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Original Article
Abstract
Background: Vulvovaginal candidiasis (VVC) is most common accounting for 17 to 39% of symptomatic women.
Both Candida albicans and non albicans Candida species are involved in VVC. Amongst various virulence factors
proposed for Candida, extracellular phospholipases is one of the virulence factor implicated in its pathogenicity. With
this background the present study was carried out to find the prevalence of different Candida species and to detect
phospholipase producing strains isolated from symptomatic women with VVC. Materials and Methods: At least
two vaginal swabs from 156 women of reproductive age with abnormal vaginal discharge were collected. Direct
microscopy and Grams stained smear examined for presence of budding yeast and pseudo mycelia followed by isolation
and identification of Candida species. Extracellular phospholipase activity was studied by inoculating all isolates on
Sabourauds dextrose egg yolk agar (SDA) medium. Results: Of the 156 women with curdy white discharge alone or in
combination with other signs, 59 (37.82%) women showed laboratory evidence of VVC. A total of 31 (52.54%) women
had curdy white discharge followed by 12 (20.33%) with other signs and symptoms. C. albicans (62.59%) and non
albicans Candida (37.28%) in a ratio of 1.68:1 were isolated. Of the 37 strains of C. albians 30 (81.08%) showed the
enzyme activity. Seventeen (56.66%) strains showed higher Pz value of < 0.70 (++++). Conclusion: Although there may
be typical clinical presentation of Candidiasis. all the patients did not show laboratory evidence of infection. Pregnancy
was found to be major risk factor for development of VVC. C. albicans was prevalent species but non albicans species
were also frequently isolated. Extracellular phospholipase activity was seen in C. albicans and not in non albicans
Candida isolates.
Key words: Candida albicans, non albicans Candida, phospholipase, vulvovaginal Candidiasis
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January - March 2015 Fule, et al.: Phospholipase enzyme activity of Candida 93
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94 Indian Journal of Medical Microbiology vol. 33, No. 1
Table 1: Prevalence of Candida albicans and non albicans species in relation to clinical presentations
Clinical presentation No. isolated C. albicans C. parapsilosis C. dubliniensis C. krusei C. glabrata C. tropicalis
(n=59) (n=37) (n=6) (n=2) (n=2) (n=5) (n=7)
Curdy white discharge 31 23 (23) 3 1 - 2 2
Curdy white discharge with 5 3 (2) 2 - - - -
pruritus
Curdy white discharge with 12 6 (3) 1 - 1 2 2
lower abodominal pain
Curdy white discharge 6 1 (0) - - 1 1 3
with pruritus, dysuria and
abdominal pain
Curdy white discharge 5 4 (2) - 1 - - -
with pruritus and lower
abdominal pain
Number in parenthesis shows positive phospholipase activity of C. albicans
Table 2: Phospholipase activity exhibited by C. albicans study C. albicans (62.59%) was found to be predominant
isolated from VVC yeast species to cause VVC followed by non albicans
species (37.28%). The most frequent non albicans species
Phospholipase No. of strain showing phospholipase
isolated was C. tropicalis followed by C. parapsilosis,
activity-Pz value activity. (no. of strains tested n=37) (%)
C. glabrata, C. krusie and, C. dubiliensis [Table 1], hence
1(negative) 7 (18.91) non albicans species are regarded as pathogens and are
<0.90-0.99 (+) 2 (5.40) frequently isolated.[18] Changes in species distribution can
0.80-0.89 (++) 4 (10.81) occur from time to time as well as at different geographical
0.70-0.79 (+++) 7 (18.91) locations.
<0.70 (++++) 17 (45.94)
All non albicans candida species were negative for phospholipase Several features of C. albicans have been described
activity, VVC: Vulvovaginal candidiasis and proposed to be virulence factors that enable the
organism to cause local and disseminated infections
ability of the organisms to cause disease and explain the in susceptible hosts. Potential role of phospholipase
differences in the pathogenicity among species.[19] Risk in virulence and fungal pathogenesis has been studied
factors for VVC are frequently absent but severe forms may extensively.[23] Evidence implicating phospholipase as
be associated with use of oral contraceptives, corticosteroids a virulence factor of C. abicans is mounting.[17] Ashraf
or antibiotics[20] and pregnancy.[21] In the present study et al.,[17] had strongly suggested that phospholipases
59 women with VVC, 47 (78.66%) were pregnant indicating are important factors in the pathogenesis of C. albicans
a major risk factor for development of VVC. experimentally in new borne mouse model. Therefore,
in the present study all C. albicans and non albicans
Clinical prevalence of different Candida species species studied for in-vitro phospholipase activity,
is reported; however, C. albicans is most commonly 30 (81.08%) of C. albicans showed the enzyme activity.
implicated species.[22] It is responsible for the vast Seventeen (56.66%) strains showed higher Pz value of <
majority of symptomatic episodes of VVC accounting for 0.70 (++++). None of the non albicans Candida species
over 80% of cases as reported earlier,[3,9] but its prevalence showed this activity. Mahmoudabadi et al.,[24] reported
is declining and non abicans species rapidly supervening. that all clinical isolates of C. albicans from VVC showed
Similar declining trend in prevalence of C. albicans was phospholipase activity while Basu et al.,[25] reported
observed in the present study. Because vaginal yeast 66.6% of vaginal isolates exhibited the enzyme activity.
culture are not done routinely in the management of Table 1 shows the clinical correlation of phospholipase
uncomplicated VVC, the relative contribution of non producing C. albicans. The C. albicans strains isolated
albicans yeast species to the burden of VVC is difficult to from women with only curdy white discharge were
measure. But in the present study yeast culture revealed positive for phospholipase activity, while variable number
that non albicans yeast species supervened. Changes in showed this activity when isolated from women with
species distribution can occur not only overtime but also other associated symptoms.
in different locations. Although, exposure to antifungal
agents has long been considered the main factor for this Considering the observations of the present study it may
change, not a single woman gave history of exposure be concluded that non albicans Candida species is slowly
to antifungal agents in the present study. In the present replacing C. albicans in VVC. Though not all the strains of
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January - March 2015 Fule, et al.: Phospholipase enzyme activity of Candida 95
C. albicans showed phospholipase activity the potential role of cellular and extracellular phospholipases. J Clin Invest
of phospholipase in virulence and pathogenesis is mounting. 1990;85:1925-35.
14. Silverman DJ, Santucci LA, Meyers N, Sekeyova Z.
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Indian J Med Microbiol 2015;33:92-5.
Bacterial phospholipid hydrolysis enhances the destruction
of Escherichia coli ingested by rabbit neutrophils. Role Source of Support: Nil, Conflict of Interest: None declared.
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