Candidíase vulvovaginal na população do Recôncavo Baiano: prevalência, diagnóstico e suscetibilidade à antifúngicos

Abstract

Vulvovaginal candidiasis is the second most common vulvovaginitis affecting women, with uncomfortable clinical complaints that can impact their quality of life. However, empirical treatment, without knowledge of the resistance profile of the fungal species that cause this community-acquired infection, has allowed albicans and non-albicans species to develop resistance to commonly used antifungals. In addition, the lack of epidemiological monitoring of fungal species and their resistance to antimicrobials may be associated with complications in clinical cases of vulvovaginal candidiasis. Furthermore, there is a lack of studies on vulvovaginal candidiasis in the Recôncavo Baiano region, allowing therapeutic approaches to be established in accordance with national and international standards. Therefore, the aim of this study was to define the epidemiological profile and clinical and laboratory aspects of vulvovaginal candidiasis in the Recôncavo Baiano region.. To this end, cervical-vaginal samples were collected from women who sought care at the Basic Health Units in the municipalities of Cruz das Almas, Sapeaçu and Governador Mangabeira, for Pap smears. Clinical data was extracted from the information described by the nursing professional, responsible for the collection, in the Cytopathological Examination Requisition. Conventional cytology slides were made and then stained using the Papanicolaou technique, while swabs containing the sample were sown on Sabouraud Dextrose Agar with chloramphenicol to isolate yeasts. Gram staining and PCR-RFLP tests were used to identify the yeast species. Antifungal tests were carried out to determine the sensitivity profile to fluconazole, itraconazole, miconazole, nystatin, clotrimazole and ketoconazole. Fisher's exact test was used to determine associations, while the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the Pap test were calculated using culture as the gold standard. The Pap test was associated with vulvovaginal candidiasis, with a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 32%, 100%, 100%, 88,8% and 89,4%, respectively, when compared to the mycological culture test. C. albicans was the most isolated species (64%), followed by Nakaseomyces glabratus, C. parapsilosis, C. tropicalis, Meyerozyma guilliermondii and Pichia kudriavzevii. Pruritus and bleeding were signs and symptoms associated with vulvovaginal candidiasis when the etiological agent isolated was C. albicans. Itraconazole and miconazole were the antifungals that showed the greatest variability in the sensitivity profile, but the only case of resistance was reported by N. glabratus to itraconazole. Pap smears are an important strategy for the early diagnosis of vulvovaginal candidiasis, especially within the Unified Health System, where more complex laboratory tests are not always available. The prevalence of non-albicans species in this study demonstrates the relevance of epidemiological research to monitor changes in the distribution of C. albicans species to non-albicans species. Although antifungal drugs still appear to be active against the yeast isolates identified, changes in the sensitivity profile of non-albicans species may indicate a need to search for alternative antifungal drugs in the treatment of vulvovaginal candidiasis