Vaginal Candidiasis among Pregnant Women in Ebonyi State, South East Nigeria.
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Abstract
Vaginal candidiasis is an infection of the genital tract caused by overgrowth of opportunistic Candida species in women. The prevalence of this infection among pregnant women attending antenatal clinic in selected hospitals in Ebonyi State, Nigeria was investigated. A total of 816 High Vaginal Swab (HVS) samples of pregnant women who consented to the study were collected between November, 2022 and January, 2023 and subjected to wet mount examination and also cultured on Sabouraud Dextrose Agar (SDA). Isolates were identified to species level using microscopic and morphological features, germ tube and biochemical tests. Results of the structured questionnaire used for demographic data were analyzed statistically. The overall prevalence of candidiasis among the pregnant women was 43.3%, with Candida albicans having the highest prevalence (84.1%), followed by Candida tropicalis (6.5%), Candida parapsilosis (5.4%) and Candida peudotropicalis (4.0%). Highest prevalence of infection, 45.4%, 54.2%, 60.9% and 58.9% were observed in age group 26 – 30 years (P=0.062), 3rd trimester (P=0.023), primigravida (P=0.018) and farmers (P=0.054) respectively. Prevalence of vaginal candidiasis among study participants was high with Candida albicans implicated as the most prevalence yeast. Early screening of pregnant women for candidiasis and proper education is very important during antenatal visits.
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Ekwealor, C. C., Okoro, E. O., Oyeka, C. A., & Amasiani, R. (2023). Vaginal Candidiasis among Pregnant Women in Ebonyi State, South East Nigeria. The Bioscientist Journal, 11(2), 220-230. Retrieved from https://bioscientistjournal.com/index.php/The_Bioscientist/article/view/154
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References
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Akortha, E., Nwaugo, V. and Chikwe, O. (2009). Antifungal resistance among Candida species from patients with genitourinary tract infection isolated in Benin City, Edo State Nigeria. African Journal of Microbiology Research 3(11): 694-699
Altayyar, I. A., Alsanosi, A. S. and Osman, N. A. (2016). Prevalence of vaginal candidiasis among pregnant women attending different gynecological clinics at South Libya. European Journal of Experimental Biology 6(3): 25-29
Al-Rusan, R. N., Darwezeh, M. C. and Lataifeh, I. M. (2017). The relationship of Candida colonization of the oral and vaginal mucosa of mothers and oral mucosa of their new born at birth, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology 123(4): 459-463
Brandao, L. D. S., Boniek, D., Resende Stoianoff, M. A., da Mata F. M. R., Fernandes, J. V. and Andrade, V. S. (2018). Prevalence and antifungal susceptibility of Candida species among pregnant women attending a school maternity at Natal, Brazil. Letters in Applied Microbiology 67(3): 285-291
Carolus, H., Pierson, S., Lagrou, K. and Van Dijck, P. (2020). Amphotericin B and other polyene-Discovery, clinical, use, mode of action and drug resistance. Journal of Fungi 6: 321
Cooper, B. H. and Hunter, M. S. (1991). Yeasts of medical importance. Manual of Clinical Microbiology 5th Edition American Society for Microbiology Publication.
