Study of Azole Susceptibility and Virulence Patterns of Vulvovaginal Candida Species in Menoufia, Egypt

Background: Vulvovaginal candidiasis (VVC) is one of the most common forms of superficial fungal infections. Azoles are the first line antifungals used in the treatment and prevention of VVC. Objectives: This study aimed to determine the prevalence rate of VVC with evaluation of the potential risk factors. Also, to assess azoles susceptibility patterns with association to biofilm formation and to detect candidal virulence genes (HWP1, ALS1 and INT1) and ERG11 gene expression. Methodology: Evaluation of vaginal infection risk factors was achieved by a designed questionnaire. Candida strains isolated from high vaginal swab samples were identified up to species level by conventional methods. Assessment of antifungal susceptibility patterns (by disk diffusion method) and phenotypic detection of biofilm formation were also performed followed by molecular detection of virulence genes (HWP1, ALS1 and INT1) by multiplex PCR and ERG11 gene expression by real time PCR. Results: VVC represented 33.9% of vaginal infections. C. albicans was the predominant isolated species (62.4%). The highest resistance rate (40%) was observed to itraconazole and the lowest (12.9%) was to voriconazole. Biofilm formation rate was 51.8% by cultivation on Congo red agar and 57.6% by microtiter plate method. About, 79.6%, 71.4% and 81.6% of biofilm producers carried HWP1, ALS1 and INT1 virulence genes respectively. ERG11 gene Overexpression was detected in 31% of fluconazole resistant Candida isolates. Conclusion: Evaluation of VVC risk factors can help in the implementation of appropriate preventative measures. The elevated azoles resistance rates among Candida spp necessitates the critical need for new alternative therapeutic approaches