A Prevalence Of Fungal Infection Among The Pregnant Women Attending Wushishi General Hospital
This study examined the prevalence of fungal infection among the pregnant women attending Wushishi General Hospital. The study covered pregnant women who attend the unit of obestitric and gynecology during period of March – June 2021. This study adopted descriptive –cross- sectional research design. The study included pregnant women who presented with self-reported symptoms of abnormal vaginal discharge, itching and genital burning or burning micturition. The study utilized a non- probability sampling method, totaling one hundred pregnant women. Data was collected by self-interviewing and questionnaire. The result revealed that, 48 (48%) samples were positive for VC, while 52 (52%) samples were negative. The most frequently encountered species was Candida albicans 28 (58%), followed by C.parapsilosis 10 (21%), C. guilliermondii 8 (17%) and C. glabrata 2 (4%). According to duration of pregnancy, 24 (50%) of infected pregnant women were in third trimester, 16 (33%), 8 (17%) in first and second trimester respectively. Statistically there was significant association (p value= 0.001) between VC and duration of pregnancy. Regarding to medical history of disease (VC), 14 (29%) of pregnant women have past infection; C. abicans is the most causative agent for all cases. This study concluded that VC a fungal disease of considerable importance during pregnancy as (48%) of pregnant women under study suffered from it. Also, Itching, pain and whitish vaginal discharge were the main signs and symptoms of VVC, but laboratory support is necessary for a differential diagnosis or to confirm the clinical diagnosis of vaginal candidiasis. The study recommended that diagnosis of fungal infection should not be made on clinical criteria only, because some time women have another condition. Also, Health education program should be introduced for all pregnant women for recommend prevention, early diagnosis and increase awareness about importance of treatment because multiple unreasonable miscarriage and neonatal death has been reported.
A fungal infection, also called mycosis, is a skin disease caused by a fungus(Abdelaziz et al., 2021., Rasti et al.,2020). There are millions of species of fungi. They live in the dirt, on plants, on household surfaces, and on your skin. Sometimes, they can lead to skin problems like rashes or bumps. A fungus that invades the tissue can cause a disease that’s confined to the skin, spreads into tissue, bones and organs or affects the whole body(Abdelaziz et al., 2021., Rasti et al.,2020). Symptoms depend on the area affected, but can include skin rash or vaginal infection resulting in abnormal discharge. Candidiasis is a fungal infection caused by a yeast (a type of fungus) called Candida. Some species of Candida can cause infection in people; the most common is Candida albicans. Candida normally lives on the skin and inside the body, in places such as the mouth, throat, gut, and vagina, without causing any problems(Rathod and Buffler, 2021).
Vulvovaginal Candidiasis (VVC) is described as consisting of a white “cottage cheese” discharge with associated vulval and vaginal inflammation (Zhou et al., 2009).The vagina could be infected by a variety of pathogens including bacteria, fungi, viruses, and parasites. Vaginal complaints such as Bacterial Vaginosis (BV), candidiasis, trichomoniasis, and Chlamydia trachomatis infections are common among women of reproductive age, with high incidences during pregnancy (Abdelaziz et al., 2021).
Microbial infections of the vagina (vaginosis and vaginitis) among pregnant women are serious problems because they can lead to serious medical complications such as preterm labor, amniotic fluid infection, premature rupture of the fetal membranes, and low birth weight of the neonate (LBW), leading to high prenatal mortality. However, proper identification and treatment will reduce the risk of preterm birth and its consequences (Abdelaziz et al., 2021., Rasti et al.,2020).
Vulvovaginal candidiasis (moniliasis or thrush) is a commonly reported gynecological condition and frequently distressing infection for many pregnant women (Kamath et al., 2021). Which may cause systemic infections in neonate (Rasti et al., 2020). And is diagnosed in a large proportion of women of different age groups, regardless of their sexual activities presenting to medical facilities with a complaint of abnormal vaginal discharge (Rathod and Buffler, 2021., Oyewole et al., 2020).
Numerous studies around the world showed that Candida albicans is responsible for the largest number of symptomatic episodes of vaginal candidiasis. Nonalbicans species are most commonly represented by C. tropicalis, C. glabrata, and C. krusei. Accurate species identification is important for the treatment of the Candida infections, as the non-albicans species of Candida continue to be increasingly documented (Kazemi et al., 2020).
While not a cause of mortality, the morbidity associated with vulvovaginal candidiasis make it a major cause of mental distress and economic costs. Though there are well-recognized limitations of the existing epidemiologic data for vulvovaginal candidiasis (Rathod and Buffler, 2021).
