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Candida lusitaniae as an unusual cause of recurrent vaginitis and its

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Candida lusitaniae as an unusual cause of recurrent vaginitis and its

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Candida lusitaniaeas an unusual cause of recurrent vaginitis and its successful treatment with intravaginal boric acid Neil S. Silverman1, Margie Morgan2and W.S. Nichols2

1Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center,

Burns & Allen Research Institute, UCLA School of Medicine, Los Angeles, CA

2Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center,

Burns & Allen Research Institute, UCLA School of Medicine, Los Angeles, CA lusitaniae, a previously unreported cause of candidal vaginitis. Key words: VULVOVAGINITIS; VAGINITIS; CANDIDA; BORICACID

CASE REPORT

A55-year-oldgravida4,para2022Caucasian

womanwasreferredforevaluationandmanage- mentofchronicrecurrentvulvovaginitis.The patientreportedapproximatelyfiveyearsof

1-3months.Shehadbeentreated,inresponseto

symptomsandcultureresults,withavarietyof overthepastyears.Hermostrecentantifungal therapywas6monthspriortoreferral,andcon- creamafteravaginalculturewaspositivefor symptomatic relief after that therapy.

Thepatientwasingoodhealth,withnochronic

medicalconditions.Shewastakingnomedica- tions.Atotalabdominalhysterectomywith earlierforuterineleiomyomata.Thepatient reportednomenopausalvasomotorsymptoms, were not in the menopausal range.

Atthetimeofinitialevaluation,thepatient

reportedonlyminimalsymptomatology.Exami- nationrevealednorednessorswellingofthe externalgenitaliaorthevagina.Nolesionsor excoriationswerepresent.ThevaginalpHwas

Infect Dis Obstet Gynecol 2001;9:245-247

Boulevard, Suite 160W, Los Angeles, CA 90048. Email: silvermann@cshs.org

Gynecologic case report245

culturesobtainedatthatvisitsubsequently symptom recurrence.

Thepatientreturnedforsymptomrecurrence

vaginalpHwas4.5,andwetprepagainshowed werenegative.Thepatientwasstartedonoral fluconazoletobeginat200mgevery4daysfor symptomsandcolonizationwereprovenon fiedinourlaboratorythroughmorphologyon

CA)andinoculationofanAPI20Cassimilation

strip(bioMerieux,Hazelwood,MO).Toelimi- too,withabsenceofmaltosefermentationcon- wascontactedandreportedthatshewasstill symptomatic,withnorelieffromtheketo- theendoftherapy,whichrespondedtoatopical emollient cream.

DISCUSSION

WhileCandidaalbicansremainsthemostcommon

1970sto21%throughthe1980s,withTorulopsis

percentage increases for individual species2,3.

Thechangeinbreakdownofpathogenicyeast

mentofcandidalvulvovaginitis.Thewidening resultatleastinpartfromexpandinguseof ingfortheemergenceofresistantorganisms. species,ashasbeenshowntobethecasewiththe symptomswhoarethentreatedwithmultiple antifungals,allowingtheemergenceofless- sensitive non-albicansspecies.

1979inapatientwithacuteleukemia7,andhas

casesreportedthrough20008,9.Two-thirdsof Successful treatment ofCandida lusitaniaeSilvermanet al. 246

INFECTIOUSDISEASESINOBSTETRICSAND GYNECOLOGY

thesecasesoccurredinimmunocompromised

C.lusitaniaeinotherwisehealthywomenhave

beenreportedtodate.Ofnoteisthefactthat competent fungemic patients8.

Bothfluconazoleandketoconazoleproved

agentshavebeenshowntobeeffectiveinahigh

197411,andithasbeenshowntobeeffective

regimenofintravaginalboricacidcapsulesas describedinSobel"sserieswasemployed,with

C.lusitaniaeachieved.

Inreportingwhatwebelievetobethefirst

withnon-azoletherapy,weaddourconcernsto callytreatedinfections.Whileourpatient ongoingneedtoinvestigatenewerantifungal spectrumofpathogenicagents,evenin immunocompetent individuals.

REFERENCES

problem.Derm Clin NA1998;16:763-8

2.OddsFC,WebsterCE,RileyVC,etal.Epi-

canceofnumbersofvaginalyeastsandtheir

25:53-66

patient care.J Clin Pharmacol1992;32:248-55 opportunisticpathogensCandidaalbicansand (suppl B):39-49

Curr Prob Obstet Gynecol Fertil1990;8:241-5

Fungemiaintheimmunocompromisedhost:

Am J Med1981;71:363-70

7.PappagianisD,CollinsMS,HectorR,etal.

DevelopmentofresistancetoamphotericinBin

Agents Chemother1979;16:123-6

Clin Infect Dis2001;32:186-90

genceofanewopportunisticpathogen,Candida lusitaniae.J Clin Microbiol1989;27:236-40 ketoconazoletherapy.NEnglJMed1986;315:

1455-8

11.SwateTE,WeedJC.Boricacidtreatmentof

893-5

12.SobelJD,ChaimW.TreatmentofTorulopsis

therapy.Clin Infect Dis1997;24:649-52

RECEIVED06/18/01; ACCEPTED10/04/01

Successful treatment ofCandida lusitaniaeSilvermanet al.

INFECTIOUSDISEASESINOBSTETRICSAND GYNECOLOGY

247
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