Deorukhkar, S. C., Saini, S. and Mathew, S. (2014). Non-albicans Candida infection: an emerging threat. Interdisciplinary Perspectives on Infectious Diseases: 615958
Disha, T. and Haque, F. (2022). Prevalence and risk factors of vulvovaginal candidosis during pregnancy: A Review. Infectious Diseases in Obstetrics and Gynecology Article ID 6195712
Edress, A. A., Al-Asbali. A. A., Al-Shehari, W. A. and Qasem, E. A. (2020). Vulvovaginal candidiasis prevalence among pregnant women in different hospitals in IBB Yamen. Universal Journal of Pharmaceutical Research 5(4): 1-5
Eckert, L. O., Hawes, S. E., Sterens, C. C., Konsky, I. A., Eschenbach, D. A. and Holmes, K. K. (1998). Vulvovaginal candidiasis, clinical manifestations, Risk factors, management algorithm. Obstetrics and Gynecology 92: 757-768
Enweani, I. B., Obi, C. and Jokpeyibo, M. (1994). Prevalence of Candida species in Nigerian children with diarrhea. Journal of Diarrhoeal Diseases Research 12(2): 133 - 135
Frobenius, W. and Bogdan, C. (2015). Diagnostic value of vaginal discharge, wet mount and vaginal pH- An update on the basics of gynecologic infectiology. Geburtshilfe und Frauenheilkunde 75(4): 355-366
Ghaddar, N., El Roz, A., Ghssein, G and Ibrahim, J. N. (2019). Emergence of vulvovaginal candidiasis amongLebanese pregnant women: Prevalence, risk factors and species distribution. Infectious diseases in obstetrics and Gynecology 8pages
Goncalves, B., Ferreira, C., Alves, C. T., Henriques, M., Azeredo, J. and Silva, S. (2016). Vulvovaginal candidiasis: Epidemiology, Microbiology and Risk factors. Critical Reviews in Microbiology 42 (6): 905-927
Howell, S. A., Hazen, K. C. and Brandt M. E. (2017). Candida, Cryptococcus and other yeasts of medical importance. Manual of Clinical Microbiology 11th Edition: American Society for Microbiology, Chapter 117.
Idowu, M. O., Makinde, G. I., Olurati O. O., Adebayo, M. O. and Adekunle, O. A. (2022). Prevalence of vulvovaginal candidiasis among women attending clinics in selected hospitals in Oyo State, Southwest Nigeria. Journal of Public Health and Epidemiology 14 (5): 45-52
Kish, L. (1965). Survey sampling. New York: John Wiley and Sons, Inc.
Masri, S. N., Noor, S. M., MatNor, L. A., Osman, M. and Rahman, M. M. (2015). Candida isolates from pregnant women and their antifungal susceptibility in a Malaysian tertiary-care hospital. Pakistan Journal of Medical Sciences 31(3):658-661
Mukasa, K. T., Herbert, I., Daniel, A. Sserunkuma, K. L. and Fredrick, B. (2015). Antifungal susceptibility patterns of vulvovaginal Candida species among women attending antenatal clinic at Mbarara Regional referral hospital, South Western Uganda. British Microbiology Research Journal 5(4): 322
Mumuney, K. T. and Abalaka, M. E. (2019). Comparative study of vaginal candidiasis in pregnant and non pregnant women attending Ibrahim Badamasi Babangida specialist hospital and General hospital Minna, Niger State, Nigeria. Journal of Advances in Microbiology 14(2) Article number JAMB 45762
Morgan, M. A., Wikowske, C. J. and Robert, G. D. (1984). Candida pseudotropicalis fungemia and invasive disease in an immunocompromised patient. Journal of Clinical Microbiology 20(5): 1006-7
Moses, A. and Michael, E. (2012). Asymptomatic co-infection of candidiasis and vaginal trichomoniasis among pregnant women in Southeastern Nigeria. Clinical Microbiology and Infection 18(7): 242-245
Nelson, M., Wanjiru, W and Margaret, M. (2013). Prevalence of vaginal candidiasis and determination of the occurrence of Candida species in pregnant women attending antenatal clinic of Thika District Hospital, Kenya. Open Journal of Medical Microbiology 3(4) Article ID 41031 9 pages
Nnadi, D. C. and Sign, S. (2017). The prevalence of genital Candida species among pregnant women attending antenatal clinic in a tertiary health center in Northwest Nigeria. Sahel Medical Journal 20 (1): 33-37
Okonkwo N. and Umeanaeto P. (2011). Prevalence of vaginal candidiasis among pregnant women in Nnewi Town of Anambra State, Nigeria. African Research Review 4(4): 539-548
Oviasogie, F. and Okungbowa, F. (2009). Candida species among pregnant women in Benin City, Nigeria: Effects of predisposing factors. African Journal of Clinical and Experimental Microbiology 10(2): 92-98
Pfaller, M. A., Andes, D. R., Diekema, D. J., Horn, D. L., Reboli, A. C., Rostein, C., Franks, B. and Azie, N. E. (2014). Epideiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2, 496 patients: data from the prospective antifungal therapy (PATH) registry 2004-2008. PLoS ONE 9(7): e101510
Robertson, W. H. (1988). Mycology of vulvovaginitis. American Journal of Obstetrics and Gynecology 158(4): 989-991
Shekufeh, P., Minoo, M. and Rasoul, M. (2017). Clinical and microbiological study of vulvovaginal candidiasis (VVC), identification of clinical isolates by polymerase chain-fragment size polymorphyim (PCR-FSP) techniques. Archives of Clinical Infectious Diseases 12(2): e62761
Shinkafi, S. N., Salisu, N., Mohammed, N. and Isah, K. (2021). Prevalence of vaginal candidiasis among pregnant women attending antenatal clinic in selected hospitals within Gausau, Zamfara State, Nigeria. Nigerian Journal Botany 34(2): 229-234
Snydman, D. R. (2003). Shifting patterns in the epidemiology of nosocomial Candida infections. Chest 124(5): 500S- 503S.
