Epidemiological profile of vulvovaginal candidiasis and antifungal susceptibility of Candida isolates using two susceptibility testing methods in a resource-limited setting: Study from Bouake, Côte d’Ivoire
Paper Details
Epidemiological profile of vulvovaginal candidiasis and antifungal susceptibility of Candida isolates using two susceptibility testing methods in a resource-limited setting: Study from Bouake, Côte d’Ivoire
Abstract
Vulvovaginal candidiasis (VVC) is a common fungal infection in women, and the emergence of non-albicans Candida species with variable antifungal susceptibility may complicate treatment, particularly where access to mycological diagnosis and standardized susceptibility testing is limited. This study described the epidemiological profile of VVC and the antifungal susceptibility patterns of Candida isolates among symptomatic women attending the University Hospital of Bouaké, Côte d’Ivoire. A prospective cross-sectional study was conducted among 400 women from April 2022 to March 2023. Vaginal specimens were examined microscopically and cultured on Sabouraud agar supplemented with chloramphenicol. Isolates were identified using morphological and biochemical methods, and antifungal susceptibility was assessed using ATB Fungus 3 and agar diffusion. VVC was confirmed in 159 women, giving a prevalence of 39.75%. Candida albicans accounted for 86.79% of isolates, while non-albicans Candida species represented 13.21%. Pregnancy was significantly associated with VVC (p= 0.04). With ATB Fungus 3, susceptibility was highest to voriconazole (95.88%), fluconazole (93.81%), and 5-flucytosine (91.75%). Among non-albicans Candida isolates tested by this method, resistance was observed in 30% to fluconazole and 40% to itraconazole. Agar diffusion showed high susceptibility to amphotericin B (98.98%) and nystatin (97.96%), with greater variability for the other antifungals tested. C. albicans remains the predominant cause of VVC in this setting, while the variable susceptibility of non-albicans Candida highlights the importance of species-level identification and appropriately standardized antifungal susceptibility testing to support effective management.
Aboagye G, Waikhom S, Asiamah EA, Tettey CO, Mbroh H, Smith C, Osei GY, Asafo Adjei K, Asmah RH. 2025. Antifungal susceptibility profiles of Candida and non-albicans species isolated from pregnant women: implications for emerging antimicrobial resistance in maternal health. Microbiology Spectrum 13, e00787-25. DOI: 10.1128/spectrum.00787-25.
Amouri I, Abbes S, Sellami H, Makni F, Sellami A, Ayadi A. 2010. Vulvovaginal candidiasis: review. Journal de Mycologie Médicale 20(2), 108–115. DOI: 10.1016/j.mycmed.2010.01.005.
Anderson MR, Klink K, Cohrssen A. 2004. Evaluation of vaginal complaints. Journal of the American Medical Association 291, 1368–1379. DOI: 10.1001/jama.291.11.1368.
Angora KE, Ouattara M, N’guiachi MA, Koné S, Effoh N, Djohan V, Menan HE, N’douba AK. 2025. Vulvovaginal candidiasis and antifungal susceptibility patterns among pregnant women at the University Hospital of Angré, Abidjan, Côte d’Ivoire. International Journal of Microbiology and Mycology 21, 1–11. DOI: 10.12692/ijmm/21.5.1-11.
Babić M, Hukić M. 2010. Candida albicans and non-albicans species as etiological agent of vaginitis in pregnant and nonpregnant women. Bosnian Journal of Basic Medical Sciences 10, 89. DOI: 10.17305/bjbms.2010.2744.
Benchellal M, Guelzim K, Lemkhente Z, Jamili H, Dehainy M, Moussaoui DR, El Mellouki W, Idrissi KS, Lmimouni B. 2011. La candidose vulvo-vaginale à l’hôpital militaire d’instruction Mohammed V (Maroc). Journal de Mycologie Médicale 21, 106–112. DOI: 10.1016/j.mycmed.2011.03.003.
Bouba A, Maboulou V, Essome MCN, Ngoutane A, Mansour M, Toukap MM, Nkengazong LL, Gwet-Mbem PA, Boula A, Fooka P, Yimga G, Velhima A. 2023. Prevalence of vaginal candidiasis and risk factors: Case of patients at the Efoulan District Hospital in Yaoundé, Cameroon. International Journal of Nursing and Health Care Research 6, 1467. DOI: 10.29011/2688-9501.101467.
Brown H, Drexler M. 2020. Improving the diagnosis of vulvovaginitis: Perspectives to align practice, guidelines, and awareness. Population Health Management 23, S3–S12. DOI: 10.1089/pop.2020.0265.
Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. 2018. Global burden of recurrent vulvovaginal candidiasis: A systematic review. Lancet Infectious Diseases 18, e339–e347. DOI: 10.1016/S1473-3099(18)30103-8.
Djohan V, Angora KE, Vanga-Bosson AH, Konaté A, Kassi FK, Yavo W, Kiki-Barro PC, Menan H, Koné M. 2012. In vitro susceptibility of vaginal Candida albicans to antifungal drugs in Abidjan (Côte d’Ivoire). Journal de Mycologie Médicale 22, 129–133. DOI: 10.1016/j.mycmed.2011.11.005.
