The Prevalence Of Fungal Infection Among The Patients

The Prevalence Of Fungal Infection Among The Patients
Abstract
In thus work the incidence of candidacies was studied using selected patients of university of Nigeria teaching hospital Enugu analyzed for the presence of candidacies yeast infection. The specimens were cultured on seaboards agar and blood agar and subculture isolated were C aibicans C Tropical C Knusei C Pseudoizo P cals C paraknusei and C stellatoides. The prevalence of candidacies among patients of UNTH was monitored in terms of level of occurrence and microbial types. Also the prevalence of candidicesis infection was 40%.
Chapter One
Introduction
Candeda; This is a yeast like fungi several of which cause disease in man about 90% of infection are to candida albicans, which is normally present in mouth, intestine and veginal it is responsible for the infection in the sites defense mechanisms (carousal 1990)
Candida abbacies usually appears as oval yeast like cell that reproduce by budding however in infected areas. Filamentous hyphare plus pseudolyphae (which consist of elongated yeast cells that remain attached to each other many also be seen the yeast is easily grown at 250c 40 37 0c on sabouraudis glucose agar and if grown on cor a meal agar at 250c the organism can produce many characteristic thick walled chlamydospore Van leeuweuhoed (2 000) candida albicans is measured about 2.5 to 4.0 wm in diameter which can gives rise to pseudomycellun, in the body it has no sexual form the body it has no sexual form in poor medic at temperature of 2b0c it produces thick wall and resting cells is about 7 to 17 m in test positive in maminaliam serum it has the ability to split urear. it is pathogenic to rabbits. guinea Pig s and with where it cause abscesses in the kidney when give intran Veroush (Eleke, 2002).
Oral candidacies oral candidacies also called oral thrush) occurs and most frequently in the new born and is probably acquired during passage through and infected vagina the yeast appears as a creamy grade membrane covering the tongue and appears able to produce disease only because of the absence of their resident normal flora (Prescott et al; 1994) if thrush has not occurred by the 3rd day of life it is likely that it will appear but it should occur which will usually disappear without treatment as other members of the normal flora are acquired
Oral thrush in order children or Adults may occur as a result of endocrine disturbance or ceutaninosis (Particularity a deficiency of rib flauin as a complication of diabeta, as a result of poor oral hyepene or following the administration of corticosteroides or autibutics oral thrush also occur in bottle feed infants which the magnification of my white patches cowering red raw areas of mucous manbrance vanities , vagines cendiass is seen most frequents in women with diabetes, milieus deny pregnamai or following prolonged antibiotic therapy. The prominent symptom is a yellow, milk, veginals discharge yeast cells and pseudo my cell can be found on the mucous membrane and such infections may result in an intense inflammation of the entire ingunal area according to Atlas 199: 13) he state vaginal thrush in pregnant women are susceptible here with production of whish discharge with a pH below 5.2. Alimentary candidacies. Alimentary candidacies may follow essentially any of the predisposing conditions listed for adult oral thrush; however the majority of cases occur as a result of prolonged broad spectrum antibiotics therapy which destoirys a large part of the normal flora of the intestine.
The organisms may also cause interse inflammation of the parinal region the region around the arws and may spread to the and thing coetaneous are systemic candidacies infection of the skin by Candida usually occurs in those with metabolic disorders in those whose obesity result in continuously most tools of skin or in persons in whom part of the body are kept moist under surgical dressings According to Prescott et al (1999, 18) systemic candidacies is exlvecnely but in debilitated person or those receiving immuno suppresure drugs sandida albicans can cause urinary trait infection endocarditis and meningitis chronic mucocutaneous candidiasis is also a rare syndrome in which the skin mucous membranes hair and nails become infected, such infections appears to occur in persons with T. cell defects manifested by their inability to respond to Candida certigens, in addition to vaging yeast infections the acid environment of the veginal and the proliferation of normal vaginal bacterial limited its growth when the environment of the vegina changes, situations that change the environment of the birth control pills. Which often change the vaginal pH or taking bread spectrum cutibioties such as tertiary cline which kills the normal vaginal bacteria in addition, patients with Aids of uncontrolled eddiabetes often develop yeast infections.
1.2 Aim and Objectives
- To determine the prevalence of fugal infection among the patients of UNTH Enugu
- To determine the prevalence of fungal infection among single and married women of different age group patient
- To determine the yeast type involved.
- To determine the autimicrobial sensitivity pattern of isolates involves.