For unknown reasons, they are more prevalent in women in sub-Saharan Africa and other low-income countries than in women in developed countries, affecting up to 55% of women in some studies (Abdelaziz et al., 2021).
1.2. Statement of the Problem
In developing countries, there is scanty data on fungal infections such as vaginal candidiasis in pregnant women and the distribution of the vaginal Candida species (Nelson et al., 2020). In Nigeria, there is little data about vaginal infections in pregnant women; a crosssectional study of pregnant women was conducted at Omdurman Maternity Hospital, Niger State, Nigeria, found Candida albicans was detected in (16.6%). Higher infection rates were recorded among subjects in the third trimester (71.6%) than in the second trimester of gestation (28.4%) (Abdelaziz et al., 2021). Also another study conducted to determine the prevalence of bacterial vaginosis and vaginal candidiasis in the 100 pregnant women was to 14%, 73% respectively. Gardnerella vaginalis was isolated in 14 (14%) samples, Candida albicans in 73 (73%) samples, combined infection with Gardnerella vaginalis and Candida albicans was detected in 3 (3%) samples (Ahmed et al., 2021).
This study designed to fulfill the following objectives:
1.3.1. General Objective
To detect the prevalence of fungal infection among pregnant women attending Wushishi General Hospital in period from March to June 2021.
1.3.2. Specific Objectives
- To isolate and identify Candida species.
- To establish the frequency of Candida albicans among pregnant women.
- To determine the association of vaginal candidiasis with age, trimester, gravidity and antifungal treatment.
1.4. Justification of the Study
Vaginal candidiasis in untreated pregnant women can lead to transmission to their infant (such as cutaneous candidiasis of neonates) and may be associated with sterility and sub fertility as the complication of Pelvic Inflammatory Disease (PID) (Parveen et al., 2008), because of this accurate and prompt diagnosis is mandatory. Also, the laboratory can help the clinician to distinguish between different types of infections.
Increased awareness about mycosis and partial availability of resources were a motive to start establishing a specific technique in diagnosis of fungal vaginitis.
1.5 Scope of the Study
The study focused on the prevalence of fungal infection among the pregnant women attending Wushishi General Hospital. The study was restricted to pregnant women who attend the unit of obstetric and gynecology during period of March – June 2021.
1.6 Limitation of the Study
Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information.
The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.
Vaginal candidiasis is a common complaint among women of different age groups in any society whether or not they are sexually active (Nwadioha et al., 2010).
Vulvovaginal Candidiasis in pregnant women is usually ignored in many countries (Aslam et al., 2008).
The health of the mother duringpregnancy is important to give birth of a healthy baby (Kamth, et al., 2021).
In this study, the overall frequency of VC among pregnant women was 48%, Candida albicans predominates over other species (58%), C.parapsilosis is the second one most common (21%), but other species such as C. guilliermondii (17%) and C. glabrata (4%)are also encountered.
This is in agreement with other study conducted in Pakistan (2007), among pregnant women presenting in the antenatal clinic of a local private Hospital, Lahore during the last trimester of their pregnancy, mainly presenting with excessive vaginal discharge and itching (pruritis). Candida was isolated from 48% of all cultures. The common presenting signs and symptoms of VVC in their study were excessive vaginal discharge (100%), vaginal pruritis (91.6%) and vaginal burning (75%) (Aslam et al., 2008).
Another study performed in Sarajevo, Bosnia (2006), 447 woman included in the study were separated in two groups: 203 pregnant (in the last trimester of pregnancy), and 244 non-pregnant woman in period of fertility. The results indicated positive microscopic findings in the test group (40.9%), as well as greater number of positive cultures (46.8%). the most commonly detected species for both groups was C. albicans (test group 40.9% and control group 23.0%). The most commonly detected non-albicans species for the test group were C. glabrata (4.2%) and C. krusei (3.2 %), and for the control group were C. glabrata (3.2 %) and C. parapsilosis (3.2 %) (Babić and Hukić, 2010).
Our results regarding the predominant isolate is lower comparing with that of another study conducted in Kenya (2010), in which 104 samples obtained from the pregnant women attending the antenatal clinic of Thika District Hospital, their results indicated a high prevalence of vaginal candidiasis (42.7%). The percentage occurrence of vaginal Candida species showed that Candida albicans was the most isolated species with 60 (63.83%) isolates (Nelson et al., 2020).
Other study showed that, vulvovaginal candidiasis is an inflammation of the vagina and vulva caused by Candida albicans, the prevalence of Candida spp. was 28% (Candida albicans 90.4%; Candida glabrata 6.3%; Candida parapsilosis 1.1%, Candida kefyr 1.1 %; unidentified species 1.1 %) (Garcia et al., 2006).
