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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although Candida vulvovaginitis occurs commonly, the reasons for its occurrence and recurrence are often unclear. Several potential risk factors have been described, including the recent use of antibiotics and oral contraceptives, the presence of diabetes mellitus, dietary practices, gastrointestinal colonization by the organism, clothing and sanitary protection practices, sexual communicability of the organism, and specific immunological defects. However, the data supporting each of these factors are conflicting, and to date none are predictive of infection. In this review, the data evaluating these potential risk factors are described. From this information, implications for clinical practice are discussed.
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PMID:Risk factors for Candida vulvovaginitis. 151 28

Actual incidence of vulvovaginitis is unknown, but apparently about 75% of women experience at least 1 episode of yeast vulvovaginitis during their reproductive years. Candida species causes almost all cases, e.g., Candida albicans causes about 90% of cases. Other species include C. glabrata and C. tropicalis. The spore form of C. albicans spreads the infection and is asymptomatic. The mycelia form induces symptoms. Neither C. glabrata nor C. tropicalis produce mycelia. The 1st step in establishing an infection is bonding to the vaginal mucosa. C. albicans adheres better than do the other 2 species. Proteolytic enzymes help the fungus bind to the mucosa. Research indicates that differences in the composition of normal vaginal bacteria, dearths in site functions that are specific for Candida, or prostaglandin or IgE interference with the cellular mediated immune response specific to Candida may be responsible for recurrent infections. The signs and symptoms of yeast vulvovaginitis are not clear cut so clinicians need to request laboratory tests on samples to confirm diagnosis. The most common symptom is considerable itching. Antifungal medicine is either topical or systemic. The most common yet oldest antifungal agent is 0.5-1% gentian violet applied topically to the affected mucous membranes. There is dome evidence, however, that it causes chromosome damage in some mammal cells. No reported cases of cancer in humans exist though. Imidazoles and polyene compounds constitute the mainstays of candidiasis treatment. Oral ketoconazole has shown promise in preventing recurrence. Colonization and symptomatic vaginitis rates rise during pregnancy. Symptomatic vaginitis is most common during the 3rd trimester. Diabetes mellitus also predisposes women to vaginitis. Women who use high dose oral contraceptives, the contraceptive sponge, and antibiotics also face increased risk of colonization and symptomatic vaginitis. Vaginitis is common among women with AIDS.
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PMID:Fungal vulvovaginitis. 181 23

A total of 150 patients with cutaneous candidiasis were studied. A detailed clinical history was taken. Scrapings were examined in 10% KOH, and the material cultured on Sabouraud's agar. Species were identified by the serum germ tube test, sugar fermentation and sugar assimilation tests. Of 150 patients 79 were females. The commonest presentation was intertrigo (75), vulvovaginitis (19) and paronychia (17). A history of chronic exposure to water was obtained in 94 cases, all had erosio interdigitalis blastomycetica and/or paronychia. Diabetes melltius as a predisposing factor was observed in 22 patients. The 10 cases of balanoposthitis had associated diabetes mellitus. Smear and culture were positive in all the patients. C. albicans was isolated in 136 cases, C. tropicalis in 12, and C. guillermondi in 2. The cultures of C. albicans had positive serum germ tube test. The 6 patients in the paediatric age group having perianal/genital involvement had a stools culture positive for C. albicans.
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PMID:Clinical and mycological spectrum of cutaneous candidiasis in Bombay. 209 73

Vulvovaginitis is common in diabetic women and is often treated with antifungal agents on the assumption that the causative organism is Candida albicans. In a survey of 100 consecutive diabetic women attending a diabetes clinic 36 had complained to their general practitioner about vulvovaginal irritation during the past three years and 26 were treated with antifungal agents without a vaginal examination or swabs being taken. In a separate study 27 post-menopausal women with non-insulin dependent diabetes and symptoms of vulvovaginitis were investigated. The organisms cultured were: Candida albicans (n = 6), beta haemolytic streptococci (n = 14), Gardnerella vaginalis (n = 2), Staphylococcus aureus (n = 2), Streptococcus milleri (n = 1), Streptococcus faecalis (n = 1), Klebsiella oxytoca (n = 1), no organisms (n = 3). Where a bacterial organism was isolated symptoms resolved in all but one case with appropriate antibiotic treatment. It is recommended that the practice of initiating antifungal treatment without taking high vaginal swabs should be reviewed and treatment should be given specifically rather than empirically.
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PMID:Is candidiasis the true cause of vulvovaginal irritation in women with diabetes mellitus? 201 35

