VAGINAL CANDIDIASIS AND BACTERIURIA AMONG PREGNANT AND NON-PREGNANT WOMEN

ABSTRACT

This study evaluates vaginal candidiasis and bacteriuria among pregnant and non-pregnant women in Umuahia, Abia State. A total of 80 samples of high vaginal swab and mid-stream urine samples were aseptically collected from pregnant and non-pregnant women. Standard microbiological methods were used to isolate and identify organisms in vaginal swabs and urine specimens.The bacterial isolates includes Escherichia coli, Staphylococcus aureus, Klebsiella  aerogenes and Pseudomonas aeruginosa with Escherichia coli having the highest percentage occurrence (35.6%), followed by Staphylococcus aureus(20%) in pregnant women, 31.25% and 18.75%  respectively in non-pregnant women. The fungal isolates includeCandida albicans, having the highest level of percentage occurrence. All isolates were tested against antimicrobial agents andCandida albicanswas sensitive to antifungal agents such as ketoconazole and fluconazole, while the bacterial isolates showed high level of sensitivity to nitrofurantoin, ciprofloxacin and gentamicin. Urinary Tract Infection (UTI) is common in pregnant and non-pregnant women. Therefore, early diagnosis and adequate treatment of vaginal candidiasis and bacteriuria should be practiced.

TABLE OF CONTENTS

Title Page                                                                                                                                i

Certification                                                                                                                           ii

Dedication                                                                                                                              iii

Acknowledgements                                                                                                                iv

Table of Contents                                                                                                                   v

List of Tables                                                                                                                          vii

Abstract                                                                                                                                  viii

CHAPTER ONE

1.0       Introduction                                                                                                                1

1.1       Aim and Objectives                                                                                                    2

CHAPTER TWO

LITERATURE REVIEW

2.1       Bacteriuria                                                                                                                  3

2.1.1    Biology of Urinary Tract                                                                                            7

2.1.2    Classification of UTI                                                                                                  7

2.1.3    Uncomplicated and Complicated Urinary Tract Infection                                         7

2.1.4    Symptoms of Urinary Tract Infection                                                                        8

2.1.5    Causative Agent                                                                                                         9

2.1.6    Asymptomatic and Symptomatic UTI                                                                        10

2.2       Physiological Changes during Pregnancy                                                                  14

2.3       Route of Infection                                                                                                       16

2.4       Emergence of Resistance among UTI Pathogens                                                       17

2.5       Treatment of UTI                                                                                                        20

2.6       Vaginal Candidiasis                                                                                                    21

2.6.1    Signs and Symptoms of Vaginal Candidiasis                                                            23

2.6.2    Causes of Vaginal Candidiasis                                                                                   24

2.7       Diagnosis                                                                                                                    25

2.8       Treatment                                                                                                                   26

CHAPTER THREE

MATERIALS AND METHODS                                                                                        

3.1       Study Population                                                                                                        28

3.2       Collection of Samples                                                                                                28

3.3       Sterilization of Materials                                                                                            28

3.4       Media Preparation                                                                                                      29

3.5       Microbiological Examination of Sample                                                                   29

3.5.1    Microscopy                                                                                                                 29

3.5.2    Identification of Isolates                                                                                             29

3.6       Antimicrobial Sensitivity Test                                                                                   34

CHAPTER FOUR

4.0       Results                                                                                                                        35

CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATION                                      

5.1       Discussion                                                                                                                   40

5.2       Conclusion                                                                                                                  42

5.3       Recommendations                                                                                                      42

References                                                                                                     

LIST OF TABLES

CHAPTER ONE

1.0       Introduction

Urinary tract infection (UTI) is ranked among the most prevalent extra intestinal infection in the society. The disease burden of UTI is estimated to be 150 million cases annually worldwide, with different types of UTI posing serious health problem that affect millions of people (Stapleton, 2005). Urinary Tract Infections is more common in women than men and in pregnant women more than non-pregnant women (Stapleton, 2005). The severity of UTI depends both on the virulence of the bacteria and the susceptibility of the host. Disease spectrum in UTI includes cystitis, pyelonephritis, urosepsis, catheter related infection, as well as asymptomatic bacteriuria (Nesta, 2012).

Asymptomatic bacteriuria (ASB) is a common clinical entity in pregnancy. Approximately 2-11% of community acquired asymptomatic bacteriuria occurs in pregnancy (Nicolle et al., 2005; Tolosa, 2008; Sevki et al., 2011).

Vaginal candidiasis (VC) is a common type of vaginitis, a gynaecologic disorder that manifests with an odorless curdy white discharge (“cottage cheese”) in the female lower reproductive tracts with pruritus, irritation, dysuria or dyspareunia (Nwokedi and Anyiam, 2003). It is a common complaint among women of different age groups in any society whether or not they are sexually active. Some studies have shown high preponderance of vaginal candidiasis in infective vaginal discharge among which studies included 52.5 and 60% isolation rate respectively, of Candida species (Nwokedi and Anyiam, 2003). Risk factors for vaginal candidiasis are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way. Having a risk factor for VC makes the chances of getting a condition higher but does not always lead to vaginal candidiasis. Also, the absence of any risk factor or having a protective factor does not necessarily guard one against getting vaginal candidiasis. Some risk factors for VC include pregnancy, poorly controlled diabetes, oral contraceptive, antibiotics, immune suppression, douches, perfumed feminine hygiene sprays, topical antimicrobial agents, tight clothing, tight underwear, thyroid disorders and corticosteroid (John, 2000).

Vulvo-vaginal candidiasis is caused by the fungus Candida albicans in approximately 85% of cases, while other species such as Candida glabrata, Candida krusei, Candida tropicalis and Candida stellatoidea rarely cause vaginitis (Van Dyck et al., 1999). Candida species are usually of endogenous origin and may be transmitted by sexual partners. Changes in the vaginal environment are usually necessary before the organism can induce pathological effects. Although VC is both treatable and mild, when left untreated, is a possible risk for acquisition of HIV/AIDS as well as other complications (UNAIDS, 2003). Other complications include pelvic inflammatory disease, infertility, ectopic pregnancy, pelvic abscess, menstrual disorders, spontaneous abortion and premature birth. It is now well established that the presence of infective vaginal discharge greatly facilitates transmission and acquisition of HIV between sexual partners (FMOH, 2005; Abebe et al., 2001).

1.1       Aim and Objectives

To determine the prevalence of vaginal candidiasis and bacteriuria among pregnant and non-pregnant women in Umuahia.

Objectives

1.     To determine the prevalence of vaginal candidiasis andUrinary Tract Infection among pregnant and non-pregnant women.

2.     To determine the common microbes causing urinary tract infection.

3.     To determine the anti-microbial sensitivity patterns of the microbes causing vaginal candidiasis and Urinary Tract Infection.

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