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Caracterização de leveduras colonizadoras da vulva e avaliação de fatores de risco para a infeção
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Os casos de infeções fúngicas, com particularidade em infeções causadas por espécies do género Candida spp., nas últimas décadas, têm aumentado a sua incidência no mundo. A Candidose Vulvovaginal é uma infeção vaginal, causada por leveduras do género Candida, prevalente em mulheres em idade fértil, que afeta milhões de mulheres no mundo. Caracteriza-se pela ocorrência de sintomas na vagina e na vulva, como prurido, inchaço, irritação da vulva e uma secreção espessa e irregular. Classicamente, os sintomas na vulva estão associados à disseminação do fluido vaginal infetado. No entanto, estudos mais recentes descrevem a ocorrência de sintomas vulvares associados à recuperação da levedura deste nicho sem envolvimento vaginal. Assim, de modo a compreender melhor o papel da vulva nessa dinâmica, neste estudo, objetivamos identificar e caracterizar isolados de leveduras vulvares, através da suscetibilidade aos antifúngicos, da formação de biofilmes e produção de fosfolipases e hemolisinas, assim como avaliar a adesão, in-vitro, às células HeLa de isolados clínicos. Os resultados indicaram a presença de uma diversidade de espécies de leveduras Candida não - albicans; entre os 46 isolados vulvares, foram identificadas 11 espécies diferentes. A espécie mais frequentemente recuperada entre as amostras vulvares foi Candida parapsilosis (25%), seguida por Nakaseomyces glabratus (15%) e Meyerozyma guilliermondii (15%). No geral, verificou-se que 45% dos isolados vulvares eram resistentes ao fluconazol. A espécie Clavispora lusitanae foi a que produziu uma maior quantidade de biomassa de biofilme. Já a Pichia kudriavzevii foi a única espécie que produziu fosfolipase e detetou-se a produção de hemolisinas em isolados pertencentes a Nakaseomyces glabratus, Candida parapsilosis, Candida intermedia, Meyerozyma guilliermondii, Candidozyma haemulid e Clavispora lusitanae. Finalmente, verificou-se que Pichia kudriavzevii e Clavispora lusitanae aderiram às células HeLa. A grande diversidade de espécies encontrada, aliada à elevada taxa de resistência ao fluconazol e ao perfil virulento, leva a concluir que se considera necessária uma vigilância epidemiológica, para auxiliar o desenvolvimento de estratégias terapêuticas mais eficazes.
In recent decades, the incidence of fungal infections, particularly those caused by species of the genus Candida spp. has increased worldwide. Vulvovaginal candidosis is a vaginal infection caused by Candida yeasts, prevalent in women of childbearing age and affecting millions of women worldwide. It is characterized by the occurrence of symptoms in the vagina and vulva, such as itching, swelling, irritation of the vulva and a thick, irregular discharge. Classically, symptoms in the vulva are associated with the spread of infected vaginal fluid. However, more recent studies describe the occurrence of vulvar symptoms associated with the recovery of yeast from this niche without vaginal involvement. Therefore, in order to better understand the role of the vulva in this dynamic, in this study we aimed to identify and characterize vulvar yeast isolates, through antifungal susceptibility, biofilm formation and production of phospholipases and hemolysins, as well as evaluating adhesion, in-vitro, to HeLa cells of clinical isolates. The results indicated the presence of a diversity of yeast’s species Candida non - albicans; among the 46 vulvar isolates, 11 different species were identified. The most frequently recovered species among the vulvar samples was Candida parapsilosis (25%), followed by Nakaseomyces glabratus (15%) and Meyerozyma guilliermondii (15%). Overall, 45% of the vulvar isolates were found to be resistant to fluconazole. The Clavispora lusitanae was the species that produced the greatest amount of biofilm biomass. Pichia kudriavzevii was the only species to produce phospholipase and the production of hemolysins was detected in isolates belonging to Nakaseomyces glabratus, Candida parapsilosis, Candida intermedia, Meyerozyma guilliermondii, Candidozyma haemulid and Clavispora lusitanae. Finally, Pichia kudriavzevii and Clavispora lusitanae were found to adhere to HeLa cells. Considering the high species diversity that as found, associated with a high frequency of fluconazole resistance and virulent profiles, epidemiological surveillance is therefore believed to be necessary to help develop more effective therapeutic strategies.
In recent decades, the incidence of fungal infections, particularly those caused by species of the genus Candida spp. has increased worldwide. Vulvovaginal candidosis is a vaginal infection caused by Candida yeasts, prevalent in women of childbearing age and affecting millions of women worldwide. It is characterized by the occurrence of symptoms in the vagina and vulva, such as itching, swelling, irritation of the vulva and a thick, irregular discharge. Classically, symptoms in the vulva are associated with the spread of infected vaginal fluid. However, more recent studies describe the occurrence of vulvar symptoms associated with the recovery of yeast from this niche without vaginal involvement. Therefore, in order to better understand the role of the vulva in this dynamic, in this study we aimed to identify and characterize vulvar yeast isolates, through antifungal susceptibility, biofilm formation and production of phospholipases and hemolysins, as well as evaluating adhesion, in-vitro, to HeLa cells of clinical isolates. The results indicated the presence of a diversity of yeast’s species Candida non - albicans; among the 46 vulvar isolates, 11 different species were identified. The most frequently recovered species among the vulvar samples was Candida parapsilosis (25%), followed by Nakaseomyces glabratus (15%) and Meyerozyma guilliermondii (15%). Overall, 45% of the vulvar isolates were found to be resistant to fluconazole. The Clavispora lusitanae was the species that produced the greatest amount of biofilm biomass. Pichia kudriavzevii was the only species to produce phospholipase and the production of hemolysins was detected in isolates belonging to Nakaseomyces glabratus, Candida parapsilosis, Candida intermedia, Meyerozyma guilliermondii, Candidozyma haemulid and Clavispora lusitanae. Finally, Pichia kudriavzevii and Clavispora lusitanae were found to adhere to HeLa cells. Considering the high species diversity that as found, associated with a high frequency of fluconazole resistance and virulent profiles, epidemiological surveillance is therefore believed to be necessary to help develop more effective therapeutic strategies.
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Keywords
Candida Fatores Virulência Infeções Vulvovaginais Resistência Antifúngica Vulva Virulence Factors Vulvovaginal Infections Antifungal Resistance