Abstract
Prevalence and Antimicrobial Susceptibility Profiles of Candida and Trichomonas vaginalis in South African Women
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Background: Vaginal infections, or inflammation of the vulva and vagina, are associated with symptoms of vaginal discharge, odor, irritation, or burning, and most commonly occur secondary to infectious agents. This study aimed to investigate the prevalence of Trichomonas vaginalis and Candida infections in women from Durban, South Africa, and to investigate antimicrobial susceptibility profiles of these pathogens.
Methods: The identity of the Candida isolates was confirmed using the Applied Biosystems TaqMan® Assay. Susceptibility testing of the Candida isolates was performed using the Sensititre™ YeastOne™ YO10 AST Plate (to determine the minimal inhibitory concentrations (MICs) for C. albicans isolates to fluconazole, anidulafungin, micafungin, voriconazole, and caspofungin. T. vaginalis was detected using the Applied Biosystems TaqMan® Assay. Nitroreductase genes (ntr4 and ntr6) associated with resistance to metronidazole in T. vaginalis were amplified by quantitative PCR.
Results: From the 150 vaginal swabs which were cultured, Candida was recovered from 72 swabs, estimating a prevalence of 48%. Women who were pregnant were 4.49 times more likely to test positive for Candida [(odds ratio [OR]: 4.49; 95% CI 1.37-14.71; p=0.013). Women who were HIV positive were 2.93 times more likely to test positive for Candida (OR: 2.93; 95% CI 1.07-8.03; p=0.036). The highest number of resistant isolates were obtained for Fluconazole, (14%) when compared to 86% which were susceptible. A total of 8% (12/150) of the women tested positive for T. vaginalis infection from uncultured vaginal swabs. The ntr4 gene carrying the C213G mutation associated with metronidazole resistance was present in 33.33% (4/12) of the T. vaginalis samples. The ntr6 gene with the A238T mutation associated with metronidazole resistance was present in 33.33% (4/12) of the samples.
Conclusion: This study observed a high prevalence of Candida and T. vaginalis in women attending the King Edward Hospital. Thus, routine testing for vaginal infections is needed for the proper management of these infections.
Keywords: Candida, T. vaginalis, Real-time PCR
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