Relation of Recurrent Vulvovaginal Candidiasis with beta defensin and IL-4 among different Iraqi women

Abstract

Background: Vulvovaginal candidacies usually are caused by C. Albicans but can occasionally be caused by other Candida spp. or yeasts. Typical symptoms of VVC include pruritus, vaginal soreness, dyspareunia, external dysuria, and abnormal vaginal discharge. Candida Albicans remains the dominant species responsible for RVVC; however optimal management of RVVC requires species determination and effective treatment measures are best if species-specific. Beta defensin has a role direct fungicidal activity. In the event of Th2-skewed responses to Candida, however, the development of Th2 cells by IL-4 signaling and subsequent cytokine production (e.g. IL-10) are known to dampen the Th1-mediated protection, leading to susceptibility to Candida infection. Aim of the study: Determination the role of each of Beta defensin and IL-4 in recurrent Vulvovaginal Candidiasis among different Iraqi women. Materials and methods: During the period from October 2019 to February 2020, ninety specimens including: vaginal lavage, were collected, from two hospitals in Baghdad (Abdalmajeed private hospital and Alkadhim Teaching Hospitals), 41 patients who are suffering from pruritus, vaginal soreness, dyspareunia, external dysuria, and abnormal vaginal discharge and 47 apparently healthy (control). The specimens were divided into two smears one was examined immediately under light microscope for direct examination and the other was cultured on isolation medium. A vaginal lavage was obtained by injecting 2 ml of physiological saline solution (NaCl) into vagina of the enrolled patients then 1 ml of the recovered vaginal fluid was collected, centrifuged and then tested for cytokines. Vaginal level of IL-4 and β-defensin were determined by ELISA method using Abbexa Cytokine ELISA Kits (UK), which was designed for the quantitative measurement of cytokine in human. Results: Ninety specimens including: Vaginal lavage, were collected, during the period from October 2019 to February 2020, 41 patients who are suffering from pruritus, vaginal soreness, dyspareunia, external dysuria, and abnormal vaginal discharge and 47 apparently healthy (control). The result indicated the percentage of symptomatic patients was 46.6%, while the asymptomatic patients was 53.4%, where, that the highest infection with VVC occurred in the age group of 31-40 years with the percentage of 38.9% followed by 30%, 21.1% and 10% n age group of 20-30 years,41-45 years and less than 20 years respectively. Depending on the contraception and postcoital bleeding, the percentage was 26.1% and 73.9% in patients that have contraception and the patients that have not contraception respectively.While, 15.9% and 84.1% for patients that have postcoital bleeding and the patients that have not Postictal Bleeding was respectively. Direct smear and SDA tests found that 43 cases were positive (48.9 %) and 45 were negative (51.1 %).On the other hand, the Chromogenic agar test showed that 45 (51.1%) as negative, 29 (33.0%) C. Albicans, 6 (6.8%) C. glabrata, 6 (6.8%) C crusei and 2 (2.3%) as C tropical is the present study showed the association between recurrent Vulvovaginal Candidiasis, where the level of IL-4 (pg/ml) in samples of symptomatic patients was significantly increased compared to the samples of asymptomatic patients (p