Interspecies differences of candida species causing recurrent vulvovaginal candidiasis in response to fluconazole treatment

Background: Looking at the increased incidence of recurrent vulvovaginal candidiasis and refractory resulting from such non-albicans Candida species in recent decades, this study was performed aiming the use of rapid biochemical and molecular detection of drug-resistant Candida species in response to fluconazole in patients with vulvovaginal candidiasis and recurrent vulvovaginal candidiasis. Methods: The cross-sectional study was performed at Kowsar Gynecology Center, Motahhari educational hospital and Medical Mycology Center, Faculty of Medicine, Urmia, Iran, from October 2013 to July 2015. Those patients referred to the clinic with symptoms of vaginal discharge, itching or burning that swab samples from endo-exocervix and distal fornix discharge were taken. The vaginal discharge samples submitted to Medical Mycology Center, Urmia School of Medicine for the direct microscopic examination and cultures. Identification at the level of species was performed using CHROMagar Candida and Corn meal agar media. The molecular test polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) used for confirming culture results. For the susceptibility assay, disc diffusion method was performed with fluconazole and clotrimazole. Results: In these study 198 samples collected from patients with symptoms of vulvovaginal candidiasis, 77 vulvovaginal candidiasis cases were identified. Candida species are common in primary and recurrent cases in terms of frequency, Candida albicans (85.7%), Candida krusei (10.2%) and Candida glabrata (4.1%) were identified respectively. Total of 27 cases of recurrent vulvovaginal candidiasis, 10 cases were resistant to both clotrimazole and fluconazole (37%) was observed that the most common species are resistant to treatment were Candida albicans by (82.1%), Candida krusei (14.3%) and Candida glabrata (3.6%) respectively. Drug resistance in Candida albicans, Candida krusei and Candida glabrata causing recurrent vulvovaginal candidiasis included 69.1%, 75% and 100% respectively. Conclusion: Our findings have shown frequency of resistant non-albicans Candida species to fluconazole and clotrimazole is increasing. There is a considerable difference between Candida albicans and non-albicans species, Candida glabrata for the resistance to fluconazole and clotrimazole