Vulvovaginal candidiasis is an infection of the vulva and vagina caused by Candida sp. Approximately 85-90% of the cells isolated from vaginal yeast is Candida albicans species. The rest are non-albicans species, and the vast majority were Candida glabrata (Torulopsis glabrata). Vaginitis caused by non-albicans species are usually resistant to conventional therapies.
Candida sp is a single cell fungus, round to oval. There are around 80 species and 17 of them are found in humans. Of all the species found in humans, C.albicans was the most pathogenic. Candida sp reproduce themselves by forming blastospora (budding cells). Blastospora each other and increase the length concatenated to form pseudohyphae. The form pseudohyphae more virulent and invasive than the spores. That's because pseudohyphae are larger and thus more difficult difagositosis by macrophages. In addition, pseudohyphae have blastokonidia multiple points on a single filament so that the number of elements of existing infectious greater.
Another virulence factor in Candida is the cell wall. Cell wall mannoprotein of Candida sp contains derivatives that are immunosuppressive thus enhancing the host immune defense against fungal and aspartyl proteinases that cause Candida sp can penetrate the mucosal layer.
In the face of the invasion of Candida, the body is mobilized to eliminate phagocytic cells. Interferon (IFN)-gamma block the process of transformation of the form of spores into hyphae. So we can conclude, in a woman with humoral immunity defects, Candida easier to form themselves into a more virulent hyphae and easily cause vaginitis.
Predisposing factors of vulvovaginal candidiasis:Several predisposing factors vulvovaginal candidiasis include pregnancy (third trimester), contraceptives, diabetes mellitus, antibiotics (especially broad spectrum such as tetracycline, ampicillin, and oral cephalosporins), using tight clothing and nylon.
During pregnancy, showed increased susceptibility to vaginal Candida infection so that the prevalence of vaginal colonization and symptomatic vaginitis increased, especially the third trimester. Suspected estrogen increases Candida adherence to vaginal epithelial cells and directly enhance virulence yeast.
The emergence of candidiasis often occurs during the use of oral antibiotics such as broad-spectrum systemic particularly tetracycline, ampicillin, and cephalosporins as the normal vaginal bacterial flora such as Lactobacillus protective also eliminated.
Clothing tightly coupled with panties nylon increasing humidity and temperatures in the perineal area, making it easier to grow flowers mushrooms. C.albicans can grow in a wide pH variations. Growth would be better at a pH of 4.5 to 6.5, temperature 28-37oC.
Pathophysiology of vulvovaginal candidiasis:The infection process begins with the attachment of Candida sp. vaginal epithelial cells. This inherent ability to C.albicans better than other Candida species. Then, Candida sp. secrete proteolytic enzymes that cause damage to the bonds of host cell proteins to facilitate the invasion process. In addition, Candida sp. also secrete mycotoxins-gliotoksin them-that can inhibit phagocytic activity and suppress the local immune system. Establishment of colonization Can-di-da sp. facilitate the invasion took place, causing symptoms in the host.
Candidiasis Vulvovagina RekurensApproximately 30-40% of patients will experience vulvovaginal candidiasis re-infection for the second time and less than 5% of vulvovaginal candidiasis candidosis will be vulvovagina rekurens (vulvovaginal candidiasis R). Definition of vulvovaginal candidiasis R is 4 or more episodes of thrush infection for 12 months / 1 year. Vulvovaginal candidiasis R is a form of vulvovaginal candidiasis complications.
Vulvovaginal candidiasis R, divided into 3 groups:
- The group with the number of microorganisms that much (KOH +, high quantitative culture) were dominated by the shape of the hyphae, with typical signs and symptoms, both in the vagina and vulva.
- The group pretty much sum organism (KOH +), but the signs and symptoms alone is limited to the vaginal area
- Groups with fewer number of microorganisms, but the symptoms and signs clear enough.