Djohan V, Angora KE, Vanga-Bosson AH, Konate A, Kassi KF, Yavo W, Kiki-Barro PCM, Bedia-Tanoh AV, Miezan S, Menan EIH. 2019. Candidose vulvo-vaginale récurrente à Abidjan (Côte d’Ivoire): Etiologies et facteurs associés. Journal de Mycologie Médicale 29, 127–131. DOI: 10.1016/j.mycmed.2019.04.002.
Doumbo SN, Dara NJ, Bamadio A, Zeguime A, Diarra N, Garango A, Diarra B, Konaté A, Koné A, Tegueté I, Traoré B, Djimde A, Thera MA. 2022. Epidemiological and etiological profile of vulvovaginal candidiasis in women in consultation in the gynecology-obstetrics department, CHU Gabriel Toure, Bamako-Mali. Mali Médical 37, 35–39.
Dovnik A, Golle A, Novak D, Arko D, Takač I. 2015. Treatment of vulvovaginal candidiasis: A review of the literature. Acta Dermatovenerologica Alpina, Pannonica et Adriatica 24, 5–7. DOI: 10.15570/actaapa.2015.2.
EUCAST (European Committee on Antimicrobial Susceptibility Testing). 2025. Antifungal susceptibility testing of yeasts. EUCAST definitive document E.DEF 7.3.
Fanou BA, Klotoe JR, Dougnon V, Monteiro A, Koudokpon CH, Loko F. 2022. Prevalence and factors associated with vulvovaginal candidiasis in women admitted to the Zone Hospital of Mènontin (Bénin). Pan African Medical Journal 42, 215. DOI: 10.11604/pamj.2022.42.215.28984.
Farr A, Effendy I, Tirri BF, Hof H, Mayser P, Petricevic L. 2021. Guideline: Vulvovaginal candidosis (AWMF 015/072, level S2k). Mycoses 64, 583–602. DOI: 10.1111/myc.13248.
Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. 2016. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Critical Reviews in Microbiology 42, 905–927. DOI: 10.3109/1040841X.2015.1091805.
Kamath P, Pais M, Nayak MG. 2013. Risk of vaginal candidiasis among pregnant women. International Journal of Current Microbiology and Applied Sciences 2, 141–146.
Kechia FA, Dohbit JS, Kouotou EA, Iwewe SY, Dzoyem JP, Mbopuwouo NM, Monamele CG. 2015. Profil épidémiologique et étiologique de la candidose vulvo-vaginale chez la femme enceinte à Yaoundé (Cameroun). Health Sciences and Disease 16(4). DOI: 10.5281/hsd.v16i4.594.
Khan M, Ahmed J, Gul A, Ikram A, Lalani FK. 2018. Antifungal susceptibility testing of vulvovaginal Candida species among women attending antenatal clinic in tertiary care hospitals of Peshawar. Infection and Drug Resistance 11, 447–456. DOI: 10.2147/IDR.S153116.
Konaté A, Yavo W, Kassi FK, Djohan V, Angora EK, Barro-Kiki PC, Bosson-Vanga H, Menan EIH. 2014. Aetiologies and contributing factors of vulvovaginal candidiasis in Abidjan (Côte d’Ivoire). Journal de Mycologie Médicale 24, 93–99. DOI: 10.1016/j.mycmed.2013.11.006.
Konaté-Touré A, Kassi KF, Akpa GP, Kone EM, Bedia-Tano AV, Vanga-Bosson H, Angora KE, Miezan AJS, Djohan V, Kiki-Barro PC, Menan EIH, Yavo W. 2024. Etiology and risk factors in patients with vulvovaginal candidiasis in Abidjan (Côte d’Ivoire). Journal of Mycology and Infection 29, 155–164. DOI: 10.17966/JMI.2024.29.3.155.
Kouadio-Yapo CG, Aka NAD, Bonouman-Ira AV, Dou GSP, Sonan KHG, Zika KD, Adoubryn KD, Dosso M. 2020. Resistance of Candida albicans to antifungal drugs in Abidjan (Côte d’Ivoire). African Journal of Microbiology Research 14, 572–578. DOI: 10.5897/AJMR2018.8817.
Lalla RV, Dongari-Bagtzoglou A. 2014. Antifungal medications or disinfectants for denture stomatitis. Evidence-Based Dentistry 15, 61–62. DOI: 10.1038/sj.ebd.6401032.
Li X, Sholeh M, Moghadam MA, Ostadrahimi M, Hosseini SS. 2026. Global prevalence and trends of fluconazole resistance in non-albicans Candida species: A systematic review and meta-analysis. BMC Infectious Diseases 26, 442. DOI: 10.1186/s12879-026-12653-8.
Linas MD, Cassaing S. 2001. Méthodes d’évaluation in vitro des antifongiques: Étude comparative des différents tests. Revue Française des Laboratoires 332, 49–56. DOI: 10.1016/S0338-9898(01)80127-X.