In this study, the third trimester pregnant women are more infected (50%). The 1st and 2nd trimesters of pregnancy recorded low prevalent rates of vaginal candidiasis infection. The same finding had been documented by other investigators in India (2020), who found that (57%) of pregnant women who infected with VC in 3rd trimester, (10.65%) in 1st trimester and (32.4%) in 2nd trimester from a total of 142 pregnant women (Kamath et al., 2021).
Also other study conducted in Kenya (2010), found that 64 (68.09%) of infected pregnant women in the 3rd trimester of pregnancy. This may be explained the pregnant women in the 1st and 2nd trimesters could have less emotional stresses, high levels of vaginal defense mechanisms against Candida infections as a result of low levels of estrogen and corticoids hormones. Therefore, they have strong immune system against Candida species infections.
These factors could have contributed to the low prevalence of the infection in these two trimesters of pregnancy (Nelson et al., 2020).
In present study multigravida women are more infected with VC (67%) than primigravida (33%). Many results indicate that gravidity, as the risk factor for incidence of infection, has the significant role in the incidence of vaginal candidiasis (Babić and Hukić, 2010). This finding could be explained on the basis that multigravida has longer sexual history than the newly married primigravida and due to some alteration of the vagina, and so they are more prone to VVC than the later (Omar, 2001). The results are in agreement with a previous study conducted on 50 pregnant women in Pakistan (2007), multigravidae (60%) were more commonly affected than primigravidae (40%) (Aslam et al., 2008).
Also another result had been documented by other investigators in Hyderabad (2005), who found that most of the women 91 (82.72%) were multigravida, and the rest of all 19 (17.27%) were primigravida. 84 (76.36%) women presented were in their third trimester of pregnancy and remaining 26 (23.63%) in second trimester (Parveen et al., 2008).
In our study a higher frequency of vaginal candidiasis within different age ranges of the pregnant women was observed within the age ranges 18-25 years (50%) than the other age groups. A lower rate of prevalence of the infection in pregnant women was reported within the age ranges 34-41 years (13%).
Similar study was conducted on 110 pregnant women in Hyderabad (2005), and the results were analyzed according to their age, parity, trimester of pregnancy. Their result showed that 77 (70%) of pregnant women were between the ages of 18-30 and remaining 33 (30%) were between 31-40 years (Parveen et al., 2008). Another study conducted in Kenya (2010), showed that the percentage distribution of vaginal candidiasis within age group was highest in the age brackets 26 – 35 years with 56 (60%) patients (Nelson et al., 2020),
Also in India (2020), from a total of 142 pregnant women, (39.4%) of infected pregnant women their age between 18 – 25 years, (52.8%) between 26 – 33 years and (7.7%) between 34 – 40 years (Kamath et al., 2021).
In our study, (25%) of pregnant women who use antifungal treatment were infected with VC, and (29%) of pregnant women had history vaginal candidiasis.
The emergence of increasingly resistant Candida species does not seem to play a major part in recurrentvaginal candidiasis; women with recurrent disease dohave higher prevalence (10–15%) of Candida glabrata,which is inherently less sensitive to the imidazole group ofdrugs (Janković et al., 2010).
This study concluded that VC a disease of considerable importance during pregnancy as (48%) of pregnant women under study suffered from it.
Itching, pain and whitish vaginal discharge were the main signs and symptoms of VVC, but laboratory support is necessary for a differential diagnosis or to confirm the clinical diagnosis of vaginal candidiasis.
Candida albicans was the most prevalent vaginal Candida species across all age groups and trimesters.
Although there is generally a high frequency of vaginal candidiasis, an increased ratio of vaginal candidiasis in third trimester pregnant women requires these women to be routinely screened for vaginal candidiasis regardless of symptomatic status.
Antifungal therapy is one of the important tools to cure and help in eradication of vaginal candidiasis.
- Diagnosis of infection should not be made on clinical criteria only, because some time women have another condition.
- All patients have itching and vaginal discharge should be routinely diagnosed by culture.
- Specimens must be collected by experienced health workers.
- Treatment must be taken after full investigation and recommended by specialist.
- Health education program should be introduced for all pregnant women for recommend prevention, early diagnosis and increase awareness about importance of treatment because multiple unreasonable miscarriage and neonatal death has been reported.
- It is therefore recommended that further study be carried out to more research about VC especially recurrent infection and the validity of antifungal treatments that available and association with infertility, abortion and stillbirth.
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