CANDIDIASIS AMONG PREGNANT WOMEN OF CHILDBEARING AGE

ABSTRACT

Fifty (50) High Vaginal Swab (HVS) were carefully and aseptically carried from pregnant women with complaint of vaginal discharge. The samples were analyzed using standard microbiological methods. Wet preparation of the samples were examined microscopically and the Swabs were cultured on Sabouraud Dextrose Agar (SDA) plates and incubated at 37oC for 3-4 days. The overall prevalence of Candida albican was Eighten (36%). This investigation recommends good personal hygiene and regular check up for women domiciled in this area since Candida albicans poses a major health challenge to avoid complicated health problems.

TABLE OF CONTENTS

Title page                                                                                                                    i

Declaration                                                                                                                 ii

Certification                                                                                                                iii

Dedication                                                                                                                  iv

Acknowledgements                                                                                                    v

Table of contents                                                                                                        vi

List of tables                                                                                                               viii

Abstract                                                                                                                      ix

CHAPTER ONE

1.0       Introduction                                                                                                    1

1.2       Aims and objectives                                                                                       6

CHAPTER TWO

2.0       Literature review                                                                                            7

2.1       Candidiasis                                                                                                     7

CHAPTER THREE

3.0       Materials and Methods                                                                                   18

3.1       Collection of Samples                                                                                    18

3.2       Wet Preparation                                                                                              18

3.3       Microbiological Analysis                                                                               18

3.4       Sterilization                                                                                                    19

3.5       Identification of Bacteria                                                                               19

3.6       Gram Staining                                                                                                19

3.7       Catalase Test                                                                                                                                 20

3.7.1    Coagulase Test                                                                                               20

3.7.2    Citrate Test                                                                                                     20

3.7.3    Motility, Indole, Urease Test (MIU)                                                              21

3.7.4    Triple Sugar Iron Test                                                                                    21

3.7.5    Oxidase Test                                                                                                   22

CHAPTER FOUR

4.0       Results                                                                                                            23

CHAPTER FIVE

5.0       Discussion, Recommendation and Conclusion                                              27

5.1       Recommendation                                                                                           28

5.2       Conclusion                                                                                                      28

            References

  LIST OF TABLES

Table 1: Age distribution of pregnant women with Candidiasis                                24

Table 2: Distribution of Cadidiasis infection by trimester                                         25

Table 3: Sensitivity of different methods used in study                                             26