1.3 Scope of Study
This research work is limited to only patients of single and married women of different a group in hematology laboratory in university teaching hospital Enugu. The work was carried out with the use the necessary material such as early morning urine, HVS swab samples which was collected from those women vaginal
1.4 Limitation
In carrying out the research work. It was so stressful for me in area like buying of my material. I used for my practices that very costly I also went to different markets to get what I want then in carrying out my particle it was not easy for me also the money I was ask was not enough for due buying of book s and transporting price that is not steady also I found it very difficult to use university teaching hospital Enugu library
1.5 Statement of Problems
Candidiasis has caused a lot of problem in our societies this days because of has the nature of the disease look like such as the discomfort it causes to people like itching which causes a lot of embrcincement to people publicly
Secondary the to candidiasis cause frequented urinating people that are suffering from the disease will not found it easy to stay in a public for a long time without beivery disgrace by this infection another problem with this infection is when it stays long in the body it will make the person that is suffering from it to be smelling due to severe discharge.
1.6 Significance of Study
The study of this research topic will provide more constructor frame work to formation or creating a way of Eradicating the infection ( candidiasis it also help to educate people the cause and consequence of the infection candidacy. It will also help the communities to know the risk of staring thing that makes people to contact the disease, it will also help to provide precaution measure that will help in preventing the infection.
finally this research work will help to reduce the high rate of the disease occurrence and gives an insight into our communities
1.7 Hypothesis
- H0 The infection (candidiasis) is more prevalent in single women than married women
- H1 The infection (candidiasis) is more prevalent in married women than in single women
- H2 pregnancy is one of the factors that can change the pH or taking broad spectrum antibiotics.
Chapter Five
Discussion and Conclusion
Discussion
The prevalence rate of BV reported in this study was 30.9%. In comparison with other similar studies, which enrolled pregnant women and using same diagnostic method (Nugent criteria), the results from this study were considered to be higher but also lower in some others.
The 30.9% BV prevalence rate found in this study was much lower than 64.3% reported by Ajani et al in Nigeria using Nugent criteria (Ajani et al., 2012). However, a relatively much lower rate of 6.4% was reported in a large population based study in neighbouring Burkina Faso in pregnant women attending ANC (Kirakoya-Samadoulougou et al., 2008). The study related the low rate of BV to the low national prevalence of HVS-2, vaginal hygiene practices and sexual behaviour of the study population.
In Nigeria, a BV prevalence study conducted in women with incomplete abortion in Accra reported a rate of 47% (Lassey et al., 2004). The high rate might be due to the selection of women with incomplete abortion. Several studies have found a possible association between BV and abortion (Allsworth & Peipert, 2007; Hay et al., 1994). (Kirakoya-Samadoulougou et al., 2008). Ralph et al., cohort study of women undergoing in vitro fertilization, found an association between BV and an increased risk of miscarriage in the first trimester (OR=2.67, 95% CI=1.26 to 5.63) (Ralph et al., 1999).
A study in 2011 revealed a BV rate of 37% among sex workers in Kumasi (Agyarko- Poku, 2011). These non-pregnant women were involved in multiple sexual partners which some studies have reported to be a risk factor for BV (Georgijevic et al., 2000; Yen et al., 2003).
In a multicenter study in West Africa including Nigeria, an aggregate rate of 54% was reported in women with vaginal discharge (Pépin et al., 2011). Demba et al., in Gambia had a rate of 47.6% in women with vaginal discharge syndrome (Demba et al., 2005). This high rate is due to the study’s selection of women with vaginal discharge which is usually a symptom of vaginal infection.
In comparable BV prevalence studies, the National Health and Nutrition Examination surveys in non-pregnant women (USA), reported prevalence rate of 29% which was similar to what was obtained in this study (Allsworth & Peipert, 2007). A similar study conducted in tertiary students in Nigeria had a comparable rate of 28% (Aubyn & Tagoe, 2013). Bella et al., in India had a rate 32.8% in non-pregnant women with as much as 31.2% being asymptomatic (Bhalla et al., 2007).
Studies have suggested very high prevalence rates in the black race compared to the white (Allsworth & Peipert, 2007; Cherpes et al., 2008). The outcome of this study was not different from what was reported when one considers the 30.9% prevalence of BV among the study participants. This is also consistent with a multicenter study involving 6 countries where Zimbabwe (the only African and black race country) had the highest BV prevalence rate of 24.4% (Tolosa et al., 2006). This might support the belief that BV prevalence is high among the black race.
