Candida vulvovaginitis pathophysiology
Candida vulvovaginitis Microchapters
Candida vulvovaginitis pathophysiology On the Web
American Roentgen Ray Society Images of Candida vulvovaginitis pathophysiology
Several virulence factors of Candida are implicated in vulvovaginitis, but the process of transition from asymptomatic vaginal colonization to symptomatic vulvovaginitis is poorly understood. There may be genetic factors associated with Candida vulvovaginitis, as infection runs in families in many cases and is more common in African-American women.
Vaginal Defensive mechanisms aganist Candida
|Defense||Mechanism of protection||Evidence of protection|
|Vaginal epithelial cells|
|Vaginal bacterial flora||
|Phagocytic systems/polymononuclear leukocytes, mononuclear cells, complement||
|Defense||Mechanism||Role in Protection|
|Immunoglobulin mediated immunity||Systemic IgM, IgG, and local IgA antibodies are produced in response to the infection|
|Cell Mediated Immunity|
Candida Virulence Factors
- C. albicans exists as blastospores, germ tubes, pseudomycelia, true mycelia and chlamydospores on special culture media. C. glabrata exists exclusively in blastospores.
- All strains of Candida species possess a yeast surface mannoprotein which helps in adhering to epithelial cells of the vagina.
- Germination of the spores helps in colonizing the vagina.
- Proteolytic enzymes, toxins and phospholipase destroy the proteins that normally impair fungal invasion, enhancing the ability of Candida to colonize the vagina.
- Phenotypic switching of Candida is described in patients with recurrent vaginitis.
- C. albicans can form biofilms on the intrauterine devices or sponges, causing disease recurrence.
- Candida vulvovaginitis is a microbial disease and not all patients with detectable pathogen are symptomatic. Multiple risk factors and the imbalance in the protective vaginal defenses predispose patients to develop active disease.
- Candida vaginal infections are more common in the reproductive age group because of the high concentration of estrogen as it increases the amount of glycogen in the vagina providing a carbon source for Candida organisms to colonize. It also increases the adherence of Candida to the vaginal epithelial cells.
- The most common source of the infection is from the perianal area. Other less common source is sexual transmission and persistence of organisms in the vagina after treatment which is responsible for recurrence.
- The initial step of infection is colonization and symptoms appear with the invasion of the blastospores or pseudohyphae of the vaginal wall.
- The understanding of the transition from asymptomatic vaginal colonization with Candida to symptomatic vulvovaginitis is not clear.
- Few genetic factors are thought to be involved in patients with recurrent Candida vulvovaginitis.
- Supporting evidence is that Candida vaginitis is common in African-American women, runs in families and its association in patients with ABO-Lewis non-secretor phenotype (a rare blood group).
- In addition, women with recurrent Candida vulvovaginitis were found to have decreased concentrations of mannose binding lectin (MBL), hence, the variant (MBL) gene is thought to be a contributing factor in the development of Candida vulvovaginitis.
On speculum examination typical curdy white discharge is present.
This photograph is a speculum examination of the vagina with Candida infection and the typical thick, curdy vaginal discharge. - By Mikael Häggström - Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=35323300
This autopsy photograph of the kidneys demonstrates the multifocal punctate lesions visible on the serosal surface (arrows). Don't confuse these small yellow punctate lesions with the fat that is adherent to the renal capsule. - © Copyright UAB and the UAB Research Foundation, 1999-2013. All rights reserved
This photograph of the cut surface of these kidneys shows that these multifocal punctate lesions are primarily in the cortex (arrows). - © Copyright UAB and the UAB Research Foundation, 1999-2013. All rights reserved
Microscopic examination of the wet mount with 10% KOH or saline demonstrates hyphae, pseudohyphae and blastospores.
This is a a microscopic image of Candida albicans, grown on cornmeal agar medium. - By Y tambe - Y tambe's file, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=233284
This is a low-power photomicrograph of lymph node with three prominent areas of Candida colonies (arrows). Even at this low magnification, the purple-staining yeast and pseudohyphae can be easily seen. This section was stained with Periodic Acid-Schiff Hematoxylin (PASH), which stains the cell wall of fungi to make them more easily visible. - © Copyright UAB and the UAB Research Foundation, 1999-2013. All rights reserved
This is a low-power photomicrograph of one of the Candida colonies from this lymph node. The chains of yeast which are termed "pseudohyphae" are apparent at this magnification. - © Copyright UAB and the UAB Research Foundation, 1999-2013. All rights reserved
This higher-power photomicrograph shows the yeasts and pseudohyphae in this focus of Candida organisms. - © Copyright UAB and the UAB Research Foundation, 1999-2013. All rights reserved
This high-power photomicrograph shows the yeasts (1) and pseudohyphae (2). - © Copyright UAB and the UAB Research Foundation, 1999-2013. All rights reserved
- Candida vulvovaginitis may be associated with other pathogens that cause vulvovaginitis. These include Trichomonas vaginalis and Gardnerella vaginalis. The association may be a mixed infection, where 2 or more pathogens are symptomatic, or a co-infection, in which there are 2 or more pathogens but some are not symptomatic.
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