Abstract：
BACKGROUND: Recurrent vulvovaginal candidiasis (RVVC) is an important and underestimated fungal infection.
OBJECTIVE: We aimed to determine the fungicidal and proliferative capacities of neutrophils and peripheral blood mononuclear cells (PBMCs), respectively and the clinical and microbiological characteristics of a cohort of Colombian patients diagnosed with RVVC.
METHODS: A cross-sectional study was conducted. A total of 66 women were included (40 diagnosed with RVVC and 26 healthy women [HW]). Demographic and clinical data were recorded. Vaginal fluid samples were obtained for isolation, identification and antifungal susceptibility testing of Candida species using selective culture media and the Vitek 2.0® system. Blood samples were also obtained to evaluate cell subpopulations; furthermore, neutrophils and PBMCs were isolated to determine their fungicidal and proliferative capacities, respectively.
RESULTS: The median age was 29 (IQR: 34-23) for RVVC and 24 (IQR: 30-23) for HW. Only two species of the genus Candida were identified: Candida albicans (92.5%) and Candida lusitaniae (7.5%). Resistance to fluconazole, voriconazole, flucytosine and amphotericin B was observed on six C. albicans isolates and one C. lusitaniae isolate. Only the family history of vulvovaginal candidiasis was associated with RVVC occurrence. The RVVC group exhibited a significantly higher number of neutrophils but with lower fungicidal activity in comparison to HW; likewise, PBMCs from RVVC patients presented a lower proliferation index when stimulated with C. albicans.
CONCLUSIONS: Contrary to what has been reported worldwide, in Colombian patients with RVVC, C. albicans was the main isolated species without increased antifungal resistance. The diminished fungicidal and proliferative capacities of neutrophils and PBMCs, respectively, could suggest a possible alteration in the innate and adaptive immune responses.
OBJECTIVE: We aimed to determine the fungicidal and proliferative capacities of neutrophils and peripheral blood mononuclear cells (PBMCs), respectively and the clinical and microbiological characteristics of a cohort of Colombian patients diagnosed with RVVC.
METHODS: A cross-sectional study was conducted. A total of 66 women were included (40 diagnosed with RVVC and 26 healthy women [HW]). Demographic and clinical data were recorded. Vaginal fluid samples were obtained for isolation, identification and antifungal susceptibility testing of Candida species using selective culture media and the Vitek 2.0® system. Blood samples were also obtained to evaluate cell subpopulations; furthermore, neutrophils and PBMCs were isolated to determine their fungicidal and proliferative capacities, respectively.
RESULTS: The median age was 29 (IQR: 34-23) for RVVC and 24 (IQR: 30-23) for HW. Only two species of the genus Candida were identified: Candida albicans (92.5%) and Candida lusitaniae (7.5%). Resistance to fluconazole, voriconazole, flucytosine and amphotericin B was observed on six C. albicans isolates and one C. lusitaniae isolate. Only the family history of vulvovaginal candidiasis was associated with RVVC occurrence. The RVVC group exhibited a significantly higher number of neutrophils but with lower fungicidal activity in comparison to HW; likewise, PBMCs from RVVC patients presented a lower proliferation index when stimulated with C. albicans.
CONCLUSIONS: Contrary to what has been reported worldwide, in Colombian patients with RVVC, C. albicans was the main isolated species without increased antifungal resistance. The diminished fungicidal and proliferative capacities of neutrophils and PBMCs, respectively, could suggest a possible alteration in the innate and adaptive immune responses.
摘要：
背景：复发性外阴阴道念珠菌病（RVVC）是一种重要且被低估的真菌感染。
目的：我们旨在确定中性粒细胞和外周血单核细胞（PBMC）的杀真菌和增殖能力，分别和一组被诊断为RVVC的哥伦比亚患者的临床和微生物学特征。
方法：进行横断面研究。共纳入66名妇女（40名诊断为RVVC和26名健康妇女[HW]）。记录人口统计学和临床数据。获取阴道液样本进行分离，使用选择性培养基和Vitek2.0®系统对念珠菌进行鉴定和抗真菌药敏试验。还获得了血液样本以评估细胞亚群；此外，分离嗜中性粒细胞和PBMC以确定它们的杀真菌和增殖能力，分别。
结果：RVVC的中位年龄为29岁（IQR：34-23），HW的中位年龄为24岁（IQR：30-23）。仅鉴定出两种念珠菌属：白色念珠菌（92.5％）和念珠菌（7.5％）。对氟康唑的耐药性，伏立康唑,在6株白色念珠菌分离株和1株白色念珠菌分离株上观察到氟胞嘧啶和两性霉素B。只有外阴阴道念珠菌病的家族史与RVVC的发生有关。与HW相比，RVVC组的中性粒细胞数量显着增加，但杀真菌活性较低；同样，当用白色念珠菌刺激时,来自RVVC患者的PBMC呈现较低的增殖指数。
结论：与全球报道的相反，哥伦比亚RVVC患者，白色念珠菌是主要的分离物种，没有增加抗真菌抗性。嗜中性粒细胞和PBMC的杀真菌和增殖能力降低，分别,可能表明先天和适应性免疫反应的可能改变。
目的：我们旨在确定中性粒细胞和外周血单核细胞（PBMC）的杀真菌和增殖能力，分别和一组被诊断为RVVC的哥伦比亚患者的临床和微生物学特征。
方法：进行横断面研究。共纳入66名妇女（40名诊断为RVVC和26名健康妇女[HW]）。记录人口统计学和临床数据。获取阴道液样本进行分离，使用选择性培养基和Vitek2.0®系统对念珠菌进行鉴定和抗真菌药敏试验。还获得了血液样本以评估细胞亚群；此外，分离嗜中性粒细胞和PBMC以确定它们的杀真菌和增殖能力，分别。
结果：RVVC的中位年龄为29岁（IQR：34-23），HW的中位年龄为24岁（IQR：30-23）。仅鉴定出两种念珠菌属：白色念珠菌（92.5％）和念珠菌（7.5％）。对氟康唑的耐药性，伏立康唑,在6株白色念珠菌分离株和1株白色念珠菌分离株上观察到氟胞嘧啶和两性霉素B。只有外阴阴道念珠菌病的家族史与RVVC的发生有关。与HW相比，RVVC组的中性粒细胞数量显着增加，但杀真菌活性较低；同样，当用白色念珠菌刺激时,来自RVVC患者的PBMC呈现较低的增殖指数。
结论：与全球报道的相反，哥伦比亚RVVC患者，白色念珠菌是主要的分离物种，没有增加抗真菌抗性。嗜中性粒细胞和PBMC的杀真菌和增殖能力降低，分别,可能表明先天和适应性免疫反应的可能改变。