CHAPTER ONE

1.0           INTRODUCTION

The genital tract is the portal of entry for numerous sexually and non-sexually transmitted diseases. A number of bacterial and non-bacterial infections exist that affect the female reproductive tract and cause vaginal discharge. Vaginal discharge is a common symptom in primary health care and is often the second most common gynecological problem after menstrual disorders. Most women regard any secretion from the vagina as abnormal discharge and the first task for primary health care providers is to ascertain whether it is pathological or physiological. There are few women who complain of vaginal discharge, discomfort or odour without any objective finding (Dodson and Friedrich, 1997). Such women may be motivated by a neurotic fear of uncleanliness, guilt concerning sexual activities, or anxiety about venereal disease, whether or not sexual exposure has actually taken place. A number of vaginal infection present with few or no symptoms and yet produce serious effect and can be transmissible to other people. The major factors that increase the incidence of sexually transmitted disease include the increase in promiscuity amongst people, the spread of orogenital and anogenital sexual practices in both heterosexual practices and homosexual relationships, increase in travel and migration and the wide spread use of contraceptive techniques such as contraceptive pills and intrauterine device (IUD) which, unlike the condom, do not provide a partial barrier to infection (Haukkammaa et al., 1998; Eschenbach, 1999; Sinillo et al.,  2001; Hay, 1994; Geiger and Foxman, 1996). The bacterial pathogen associated with vagina infection are Neisseria gonorrhoea, E. coli, Streptococcus pyogenes, S. aureus, Treponema pallidum, E. faecalis, Clostridium perfringens, Proteus mirabilis, Klebsiella aerogenes etc. The non- bacterial pathogens include parasites such as Trichomonas vaginalis, Gardnerella vaginalis, and fungi like C. albicans and viruses like Herpes Simplex Virus. Others include Bacteriodes spp, Chlamydia trachomatis, Listeria monocytogenes, and hemolytic streptococci (Cheesbrough, 2000). The bacterial flora of the female genital tract is diverse and varied; normally aerobic lactobacilli appear in the vagina soon after birth and persist as long as the pH remains acidic (Cruickshank and Sharman, 1994) and more acidic (pH 4.5) during early month of pregnancy. The lactobacilli are suppressed by the administration of antimicrobial drugs; yeast or various bacteria increase in number and cause irritation and in most cases inflammation. After menopause, lactobacilli again diminish in number and mixed bacterial flora often include group hemolytic streptococci, anaerobic streptococci (peptostreptococci), Prevotella spp, Clostridia spp, G. vaginalis and Ureaplasma urealyticum. However, studies have showed that anaerobic bacteria are more in type and number than their aerobic counterpart. The anaerobes considered to be of clinical importance are the Peptostreptococcus spp, Clostridium spp and Bacteroides spp (Barlette et al., 1999). Moreover, several factors can be associated with increased rate of vaginal colonization by bacteria and C. albicans: these include pregnancy, use of high oestrogen and oral contraceptives, uncontrolled diabetes mellitus, wearing of tight-fitting synthetic underclothing, prolonged use of antibiotics which kill the good and beneficial bacteria, allowing yeast overgrowth, poor dietary habits and poor personal hygiene. The common features of vaginal infections is that at some stages, they all produce lesions at the site of infection usually in or about the external genitalia and these lesions are highly infective to the male sexual partners (Muir’s, 1985; Spiegel, 1991). In women (both pregnant and non-pregnant) C. albicans and S. aureus seem to be the most prevalent microorganisms (Kamara et al., 2000; Sobel, 1997). The high prevalence of bacteria in vaginal diseases orinfection and concomitant lower genital tract infections among symptomatic and asymptomatic pregnant women and the resultant adverse pregnancy outcome associated with bacteria vaginal and Candida infection confirm the report from Govander et al., (1996). Pelvic inflammation diseases (Spiegel, 1991), sexually transmitted infection and reproductive tract infections continue to exert a tremendous health burden on women in developing countries. Poor social economic status, inadequate knowledge, lack of diagnostic facilities and shortage of effective treatment all contribute to the high incidence of sexually transmitted and reproductive tract infections (Tyadal et al., 1992; Burrow and Bueshing, 1999). The genital tract is the portal of entry for numerous sexually and non-sexually transmitted diseases. A number of bacterial and non-bacterial infections exist that affect the female reproductive tract and cause vaginal discharge. Vaginal discharge is a common symptom in primary health care and is often the second most common gynecological problem after menstrual disorders. Most women regard any secretion from the vagina as abnormal discharge and the first task for primary health care providers is to ascertain whether it is pathological or physiological. There are few women who complain of vaginal discharge, discomfort or odour without any objective finding (Dodson and Friedrich, 1997). Such women may be motivated by a neurotic fear of uncleanliness, guilt concerning sexual activities, or anxiety about venereal disease, whether or not sexual exposure has actually taken place. A number of vaginal infection present with few or no symptoms and yet produce serious effect and can be transmissible to other people. The non- bacterial pathogens associated with vagina infection are Trichomonas vaginalis, Gardnerella vaginalis, and fungi like C. albicans and viruses like Herpes Simplex Virus. Others include Bacteriodes spp, Chlamydia trachomatis, Listeria monocytogenes, and β- hemolytic streptococci (Cheesbrough, 2000). Candidiasis is the most common opportunistic fungal infection (Hedayati and Shafiei, 2010). Vaginitis is one of the principal motives that lead women to seek out an obstetrician or gynecologist. Candidiasis is responsible for 90% of the cases of infectious vaginitis (Adad et al., 2001). Vulvovaginal candidiasis (VVC) is a fungal infection of the female lower genital tract-the vulva and the vagina, caused by Candida species (Sobel, 2007; Akah et al., 2010). Candida is the fourth most common cause of nosocomial bloodstream infection in the United States (Pappas et al., 2009). Candida species that cause vaginitis most often are C. albicans, C. g/abrata and C. tropicalis. Candida spp. that rarely causes infection includes C. parapsilosis, C. pseudotropicalis, C. krusei, C. guilliermondi and C. stellatoidea (Cronje et al., 1994). The bacterial flora of the female genital tract is diverse and varied; normally aerobic lactobacilli appear in the vagina soon after birth and persist as long as the pH remains acidic (Cruickshank and Sharman, 1994) and more acidic (pH 4.5) during early month of pregnancy. The lactobacilli are suppressed by the administration of antimicrobial drugs; yeast or various bacteria increase in number and cause irritation and in most cases inflammation (Barlette et al., 1999). Several factors can be associated with increased rate of vaginal colonization by C. albicans: these include pregnancy, use of high oestrogen content and oral contraceptives (Akah et al., 2010; Alli et al., 2011), uncontrolled diabetes mellitus (CDC, 2002; Alli et al., 2011), prolonged use of broad spectrum antibiotics (Mardh et al., 2002; Alli et al., 2011) which kill the good and beneficial bacteria, allowing yeast overgrowth, poor dietary habits and poor personal hygiene. Many practitioners believe that nylon underwear and tight insulating clothing predispose to vaginal candidiasis by increasing the temperature and moisture of the perineum (Nwankwo et al., 2010; Alli et al., 2011). A study among African women wearing tight clothes reported a higher prevalence of Candida albicans in Vulvovaginal candidiasis than those wearing loose clothing (Alli et al., 2011). The same observation was made in the study by Nwankwo et al. (2010), where regular users of tight clothings had 88.2% of Candida albicans and occasional and non wearers had 68.6% of Candida albicans. Poorly supported risk factors include use of sponge, intrauterine devices (IUDS), diaphragms, condoms, orogenital sex, douching and intercourse (Mardh et al., 2002, Reed et al., 2003; Alli et al.,  2011) and diet with high glucose content (de Leon et al., 2002; Akah et al., 2010; Alli et al., 2011). Indeed, evidence in favour of sexual transmission exists. For instance, penile colonization is four times more frequent in male partners of women affected with VVC (McClell and et al., 2009; Alli et al., 2011) and infected partners commonly carry identical strains which orogenital transmission has been documented (Akah et al., 2010; Alli et al., 2011). The common features of vaginal infections is that at some stages, they all produce lesions at the site of infection usually in or about the external genitalia and these lesions are highly infective to the male sexual partners (Muir’s, 1985). Pelvic inflammation diseases, sexually transmitted infection and reproductive tract infections continue to exert a tremendous health burden on women in developing countries. Poor social economic status, inadequate knowledge, lack of diagnostic facilities and shortage of effective treatment all contribute to the high incidence of sexually transmitted and reproductive tract infections (Tyadal et al., 1992; Burrow and Bueshing, 1999).

1.1       AIMS AND OBJECTIVES

·                The aim of this study was to investigate the current status of Vaginal candidiasis among pregnant women of child bearing age.

·                To determine the prevalence of candida albicans among pregnant women.

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