Sobel, J. D. (2007). Vulvovaginal candidiasis. Lancet 369: 1961-1971
Sule-Odu, A. O., Akadri, A. A., Oluwole, A. A., Osinupebi, O. A., Andu, B. A., Akiseku, A. K . and Lawal, A. I. (2020). Vaginal candida infections in pregnancy and its implications for fetal well-being. African Journal of Reproductive Health 24(3): 33-40
Sutaria, P., Chidera, M. and Donga, S. B. (2019). A prevalence study of vaginal candidiasis among pregnant women. International Journal of Advances in Medicine 6(3): 922-926.
Thomas, J. W., Randall, T. H. and Larone, D. H. (2018). Larone’s medically important fungi: A guide to identification 6th Edition ASM Press
Van Schalkwyk, J. and Yundin, M. H. Infectious Disease Committee. (2015). Vulvovaginitis: Screening for management of trichomoniasis, vulvovaginal candidiasis and bacterial vaginosis. Journal of Obstetrics and Gynecology Canada 37 (3):266 -274
Vijaya, D., Dhanalakshmi, T. A. and Kulkami, S. (2014). Changing trends of vulvovaginal candidiasis. Journal of Laboratory Physicians 6:28-30
Waikhom, S. D., Afeke, I., Kwawu, G. S., Mbroh, H. K., Osei, G. Y., Louis, B., Deku, J. G., Kasu, E. S., Mensah, P., Agede, C. Y., Dodoo, C., Asiamah, E. A., Tampouri, J., Korbuvi, J and Opinta, J. A. (2020). Vulvovaginal candidiasis among pregnant women in the HO municipality, Ghana, species identification and antifungal susceptibility of Candida isolates. BMC Pregnancy Childbirth 20: 226.
Yadav, K. and Prakash, S. (2016). Prevalence of vulvovaginal candidiasis in pregnancy. The Global Journal of Medicine and Medical Science 4(1): 108-116
Akortha, E., Nwaugo, V. and Chikwe, O. (2009). Antifungal resistance among Candida species from patients with genitourinary tract infection isolated in Benin City, Edo State Nigeria. African Journal of Microbiology Research 3(11): 694-699
Altayyar, I. A., Alsanosi, A. S. and Osman, N. A. (2016). Prevalence of vaginal candidiasis among pregnant women attending different gynecological clinics at South Libya. European Journal of Experimental Biology 6(3): 25-29
Al-Rusan, R. N., Darwezeh, M. C. and Lataifeh, I. M. (2017). The relationship of Candida colonization of the oral and vaginal mucosa of mothers and oral mucosa of their new born at birth, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology 123(4): 459-463
Brandao, L. D. S., Boniek, D., Resende Stoianoff, M. A., da Mata F. M. R., Fernandes, J. V. and Andrade, V. S. (2018). Prevalence and antifungal susceptibility of Candida species among pregnant women attending a school maternity at Natal, Brazil. Letters in Applied Microbiology 67(3): 285-291
Carolus, H., Pierson, S., Lagrou, K. and Van Dijck, P. (2020). Amphotericin B and other polyene-Discovery, clinical, use, mode of action and drug resistance. Journal of Fungi 6: 321
Cooper, B. H. and Hunter, M. S. (1991). Yeasts of medical importance. Manual of Clinical Microbiology 5th Edition American Society for Microbiology Publication.
