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Identifier 000393839
Title Αιδοιοκολπική καντιντίαση της εγκύου και ο ρόλος της στην επίπτωση της νεογνικής καντιντίασης
Alternative Title The effect of vulvovaginal candidiasis during pregnancy on neonatal candidiasis
Author Φιλιππίδη, Ανθούλα
Thesis advisor Σαμώνης, Γεώργιος
Reviewer Γαλανάκης, Εμμανουήλ
Τσελέντης, Ιωάννης
Γκίκας, Αχιλλέας
Γιαννακοπούλου, Χριστίνα
Γερμανάκης, Ιωάννης
Κοφτερίδης, Διαμαντής
Abstract Introduction: Candidiasis refers to infection with fungi of the genus Candida. The most common and more virulent is C. albicans, responsible for 40-80% of neonatal candidiasis cases. Neonatal Candida colonization may happen, as neonates acquire Candida species vertically through the vagina during labour, or horizontally from the hospital environment. Τhere is an increased rate of vaginal Candida colonisation of pregnant women during pregnancy. Colonized neonates are asymptomatic. However, colonisation could be the first step on the development of candidiasis, in case of imbalance on host’s bacterial flora or immature immune status of the neonate. Usually, candidiasis present as localized mucocutaneous candidiasis, either on neonate’s genital area as diaper rash, or on neonate’s oral mucosa as oral thrush. Rarely, Candida may cause candidemia and invasive candidiasis, invading vital organs, as heart, central nervous system, kidneys, liver, eyes and others. Congenital candidiasis may affect some neonates. Invasive (systemic) candidiasis is a serious condition associated with high morbidity and mortality. Invasive candidiasis is a major problem, especially for premature and low birth weight neonates, admitted to the neonatal intensive care unit (NICU), and causing high mortality (25 to 35%). It is estimated that 15% of these neonates are colonised from their mother, where as the rest of them (85%) are acquiring the fungus from the environment of the NICU, during their nursery. Despite the fact, that it is common belief the major role of vertical transmission on neonatal Candida colonization, there is a deficit on verification. Objective: The objective of the present study is to explore the percentage of neonatal Candida colonisation, with or without symptoms of neonatal candidiasis and its correlation with the vaginal Candida colonization of their mothers, with or without symptoms of vulvovaginal candidiasis. Material: The collection of the samples was made at random order, from 347 pregnant women and their neonates, who were born at Obstetrics Department of the University General Hospital and Venizeleion General Hospital in Heraklion, Crete, during the period February 2005 until April 2009. Vaginal samples were collected from pregnant women, within 48 hours before delivery, who at the time of sampling 30 were expected to give birth by vaginal route. Pregnant women who finally gave birth by caesarean section were still included in the study. Neonatal samples were obtained from oral and rectal mucosa, within 72 hours after delivery. Concurrently, demographic and clinical data, involving mothers and neonates, were reported. Methods: A sterile fibre-tipped swab was used to collect the samples. The mother’s and neonate’s specimens were inoculated onto Sabouraud dextrose agar plates (Becton Dickinson Microbiology Systems, Cockeysville, MD, USA), and incubated for 72 hours at 36°C under aerobic conditions. Results were categorized semiquantitavely. Yeast isolates were identified to species level using the API 20CAUX system (BioMérieux, Marcy, L’Etoile, France). Antifungal susceptibility testing against amphotericin B, 5-fluorocytosine, fluconazole, ketoconazole, itraconazole, voriconazole, was performed by the E-test as recommended by the manufacturer (BioMérieux). Furthermore, antifungal susceptibility testing against echinocandins: caspofungin, anidulafungin and micafungin, was performed only for the Candida strains isolated from mother-neonate pairs. Genetic relatedness of C.albicans isolates from mother-infant pairs was investigated by pulsed-field gel electrophoresis (PFGE) method. Results: Overall, 82 mothers and 16 neonates were colonized by Candida species. Among pregnant women, the predominant species was C. albicans (n=68) followed by C.glabrata(n=11). No significant differences were observed regarding colonization rates or C.albicans predominance among mothers in the vaginal delivery or caesarean section groups. During pregnancy, 26.8% (22/82) colonized pregnant women experienced vulvovaginal candidiasis, while only 17% (14/82) referred antifungal therapy. Among neonates the only species isolated was C.albicans, mostly from rectal mucosa (87.5%). All colonized neonates were born to colonized mothers. Most of the colonized neonates were born to mothers colonized by C.albicans, which developed significant amount of Candida on culture of vaginal samples. In every pair motherneonate, was isolated the same Candida species (C.albicans), having the same antifungal susceptibility. All C.albicans isolates were susceptible to amphotericin B and the echinocandins. Candida genotyping revealed identical strains in all investigated neonate-mother pairs. All of the 16 mother’s strains were different 31 between them. Only one neonate developed oral thrush, on the 10th day of life, while no neonate had invasive candidiasis. Conclusions: Vaginal Candida colonization of pregnant women was 23.6%, in accordance with increased reported rates, during pregnancy, compared to general population. The most common species was C.albicans (82%). Our study showed that sexual intercourse, tobacco use and vulvovaginal candidiasis during pregnancy are risk factors for maternal vaginal Candida colonization. Almost all colonized neonates were born by vaginal delivery (15/16) from colonized mothers, indicating vaginal delivery as perinatal risk factor for infant colonization. The significance of vaginal delivery was not proven, as statistical analysis was limited by small number of samples.In every mother-neonate pair was identified identical pulsotype of C.albicans between mother and neonate. It was found that the single factor that contributed to infant’s colonization was the colonization of the mother. All of the non colonized neonates were born from non colonized mothers. Also, it was confirmed the susceptibility of C.albicans, in vitro, against amphotericin B and echinocandins. Limitations of this study included the absence of investigating the horizontal transmission of the yeast from other sources. Furthermore, it was not explored the full process of neonatal colonization on the next days of neonatal life, unless there was a case of candidiasis with clinical symptoms.Nevertheless, our findings strongly suggest that early neonatal colonization of healthy, full term neonates by C.albicans, occurs through vertical transmission during or immediately after birth. Based on the fact that neonatal colonization is considered risk factor for neonatal candidiasis, a screening control should be performed for detection of the vaginal Candida colonization of pregnant women in high risk for preterm labour, in order to eliminate it early, during pregnancy and to avoid the vertical transmission of the yeast to the neonate.
Language Greek
Subject Antifungal susceptibility
Candida colonisation
Molecular tuping
Αντιμυκητιακή ευαισθησία
Μοριακή τυποποίηση
Issue date 2015-07-17
Collection   Faculty/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
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