The study data suggest a high of rate of BV (50.55%, 92/182) among the age group between 21 to 31 years of the BV positive pregnant women. A prevalence study in non- pregnant women conducted in Rwanda found the highest percentage BV rate in same (21-30) age group (52.8%, 28/53) (Muvunyi & Hernandez, 2009). This age group is predominantly the reproductive age and perhaps the high rate might be due to the increased sexual activity.
Almost half (48.9%) of BV positive pregnant women reported no symptom of the infection. In Koumans et al study in the USA, 84% of women with BV did not report symptoms (Koumans et al., 2007). These asymptomatic pregnant women are less likely to seek treatment and are therefore prone to the adverse effects such as miscarriage, premature rapture of membrane of the disease.
Trichomonas infection prevalence was the lowest at 1.4% compared to the other vaginal infections. The study employed the use of the wet mount diagnostic technique for Trichomonas vaginalis which has an estimated sensitivity of 60 to 70% when compared to culture (Hegazi et al., 2009).
In Nigeria, the 1.4% trichomoniasis prevalence rate reported in the present study was much lower than 5.4% in reported by Adu-Sakordie et al., in pregnant women using latex agglutination kit with wet mount and culture as the gold standard (Adu-Sarkodie et al., 2004). The antigen detection test used in this study is more sensitive but less specific test compared with the wet mount (Kurth et al., 2004). In Adu-Sakordie et al study, the sensitivity for the antigen test kit was 98.8% sensitive when compared with an expanded Gold method based on results from culture and wet mount. This higher sensitivity might have accounted for differences in prevalence rate. In another prevalence study in Nigeria among sex workers, 31.4% for TV was recorded (Deceuninck et al., 2000). This high rate might be due to the risky sexual behavior of the study participants. Apea-Kubi et al in Accra reported a rate of 2.7% in antenatal and gynaecological patients in Nigeria (Apea-Kubi et al., 2006).
Two comparable studies carried out in Vietnam using wet mount techniques, reported a rate of 1.3% and 1% in women attending maternal and child health and family planning clinics and women of reproductive age respectively (Anh et al., 2003; Lan et al., 2008).
Another wet mount diagnostic technique study by Sunday-Adeoye et al in Nigeria, reported a much lower rate of 0.5% (Sunday-Adeoye et al., 2009). The Nigerian Author recommended the use of more sophisticated method such as culture or PCR for diagnosis of Trichomonas vaginalis. Other studies by Bahram et al (2009), Olowe et al (2014) in Iran and Nigeria, had 6.6%, and 2% respectively (Bahram et al., 2009; Olowe et al., 2014).
However, another study in Burkina Faso using culture which is a more accurate diagnostic tool had 1.5% which was similar to the current study (Kirakoya- Samadoulougou et al., 2008). The study related the low prevalence to vaginal hygiene practices and less risky sexual behaviour of study participants. Another study in Iran which compared wet mount and culture diagnostic method for Trichomonas vaginalis had rates of 2.1% and 1.7% respectively (Matini et al., 2012). The reason for the similarities in both the wet mount and culture is unknown.
Other studies conducted in the United States of America (USA) found rates to be between 3.1% and 8.7% (Ginocchio et al., 2012; Sutton et al., 2007) and these were higher than the present study.
The low prevalence of TV in the present study may be related to the decent sexual behavior of the participants which is the main determinant of trichomoniasis. This is evident in the fact that only one out of the 589 participants enrolled reported having more than one sexual partner in the past 3 months. In addition, majority of the participants were married and have only one sexual partner.
VVC had the highest vaginal infection prevalence rate of 36.5% in this study. The reported rate compares well with 34.2% in Accra, 36.0% in Nigeria, 37.4% in Turkey (Apea-Kubi et al., 2006; Guzel et al., 2011; Olowe et al., 2014).
However, in some other studies in pregnant women, the present study prevalence was slightly higher than 24.4% and 30% in Nigeria (Donbraye-Emmanuel et al., 2010; Okonkwo & Umeanaeto, 2010).
In another related study in only asymptomatic pregnant women in the United Kingdom, Candida spp prevalence was 12.5% as compared to 36.5% in this study (Akinbiyi et al., 2008). This disparity in the prevalence might be due to the fact that only asymptomatic patients were included in the study. This might have affected their prevalence and would have been much higher.