Deorukhkar, S. C., Saini, S. and Mathew, S. (2014). Non-albicans Candida infection: an emerging threat. Interdisciplinary Perspectives on Infectious Diseases: 615958
Disha, T. and Haque, F. (2022). Prevalence and risk factors of vulvovaginal candidosis during pregnancy: A Review. Infectious Diseases in Obstetrics and Gynecology Article ID 6195712
Edress, A. A., Al-Asbali. A. A., Al-Shehari, W. A. and Qasem, E. A. (2020). Vulvovaginal candidiasis prevalence among pregnant women in different hospitals in IBB Yamen. Universal Journal of Pharmaceutical Research 5(4): 1-5
Eckert, L. O., Hawes, S. E., Sterens, C. C., Konsky, I. A., Eschenbach, D. A. and Holmes, K. K. (1998). Vulvovaginal candidiasis, clinical manifestations, Risk factors, management algorithm. Obstetrics and Gynecology 92: 757-768
Enweani, I. B., Obi, C. and Jokpeyibo, M. (1994). Prevalence of Candida species in Nigerian children with diarrhea. Journal of Diarrhoeal Diseases Research 12(2): 133 - 135
Frobenius, W. and Bogdan, C. (2015). Diagnostic value of vaginal discharge, wet mount and vaginal pH- An update on the basics of gynecologic infectiology. Geburtshilfe und Frauenheilkunde 75(4): 355-366
Ghaddar, N., El Roz, A., Ghssein, G and Ibrahim, J. N. (2019). Emergence of vulvovaginal candidiasis amongLebanese pregnant women: Prevalence, risk factors and species distribution. Infectious diseases in obstetrics and Gynecology 8pages
Goncalves, B., Ferreira, C., Alves, C. T., Henriques, M., Azeredo, J. and Silva, S. (2016). Vulvovaginal candidiasis: Epidemiology, Microbiology and Risk factors. Critical Reviews in Microbiology 42 (6): 905-927
Howell, S. A., Hazen, K. C. and Brandt M. E. (2017). Candida, Cryptococcus and other yeasts of medical importance. Manual of Clinical Microbiology 11th Edition: American Society for Microbiology, Chapter 117.
Idowu, M. O., Makinde, G. I., Olurati O. O., Adebayo, M. O. and Adekunle, O. A. (2022). Prevalence of vulvovaginal candidiasis among women attending clinics in selected hospitals in Oyo State, Southwest Nigeria. Journal of Public Health and Epidemiology 14 (5): 45-52
Kish, L. (1965). Survey sampling. New York: John Wiley and Sons, Inc.
Masri, S. N., Noor, S. M., MatNor, L. A., Osman, M. and Rahman, M. M. (2015). Candida isolates from pregnant women and their antifungal susceptibility in a Malaysian tertiary-care hospital. Pakistan Journal of Medical Sciences 31(3):658-661
Mukasa, K. T., Herbert, I., Daniel, A. Sserunkuma, K. L. and Fredrick, B. (2015). Antifungal susceptibility patterns of vulvovaginal Candida species among women attending antenatal clinic at Mbarara Regional referral hospital, South Western Uganda. British Microbiology Research Journal 5(4): 322
Mumuney, K. T. and Abalaka, M. E. (2019). Comparative study of vaginal candidiasis in pregnant and non pregnant women attending Ibrahim Badamasi Babangida specialist hospital and General hospital Minna, Niger State, Nigeria. Journal of Advances in Microbiology 14(2) Article number JAMB 45762
Morgan, M. A., Wikowske, C. J. and Robert, G. D. (1984). Candida pseudotropicalis fungemia and invasive disease in an immunocompromised patient. Journal of Clinical Microbiology 20(5): 1006-7
Moses, A. and Michael, E. (2012). Asymptomatic co-infection of candidiasis and vaginal trichomoniasis among pregnant women in Southeastern Nigeria. Clinical Microbiology and Infection 18(7): 242-245
