# Acute fungal endometritis in women with abnormal uterine bleeding: Clinical and microbiological insights

## TL;DR

This study explores fungal endometritis in women with abnormal uterine bleeding, emphasizing the need for direct sampling and proper diagnosis.

## Contribution

The study presents a pioneering clinical and microbiological analysis of fungal endometritis cases in women with abnormal uterine bleeding.

## Key findings

- Fungal endometritis was diagnosed in 11.62% of patients with abnormal uterine bleeding.
- Direct endometrial sampling was crucial as vaginal discharge cultures were negative in confirmed cases.
- Combined treatment with voriconazole and surgical debridement was effective against isolated fungal species.

## Abstract

Fungal endometritis, an uncommon yet severe condition affecting the uterine lining, typically manifests with abnormal uterine bleeding (AUB), pelvic discomfort, and vaginal discharge. This investigation aimed to present a pioneering study focused on fungal endometritis in women presenting with these clinical symptoms.

A cohort of 43 female patients experiencing abnormal uterine bleeding was comprehensively evaluated at Babol University of Medical Sciences in Babol, Iran, between March 21, 2023, and March 19, 2024. Diagnostic procedures encompassed ultrasound imaging, a range of laboratory tests, hysteroscopy for direct visualization and tissue sampling, microscopic examination, fungal culture with subsequent colony count, and polymerase chain reaction for enhanced accuracy in fungal identification. Additionally, drug susceptibility patterns were assessed for all isolated fungal species.

Among the 43 patients, five (11.62%) received a definitive diagnosis of fungal endometritis.
The identified species included two isolates of Candida albicans, two isolates of Nakaseomyces glabratus (previously known as C. glabrata),
and one isolate of Candida orthopsilosis. A notable diagnostic observation was that all confirmed cases yielded negative results from vaginal discharge cultures,
emphasizing the necessity of direct endometrial sampling. Antifungal susceptibility testing revealed varying minimum inhibitory concentrations among the isolates,
though all responded effectively to the combined treatment of voriconazole and surgical debridement.

This study highlighted the critical importance of prompt evaluation and precise diagnosis, including comprehensive antifungal susceptibility testing, in individuals presenting
with acute endometritis and AUB. Such rigorous considerations are essential for guiding clinical management and mitigating the risk of adverse outcomes, particularly given
the increasing antifungal resistance and the emergence of non-albicans Candida species as significant pathogens.