Epidemiology of candida vaginitis in pregnant women

Background: One of the most important risk factors for Candida vaginitis (CV), which three out of every four women are exposed to at least once in their lifetime, is pregnancy. This study sought to determine the prevalence of CV in pregnant women admitted to our hospital, its distribution by trimester, and the most common fungal species and to compare diagnostic methods. Methods: Posterior fornix swab samples from 250 pregnant women who were admitted to the Cukurova University Faculty of Medicine Balcali Hospital Gynecology and Obstetrics Clinic between April and June 2021 were delivered to the microbiology laboratory the same day, each stored in 2 ml Sabouraud glucose broth. The samples were evaluated by direct microscopic examination, Gram stain, and fungal cultures (CHROMAgar Candida [CAC] and Sabouraud glucose agar [SGA]). Yeast isolates were identified by germ-tube tests, micromorphology on cornmeal-Tween 80 agar, the appearance of colonies on CAC, and the MALDI-TOF MS method. The identification performance of the CAC medium was also evaluated with reference to the MALDI-TOF MS method. Results: The prevalence of fungal vaginitis in pregnant women admitted to our hospital was 43.2%. Of the 108 patients diagnosed with fungal vaginitis, 22 (20.4%) experienced recurrent vaginitis and 82.4% were in the second or third trimesters. There was no difference between the two media in terms of isolation performance. The most frequently isolated Candida species was C. albicans (49.6%), followed by C. glabrata (35.3%), C. krusei (7.5%), C. kefyr (3.4%), C. tropicalis (1.7%), S. cerevisiae (1.7%), and C. dubliniensis (0.8%). The sensitivity of the germ-tube test for C. albicans was 88.1% and the specificity was 98.3%. A polyfungal population was present in 10 cases (9.3%); of these, C. albicans + C. glabrata (60%) was the most common coexistence. The accuracy values of the CAC medium were 99.1% for C. albicans, 97.5% for C. glabrata, and 99.2% for C. krusei. Conclusion: CV is an important problem in the pregnant population, and the increased prevalence of fungal vaginitis in recent years, especially non-albicans Candida vaginitis, has reached alarming proportions. Also, chromogenic media provide convenient, rapid, and accurate diagnosis of fungal vaginitis throughisolation and identification in a single plate and through identification of the polyfungal populations. If CV in pregnant women is not treated, it can cause pregnancy complications, such as chorioamnionitis and subsequent preterm delivery. Patients and physicians should therefore be educated about and conscious of this issue.