Molecular Detection of Virulence and Antifungal Resistance Genes in Candida species Isolated from Women with Vulvovaginitis in Assiut University

Abstract

Background: Vulvovaginal candidiasis (VVC) is a common infection affecting millions of women, with Candida species capable of shifting from commensal to pathogenic states through various virulence factors. Rising antifungal resistance, driven by extensive drug use and limited therapeutic options, further complicates management. So, this study aimed to investigate prevalence of different Candida species and their antifungal resistance profiles, detect virulence and resistance genes and evaluate the relationship between virulence and resistance patterns in Candida species isolated from women with VVC in Assiut University. Methodology: 125 vaginal swabs were cultured on Sabouraud’s Dextrose agar. Identification and antifungal susceptibility testing of Candida spp. by VITEK ® 2 were done. Virulence and resistance genes as INT1, CPH1, ALS1, HWP1, SAP1, SAP2, PLP, CDR1, and MDR1 were detected by PCR. Results: Forty Candida isolates were obtained. C. albicans was the most prevalent species, followed by C. Ciferrii, C. tropicalis, C. glabrata and C. dubilinesis, while one isolate of each of C. haemulonii, C. inconspicua, C. krusei, C. rugosa and Cryptococcus laurentii was detected. All isolates were sensitive to voriconazole, micafungin and amphotericin B except 15 C. albicans and 2 C. tropicalis isolates resistant to fluconazole, one isolate of C. albicans resistant to caspofungin and one isolate of each of C. glabrata, C. dubilinesis and C. krusei resistant to flucytosine. All genes were detected at variable frequencies. Conclusion: High susceptibility rates were observed for voriconazole, amphotericin B, caspofungin, and flucytosine, while azole resistance remained prevalent. Co-expression of virulence and resistance genes in several isolates underscores the dual challenge posed by these strains.