The occurrence of candida vulvovaginitis (CVV) has been estimated based on statistical data from Great Britain to be an increase to 200/100,000 over 10 years to 1984. CVV in the US is the 2nd commonest cause of vaginal infection, with bacterial vaginosis occurring twice as often. 85-90% of the yeasts isolated from the vagina are candida albicans, based on biotyping rather that the newer methods of DNA hybridization. The pathogenesis of CVV is discussed in terms of the microbiology (virulence factors, adherence, germ tube and mycelium formation, proteinase secretion, and switching colonies), asymptomatic vaginal colonization, transformation to symptomatic vaginitis, host predisposing factors (pregnancy, oral contraceptives, diabetes mellitus, antimicrobes, and other), vaginal defense mechanisms (humoral system, phagocytic system, cell mediated immunity, vaginal flora, other), and pathogenesis of recurrent and chronic CVV (internal reservoir, sexual transmission, vaginal relapse, and experimental models) The discussion of the development of virulent symptoms is capsuled in the following comments. Vaginal cell receptivity varies among individuals, but all strains of C. Albicans adhere to both exfoliated vaginal and buccal epithelial cells, or mucosal surfaces, through the yeast surface mannoprotein. It is suggested from in vitro studies that germ tube and mycelium formation facilitates vaginal mucosal invasion. Exogenous and endogenous factors may enhance germination and precipitate symptomatic vaginitis, or inhibit germination. Increased proteinase secretion may be a result of the transformation from the blastoconidium/colonization phase to the germinated invasive vaginitis stage or an independent virulence factor. It is reported that hereditable spontaneous switching may occur spontaneously in vivo also. Colonizing yeasts with a change in environment can transform to a more virulent phase. Colonization rates vary from 10-25%, and the critical issue is understanding the process of asymptomatic colonization to symptomatic vaginitis, which is unclear. Inflammation may be caused by direct hyphal invasion or inducing symptoms of allergic reaction without identification of a specific event. Precipitating factors are pregnancy, where estrogens enhance yeast mycelium formation, or high levels of reproductive hormones. High oral contraceptive use is related to the presence of candida as well as uncontrolled diabetes, during or following use of antimicrobial agents, and use of poorly ventilated clothing.
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PMID:Pathogenesis of Candida vulvovaginitis. 268 24

A study was undertaken in children and adolescents aged 4-18 years on the value of benzydamine vaginal douche in addition to chemotherapy for moderate to severe vulvovaginitis, including those also suffering from insulin-dependent diabetes mellitus (IDDM). It is considered that topical benzydamine gave beneficial results compared with the controls receiving chemotherapy alone and had in the IDDM patients a useful prophylactic effect.
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PMID:Benzydamine for the topical treatment of vulvovaginitis in children and adolescents. 389 74

The purpose of this study was to know the utility of traditional administration of itraconazole to vulvovaginitis by Candida in patients with diabetes mellitus. A randomized, single blind, controlled clinical assay, was carried out in 32 patients with diabetes mellitus type II and vulvovaginitis for Candida albicans. A study group was formed with 16 patients. They received 200 mg/day of itraconazole with breakfast for 3 days. The other 16 women were the control group. A good clinical response was obtained in 87.50% of the patients (p = 0.001). Candida disappeared in 56.25% of the cases. General response showed medication failure in 43.75%. It is concluded that the traditional treatment of itraconazole for vulvovaginitis for Candida albicans in women with diabetes mellitus is a good choice to control the signs and symptoms, but it doesn't erradicate the fungus.
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PMID:[Itraconazole in the treatment of Candida vulvovaginitis in patients with type II diabetes mellitus (non-insulin dependent)]. 789 49

