The Impact of Antifungal Agents on the Morphology Dimorphism of Vaginal Candida Albicans
Keywords:Candida albicans, the yeast form, the mycelial form, antifungal susceptibility.
Objective: To compare the MICs of the five antifungal agents against Candida albicans isolated from patients with vulvovaginal candidiasis (VVC) in yeast form and in mycelial form. Method: 60 Candida organisms were cultured from samples obtained from patients with VVC of the Gynecology outpatient. Antifungal susceptibility testing was performed using the broth microdilution (BMD) method (CLSI, document M27-A2) of five agents. Results: The MIC values of miconazole and nystatin against C. albicans in mycelial form were significantly higher than those in yeast form, while the MIC of itraconazole against C. albicans in mycelial form was lower than those in yeast form (P<0.01). MIC values of clotrimazole and fluconazole showed no difference between the two forms (P>0.05). The susceptibility rate of the C. albicans in mycelia form (98.3%) to itraconazole was significantly higher than that in yeast form (51.7%). In yeast form, the susceptibility rate of C. albicans to itraconazole was significantly lower than that of fluconazole (51.7%, 100%). In mycelial form, the susceptibility rate of the two azoles were similar (98.3%, 100.0%). Conclusion: The mycelial form of C. albicans was more sensitive to itraconazole than the yeast form. All the azole agents had a good antifungal activity to the mycelium.
Sobel JD. Vulvovaginal candidosis. Lancet 2007; 369 (9577): 1961-1971. http://dx.doi.org/10.1016/S0140-6736(07)60917-9
Torosantucci A, Chiani P, Cassone A. Differential chemokine response of human monocytes to yeast and hyphal forms of Candida albicans and its relation to the -1,6 glucan of the fungal cell wall. J Leukoc Biol 2000; 68(6): 923-932.
Gow NA. Germ tube growth of Candida albicans. Curr Top Med Mycol 1997; 8(1-2): 43-55.
M27-A2 Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of yeasts; approved standard. 2nd ed. 2002; 22(15): 1-30.
Wakabayashi H, Abe S, Teraguchi S, Hayasawa H, Yamaguchi H. Inhibition of hyphal growth of azole-resistant strains of candida albicans by triazole antifungal agents in the presence of lactoferrin-related compounds. Antimicrob Agents Chemother 1998; 42(7): 1587-1591.
Chandra J, Kuhn DM, Mukherjee PK, Hoyer LL, McCormick T, Ghannoum MA. Biofilm formation by the fungal pathogen Candida albicans: development, architecture, and drug resistance. J Bacteriol 2001; 183(18): 5385-5394. http://dx.doi.org/10.1128/JB.183.18.5385-5394.2001
Calderone RA, Braun PC. Adherence and receptor relationships of Candida abicans. Microbiol Rev 1991; 55(1): 1-20.
Prakash P, Solanki A, Joshi KR. A simple synthetic liquid medium for development of yeast and mycelial form of pathogenic species of Candida. Indian J Pathol Microbiol 1997; 40(1): 55-58.
Barone JA, Koh JG, Bierman RH, Colaizzi JL, Swanson KA, Gaffar MC, et al. Food interaction and steadystate pharmacokinefies of itraconazole capsules in healthy male volunteers. Antimicrob Agents Chemother 1993; 37(4): 778- 784. http://dx.doi.org/10.1128/AAC.37.4.778
De Punzio C, Garutti P, Mollica G, Nappi C, Piccoli R, Genazzani AR. Fluconazole 150 mg single dose wersus itraconazole 200 mg per day for 3 days in the treatment of acute vaginal candidiasis: a double-blind randormized study. Eur J Obstet Gynecol Reprod Biol 2003; 106(2): 193-197. http://dx.doi.org/10.1016/S0301-2115(02)00233-6
Fan SR, Liu XP, Li JW. Clinical characteristics of vulvovaginal candidiasis and antifungal susceptibilities of Candida species isolates among patients in southern China from 2003 to 2006. J Obstet Gynaecol Res 2008; 34(4): 561-566. http://dx.doi.org/10.1111/j.1447-0756.2008.00817.x
Shibata N, Suzuki A, Kobayashi H, Okawa Y. Chemical structure of the cell-wall mannan of Candida albicans serotype A and its difference in yeast and hyphal forms. Biochem J 2007; 404(3): 365-372. http://dx.doi.org/10.1042/BJ20070081