Nelson, M., Wanjiru, W and Margaret, M. (2013). Prevalence of vaginal candidiasis and determination of the occurrence of Candida species in pregnant women attending antenatal clinic of Thika District Hospital, Kenya. Open Journal of Medical Microbiology 3(4) Article ID 41031 9 pages
Nnadi, D. C. and Sign, S. (2017). The prevalence of genital Candida species among pregnant women attending antenatal clinic in a tertiary health center in Northwest Nigeria. Sahel Medical Journal 20 (1): 33-37
Okonkwo N. and Umeanaeto P. (2011). Prevalence of vaginal candidiasis among pregnant women in Nnewi Town of Anambra State, Nigeria. African Research Review 4(4): 539-548
Oviasogie, F. and Okungbowa, F. (2009). Candida species among pregnant women in Benin City, Nigeria: Effects of predisposing factors. African Journal of Clinical and Experimental Microbiology 10(2): 92-98
Pfaller, M. A., Andes, D. R., Diekema, D. J., Horn, D. L., Reboli, A. C., Rostein, C., Franks, B. and Azie, N. E. (2014). Epideiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2, 496 patients: data from the prospective antifungal therapy (PATH) registry 2004-2008. PLoS ONE 9(7): e101510
Robertson, W. H. (1988). Mycology of vulvovaginitis. American Journal of Obstetrics and Gynecology 158(4): 989-991
Shekufeh, P., Minoo, M. and Rasoul, M. (2017). Clinical and microbiological study of vulvovaginal candidiasis (VVC), identification of clinical isolates by polymerase chain-fragment size polymorphyim (PCR-FSP) techniques. Archives of Clinical Infectious Diseases 12(2): e62761
Shinkafi, S. N., Salisu, N., Mohammed, N. and Isah, K. (2021). Prevalence of vaginal candidiasis among pregnant women attending antenatal clinic in selected hospitals within Gausau, Zamfara State, Nigeria. Nigerian Journal Botany 34(2): 229-234
Snydman, D. R. (2003). Shifting patterns in the epidemiology of nosocomial Candida infections. Chest 124(5): 500S- 503S.
Sobel, J. D. (2007). Vulvovaginal candidiasis. Lancet 369: 1961-1971
Sule-Odu, A. O., Akadri, A. A., Oluwole, A. A., Osinupebi, O. A., Andu, B. A., Akiseku, A. K . and Lawal, A. I. (2020). Vaginal candida infections in pregnancy and its implications for fetal well-being. African Journal of Reproductive Health 24(3): 33-40
Sutaria, P., Chidera, M. and Donga, S. B. (2019). A prevalence study of vaginal candidiasis among pregnant women. International Journal of Advances in Medicine 6(3): 922-926.
Thomas, J. W., Randall, T. H. and Larone, D. H. (2018). Larone’s medically important fungi: A guide to identification 6th Edition ASM Press
Van Schalkwyk, J. and Yundin, M. H. Infectious Disease Committee. (2015). Vulvovaginitis: Screening for management of trichomoniasis, vulvovaginal candidiasis and bacterial vaginosis. Journal of Obstetrics and Gynecology Canada 37 (3):266 -274
Vijaya, D., Dhanalakshmi, T. A. and Kulkami, S. (2014). Changing trends of vulvovaginal candidiasis. Journal of Laboratory Physicians 6:28-30
Waikhom, S. D., Afeke, I., Kwawu, G. S., Mbroh, H. K., Osei, G. Y., Louis, B., Deku, J. G., Kasu, E. S., Mensah, P., Agede, C. Y., Dodoo, C., Asiamah, E. A., Tampouri, J., Korbuvi, J and Opinta, J. A. (2020). Vulvovaginal candidiasis among pregnant women in the HO municipality, Ghana, species identification and antifungal susceptibility of Candida isolates. BMC Pregnancy Childbirth 20: 226.
Yadav, K. and Prakash, S. (2016). Prevalence of vulvovaginal candidiasis in pregnancy. The Global Journal of Medicine and Medical Science 4(1): 108-116