Vulvovaginal Candidiasis in Pregnant Women and Susceptibility Profile to Fluconazole and Voriconazole

Shaista Syed; Muhammad Irfan Khan; Mukesh Kumar; Sayed Raheel Hashmi; Muhammad Anwar; Lubna Razaq

Shaista Syed Microbiologist, Incharge Laboratory, Abbasi Shaheed Hospital KMC, Karachi
Muhammad Irfan Khan Associate Professor, Pathology Department, SMBBMC Lyari, Karachi
Mukesh Kumar Assistant Professor, Pathology Department SMBBMC, Karachi
Sayed Raheel Hashmi Public Health Specialist, Sindh Government Hospital New Karachi
Muhammad Anwar Associate Professor, Department of Pathology BMSI, Jinnah Postgraduate Medical Center Karachi
Lubna Razaq Senior lecturer, Al-Tibri Medical college & hospital Isra university Karachi Campus

Keywords: Vulvovaginal candidiasis, Species, Fluconazole, Voriconazole

Abstract

Objective: To evaluate the prevalence of vulvovaginal candidiasis (VVC) among pregnant women, identify the species of candida responsible for infections, and evaluate their susceptibility to antifungal agents, specifically fluconazole and voriconazole.

Methodology: The study was conducted at the Department of Microbiology at Basic Medical Sciences Institute (BMSI), in collaboration with the Gynaecology Outpatient Department at Jinnah Postgraduate Medical Centre (JPMC), Karachi from Feb 2021 to Oct 2022. All pregnant patients suspected of vulvovaginal candidiasis irrespective of age have been included. After taking informed vaginal swabs were collected and analyzed for Candida species using Gram staining and antifungal susceptibility testing via disk diffusion on Mueller-Hinton agar. Statistical analysis was done using SPSS version 26

Results: Overall mean age was 27 years. Among 323 patients, 88% belonged to lower socioeconomic classes, and 38% were in their first trimester. Candida albicans was the most common species (88%), followed by C. glabrata (8%) and C. krusei (4%). Antifungal susceptibility showed resistance to fluconazole in 57% of C. albicans, 81% in C. glabrata, and 100% in C. krusei. C. albicans and C. glabrata were more susceptible to voriconazole (85% and 69%, respectively)

Conclusion: A high prevalence of VVC observed among pregnant women, with Candida albicans being the most frequently isolated species, followed by C. glabrata and C. krusei. There was a significant antifungal resistance, especially to fluconazole, in C. albicans and C. glabrata, with C. krusei exhibiting complete resistance to fluconazole. Voriconazole found to be the better effective across all Candida species.