Torulopsis glabrata vaginitis: clinical aspects and susceptibility to antifungal agents

Article Abstract:

Yeast infections in American women are usually caused by the organism Candida albicans, but the yeast Torulopsis glabrata (T. glabrata) has been identified in up to 11 percent of cases. The occurrence and antifungal susceptibility of T. glabrata infections have not been well studied. Consequently, the records of 33 patients with T. glabrata vaginitis were assessed. The women, aged 22 to 72 years, were middle-class, racially mixed, and not sexually promiscuous. They were divided into three groups. The first, with 42 percent of the participants, had symptoms of yeast infection; the second, with 30 percent, had no symptoms; and the third, with 27 percent of the women, had other dermatologic disorders with uncertain contributions to vaginal disease. The symptoms of T. glabrata infection were similar to those associated with Candida albicans vaginitis, including redness of the skin and mucous membranes, abnormal white vaginal discharge, and vulvovaginal itching. Among 12 patients who received follow-up care, 8 responded well to antifungal agents, such as clotrimazole, ketoconazole, or itraconazole with boric acid. However, complete cure, indicated by absence of the organism, occurred in only two of eight women. Three patients had persistent vaginitis, which eventually responded to flucytosine or vaginal boric acid, and these cases are described. Up to 73 percent of all patients had been recently treated with antibiotic or antifungal agents. Laboratory tests of the organisms isolated from the patients were used to test antifungal susceptibility. T. glabrata organisms were susceptible to typically effective doses of antifungal agents, but susceptibility did not correlate with patients' responses to therapy. One strain of T. glabrata developed resistance to flucytosine during testing. The results indicate that patients with T. glabrata vaginal infections should be treated initially with azole-type antifungal agents. If symptoms persist, treatment with flucytosine or topical boric acid should then be used. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Prognosis, Drug therapy, Cryptococcaceae

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Vulvovaginal candidiasis complicating recurrent bacterial vaginosis

Article Abstract:

Bacterial vaginosis (BV), a vaginal infection producing a grayish-white discharge, is diagnosed on the basis of the microscopic evidence of clue cells, discharge and a positive amine test, whereby the addition of a chemical to the discharge creates a distinct smell when positive. Vulvovaginal candidiasis, a yeast infection in the vagina, can be confirmed by examining vaginal discharge under the microscope, by a negative amine test and culture. These two common infections represent 75-90 percent of all vaginal infections. Although treatment of bacterial vaginosis with metronidazole is 80 to 90 percent effective, 15 to 30 percent of those affected will have a recurrence. The factors predisposing women to recurrent bacterial vaginosis infections are not known. However, when bacterial vaginosis is detected, there is frequently a candida infection present as well. A simultaneous infection with candida was found in 10 out of 35 patients (29 percent) with a history of recurrent bacterial vaginosis. A mixed infection was found in 12 women (34 percent). If signs and symptoms of both infections exist, treatment should be for both infections. Although a yeast infection can follow metronidazole therapy, the cause in recurrent bacterial vaginosis is less understood. Therefore, specific treatment should be administered for each separate infection diagnosed in each individual episode. (Consumer Summary produced by Reliance Medical Information, Inc.)

Vaginosis, Bacterial vaginitis

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Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations

Article Abstract:

Vulvovaginal candidiasis is an infection of the vulva and vagina by a strain of Candida yeast, and it may cause burning, itching, soreness, and a whitish, cheesy vaginal discharge. Candida is a microorganism normally present in the vagina, but sexual activity, contraception, antibiotic use, and other factors may precipitate overgrowth of the yeast. Candidiasis should be confirmed by diagnostic testing, although many women self-treat with over-the-counter medications. Oral and topical antifungal medications are equally effective in most cases of vulvovaginal candidiasis.

Health aspects

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