Mbatudde N, Nalumaga PP, Bazira J, Kabanda T. 2025. Symptomatic vulvovaginal candidiasis and antifungal resistance in HIV-1 positive women at Mbarara city health centre IV. Scientific Reports 15, 24123. DOI: 10.1038/s41598-025-09215-4.
Neal CM, Martens MG. 2022. Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis. SAGE Open Medicine 10, 20503121221115201. DOI: 10.1177/20503121221115201.
Nelson M, Wanjiru W, Margaret MW. 2013. Prevalence of vaginal candidiasis and determination of the occurrence of Candida species in pregnant women attending the antenatal clinic of Thika District Hospital, Kenya. Open Journal of Medical Microbiology 3, 264–272. DOI: 10.4236/ojmm.2013.34040.
Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. 2016. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clinical Infectious Diseases 62, e1–e50. DOI: 10.1093/cid/civ933.
Peyton LR, Gallagher S, Hashemzadeh M. 2015. Triazole antifungals: A review. Drugs of Today 51, 705–718. DOI: 10.1358/dot.2015.51.12.2421058.
Qin F, Wang Q, Zhang C, Fang C, Zhang L, Chen H, Zhang M, Cheng F. 2018. Efficacy of antifungal drugs in the treatment of vulvovaginal candidiasis: A Bayesian network meta-analysis. Infection and Drug Resistance 11, 1893–1901. DOI: 10.2147/IDR.S175588.
Rosati D, Bruno M, Jaeger M, ten Oever J, Netea MG. 2020. Recurrent vulvovaginal candidiasis: An immunological perspective. Microorganisms 8, 144. DOI: 10.3390/microorganisms8020144.
Shokoohi G, Javidnia J, Mirhendi H, Rasekh-Jahromi A, Rezaei-Matehkolaei A, Ansari S, Maryami F, Goodarzi S, Romeo O. 2021. Molecular identification and antifungal susceptibility profiles of Candida dubliniensis and Candida africana isolated from vulvovaginal candidiasis: A single-centre experience in Iran. Mycoses 64, 771–779. DOI: 10.1111/myc.13280.
Sobel JD. 2007. Vulvovaginal candidosis. Lancet 369, 1961–1971. DOI: 10.1016/S0140-6736(07)60917-9.
Sobel JD. 2016. Recurrent vulvovaginal candidiasis. American Journal of Obstetrics and Gynecology 214, 15–21. DOI: 10.1016/j.ajog.2015.06.067.
Sylla K, Sow D, Lakhe NA, Tine RC, Dia M, Lelo S, Ahamada HM, Faye B, Dieng T, Dieng Y. 2017. Candidoses vulvo-vaginales au laboratoire de Parasitologie-Mycologie du Centre Hospitalier Universitaire de Fann, Dakar (Sénégal). Revue Africaine et Malgache de Recherche Scientifique/Sciences de la Santé 5, 21–22.
Tsega A, Mekonnen F. 2019. Prevalence, risk factors and antifungal susceptibility pattern of Candida species among pregnant women at Debre Markos Referral Hospital, Northwest Ethiopia. BMC Pregnancy and Childbirth 19, 527. DOI: 10.1186/s12884-019-2494-1.
Waikhom SD, Afeke I, Kwawu GS, Mbroh HK, Osei GY, Louis B, Deku JG, Kasu ES, Mensah P, Agede CY, Dodoo C, Asiamah EA, Tampuori J, Korbuvi J, Opintan JA. 2020. Prevalence of vulvovaginal candidiasis among pregnant women in the Ho municipality, Ghana: Species identification and antifungal susceptibility of Candida isolates. BMC Pregnancy and Childbirth 20, 266. DOI: 10.1186/s12884-020-02963-3.
Whaley SG, Berkow EL, Rybak JM, Nishimoto AT, Barker KS, Rogers PD. 2017. Azole antifungal resistance in Candida albicans and emerging non-albicans Candida species. Frontiers in Microbiology 7, 2173. DOI: 10.3389/fmicb.2016.02173.
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. 2015. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommendations and Reports 64, 1–137.
Affoué Sandrine Josette Kouakou*, Kalou Dibert Zika, Mbro Clausen Georgie, Ahou Sandrine Konan, Yaya Samake, Gonat Serge Dou, Yethanaba Kamissa Kone, Yene Lea Constante Karidioula, Estelle Massafoma Kone, Kondo Fulgence Kassi, Yacouba Doumbia, Eby Herve Menan, Koffi Daho Adoubryn, 2026. Epidemiological profile of vulvovaginal candidiasis and antifungal susceptibility of Candida isolates using two susceptibility testing methods in a resource-limited setting: Study from Bouake, Côte d’Ivoire. Int. J. Microbiol. Mycol., 23(2), 1-17.
Copyright © 2026 by the Authors. This article is an open access article and distributed under the terms and conditions of the Creative Commons Attribution 4.0 (CC BY 4.0) license.