Vulvovaginitis is the most common clinical manifestation of fungal infections causing human mycoses; the incidence occurs in 10% of women, during pregnancy the incidence achieves 30% of cases. Candida albicans has resulted to be the most commonly isolated agent in patients with fungemia. In fact, Candida appears to be the species recovered in as many as 90% of cases. They are mainly the sexual activity, hormonal contraception and several pathologies such as diabetes mellitus and thyroiditis responsible for the pathogenesis of infection. The first symptom of this infection is usually pruritus associated to leukorrhea, dyspareunia and vulvovaginal irritation. Antifungal therapy may be required in more severe cases of vulvovaginal candidiasis. Candida species can be identified on isolation culture media including agar and on direct examination. Diagnosis can also be made through san immunologic examination. However, the authors confirm that the risk factors together with a correct diagnosis of the Candida etiological agent in the different species (albicans, glabrata, tropicalis, krusei) should be accurately investigated in order to give the correct therapeutical approach.
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PMID:[Mycotic vulvovaginitis]. 947 43

The etiological significance of intestinal Candida colonization continues to be controversial. This is a systematic review to determine the pathogenetic significance of intestinal Candida colonization. The search was essentially performed from 1990 to 12/7/2000 in Medline and the Cochrane-Library. The data source was restricted to articles in English and German. Selection criteria covered the topics "Epidemiology", "Infectious Diseases", "Candida-Syndrome" and "Therapy" and were essentially confined to in-vivo examination of immunocompetent adults. Two reviewers extracted independently data using predefined criteria. In total, 96 citations that proved suitable for use in the systematic review were found. Depending on the localization in the gastrointestinal tract, the recovery technique employed, and transport times, Candida colonization is frequently detected in healthy, immunocompetent adults (prevalence: 4-88%). None of the studies available so far furnish any evidence that nutritional factors, food additives, pollutants, anti-ovulants, other types of medication or diabetes mellitus might be predisposing factors for intestinal Candida colonization. However, therapeutic studies point to the possibility of Candida playing a role in antibiotic-associated diarrhea. On the other hand, antibiotics seem to favor bacterial dysbiosis, and this, like the direct side effects of drugs, offers a more plausible explanation for diarrhea or gastrointestinal symptoms. The role of intestinal colonization by Candida in Candida-associated vulvovaginitis and IgE-mediated disorders remains contradictory. Nevertheless, neither epidemiological nor therapeutic studies provide evidence for the existence of the so-called "Candida-syndrome" or "Candida-hypersensitivity-syndrome". At present, there are no proven treatment indications for antifungal "bowel decontamination".
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PMID:The pathogenetic significance of intestinal Candida colonization--a systematic review from an interdisciplinary and environmental medical point of view. 1476 78

The aim of the study was to investigate the relation between genital infections (frequency, etiology, clinical presentation) among girls with type 1 diabetes and some factors as age of the girls, duration and metabolic control of diabetes. Forty-three girls with type 1 diabetes and twelve healthy girls for controls were involved in the study. Methods used are: genital tract inspection, direct microscopy and cultures from genital discharge and urine. Glycaemic control in the diabetic girls was assessed by measuring total glycosylated haemoglobin. The results show vulvovaginal candidiasis in 27 (62.8%) in diabetic girls versus 2 (16.6%) in controls (p < 0.01). There was clear prevalence of non-albicans Candida species. Concomitant infection with bacterial pathogens were proved in only 6 (13.9%) of diabetic girls and 1 (8.5%) of the controls. The clinical presentation of genital candidiasis was vulvovaginitis and most of the affected diabetic girls (88.9%) were in puberty period. There was no relation between duration and metabolic control of diabetes and genital infections.
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PMID:[Genital infections in girls with type 1 diabetes]. 1531 38


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