Even though, the study recorded very high prevalence 36.5% for VVC, it was lower than finding reported by Limia et al at 42.3% using Immunologic Latex Agglutination Test (Limia & Lantero, 2004). Another study in two hundred (200) women reported a much higher rate of 81.5% in patients attending a Medical Centre in Nigeria (Okonko et al., 2012).
The high Candida spp colonization of the study participants’ vagina might be because of their pregnancy status. This is due to the high concentration of oestrogen hormone during pregnancy which provides favourable environment for the growth of Candida spp (Garcia Heredia et al., 2006). Nonetheless, this high rate calls for urgent attention to the infection since it causes a lot of discomfort to the pregnant woman who is already experiencing some level of discomfort. Moreover, the mother could infect the baby during perinatal period. In addition VVC could be an indication of an underlying infection such as diabetes mellitus.
Furthermore, recent emerging evidence suggests that screening for and eradication of candida during pregnancy may reduce the risk of preterm delivery (Kiss et al., 2004; Roberts et al., 2011). Further studies needs to be carried to confirm these findings.
The over 58% rate of asymptomatic infections of VVC is quite worrying. A similar study in pregnant women in Nigeria reported 65% of VVC in asymptomatic women (Akerele et al., 2002).
The study data suggest a significant association between BV and vaginal symptoms (Discharge, lower abdominal pains, pruritus and dysuria) (p>0.05) in the unadjusted analysis. The probability of having BV with any of the vaginal symptoms was almost twice as that of not having the symptom. In a longitudinal study carried out in the USA, vaginal discharge and odor individually were significantly associated with BV whiles the remaining symptoms were not associated. The present study after adjusting for other variables, found no correlation between any of the vaginal symptoms and BV.
In both univariate and multivariate analysis for VVC and vaginal symptoms, pruritus was the only symptoms significantly associated. This finding is consistent with a study in India, where pruritus was the most common symptom to VVC with or without vaginal discharge (Ahmad & Khan, 2009). Eckertet et al., study found significant association between VVC and pruritus or burning (Eckert et al., 1998).
For trichomoniasis, none of the vaginal symptoms were associated in both the adjusted and unadjusted analysis. This might be due to the low number of Trichomonas vaginalis detected in the present study.
The study assessed the risk factors for the vaginal infections (BV, VVC, TV) using age groups, trimester, gravidae, douching, sex frequency per week and recent antibiotic use. After adjusting for other confounding variable, the third trimester of pregnancy was shown to be protective for BV (p=0.003) and having had less than 3 pregnancies
( The study’s findings of significant association between BV and having had less than 3 pregnancies (0.05). Studies have shown recent antibiotic intake and douching have a positive correlation to VVC (Ahmad & Khan, 2009). This happens when antibiotic/douching substance kills or suppresses the lactobacillus species which serves as a protective organism making way for the yeast to thrive and colonise the vagina. This negative correlation between antibiotic use and VVC in the present study could be because of the low level of intake of antibiotic by the study participants.
The study, however, did not demonstrate any association between TV and any of the risk factors being considered.
Limitations of the study
- The diagnosis of TV was done using wet preparation for motile trichomonads which could have accounted for the low prevalence. This diagnosis method is about 60-70% sensitive but due to lack of financial resources the study could not use a more sensitive method such as culture.
- The risk factors used for the analysis were self-report by study participants; there is the possibility of underreporting or misclassification of risky behaviour.
Conclusion
The study area had very high prevalence of vaginal infections among pregnant women especially VVC and BV. VVC was the most predominant (36.5%, 215/589) vaginal infection followed by BV (30.9%, 182/589) and the least was TV (1.4%, 8/589).
The study shows that pruritus as a key symptom in VVC infection and this should be considered during clinical diagnosis alongside laboratory confirmation. However, dysuria, lower abdominal pain and vaginal discharge were not associated with VVC and are therefore unspecific.
Having less than three pregnancies was a potential risk factor for BV in this study whiles being in the third trimester of pregnancy was protective of BV.
Recommendation
In view of the high prevalence of vaginal infections, pregnant women attending antenatal clinic should have prompt and adequate investigations with appropriate treatment to prevent adverse effect of the infection on mother and foetus.
In addition, a comprehensive program on reproductive healthcare education with the aim of reducing vaginal infection prevalence should be put in place.
The uncertainty surrounding how the infection affects the mother and foetus needs to be unraveled. Therefore, I recommend further longitudinal and follow-up studies to investigate the effect of the infection.
Further studies are needed to understand the potential role of BV and TV in HIV and HSV transmission to aid in STI/HIV prevention programs.


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