectimmunology in Gynecology and Obstetrics, the German Society of Dermatology, the Board of German Dermatologists and the German Speaking Mycological Society. Mycoses. 2012;55:Suppl 3:1. doi: 10.1111/j.1439-0507.2012.02185.

Rathod SD, Klausner JD, Krupp K, Reingold AL, Madhivanan P. Epidemiologic features of Vulvovaginal Candidiasis among reproductive-age women in India. Infect Dis Obstet Gynecol. 2012;2012:859071. doi:10.1155/2012/859071.

Colombo AL, Guimarães T, Aranha LF. Brazilian guidelines for the management of candidiasis - a joint meeting report of three medical societies: Sociedade Brasileira de Infectologia, Sociedade Paulista de Infectologia and Sociedade Brasileira de Medicina Tropical. Braz J Infect Dis vol.17 no.3 Salvador May/June 2013.

Diba K, Namaki A, Ayatolahi H, Hanifian H. Rapid identification of drug resistant Candida species causing recurrent vulvovaginal candidiasis. Med Mycol J. 2012;53:193.

Weissenbacher T, Witkin SS, Ledger WJ. Relationship between clinical diagnosis of recurrent vulvovaginal candidiasis and detection of Candida species by culture and polymerase chain reaction. Arch Gynecol Obstet. 2009;279:125. doi: 10.1007/s00404-008-0681-9.

Доброхотова ЮЭ, Боровкова ЕИ, Бондаренко КР. Кандидозный вульвоваги-нит: состояние изученности проблемы. Российский вестник акушера-гинеколога. 2017;17(3):108-111.

Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA. 2004; 291:1368–1379. doi: 10.1001/jama.291.11.1368.

Ahmad A, Khan AU. Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India. Eur J Obstet Gynecol Reprod Biol. 2009;144:68–71. doi: 10.1016/j.ejogrb.2008.12.020.

Olowe OA, Makanjuola OB, Olowe R, Adekanle DA. Prevalence of vulvovaginal candidiasis, trichomoniasis and bacterial vaginosis among pregnant women receiving antenatal care in Southwestern Nigeria. Eur J Microbiol Immunol. 2014;4:193–197. doi: 10.1556/EUJMI-D-14-00027.

Sobel JD. Candida vulvovaginaitis. Clin Obstet Gynecol. 1993.36:153-65. 9.

Sobel JD, Chaim W. 1997. Treatment of Torulopsis glabrata vaginitis: A retrospective review of boric acid therapy. Clin Infect Dis 24:649-52. 10.

Spinillo A, Capuzzo E, Gulminetti R et al. Prevalence of and risk factors for fungal vaginitis caused by non-albicans species. Am J Obstet Gynecol. 1997.176:138-41.

Singh S, Sobel JD, Bhargava P, Boikov D, Vazquez JA. Vaginitis due to Candida krusei: Epidemiology, clinical aspects, and therapy. Clin. Infect. Dis. 2002;35:1066–1070. doi: 10.1086/343826.