# Aetiology of Vulvovaginal Candidiasis in Ecuador and In Vitro Antifungal Activity Against Candida Vaginal Isolates

## TL;DR

This study investigates the causes and antifungal resistance of vulvovaginal candidiasis in Ecuador, finding high resistance to certain antifungal drugs.

## Contribution

The study provides updated data on VVC aetiology and antifungal resistance patterns in Ecuador.

## Key findings

- Candida albicans was the most common species in both acute and recurrent VVC cases.
- High resistance to fluconazole and miconazole was observed in C. albicans isolates.
- C. parapsilosis and C. famata were only found in acute VVC cases.

## Abstract

The epidemiology of vulvovaginal candidiasis (VVC) in Ecuador remains poorly reported and outdated. We therefore conducted a 12-month prospective survey to assess the aetiology and antifungal resistance patterns among symptomatic Ecuadorian patients. VVC diagnosis was confirmed by microscopic examination and culture. Isolates were identified by biochemical and molecular methods. In vitro antifungal susceptibilities to amphotericin B, clotrimazole, fluconazole, itraconazole, miconazole, and nystatin were determined by CLSI methods. Among 195 women, 71 VVC episodes were recorded (36.4%), whereof 56 (28.7%) had acute VVC (AVVC) and 15 (7.7%) had recurrent VVC (RVVC). The predominant species was Candida albicans, isolated in pure culture from 45 AVVC (80.3%) and 9 RVVC patients (60%), and in mixed culture from 7 AVVC (12.5%) and 3 RVVC patients (20%). Candida glabrata and Saccharomyces cerevisiae were also isolated in AVVC and RVVC patients, but Candida parapsilosis and Candida famata were only isolated from AVVC. Fluconazole- and miconazole-resistant C. albicans isolates were recovered from 5 (8.9%) and 24 (42.9%) of 56 AVVC patients, respectively, and from 1 (8.3%) and 5 (41.7%) of 12 RVVC patients, respectively. Fluconazole and miconazole resistance is relevant in Ecuador, emphasising the need for targeted antifungal strategies.