National Research Centre Egypt
It is not infrequent for every woman during her different stages of life to catch a vulvovaginal candidiasis (VVC) and has to visit a gynecologist suffering from pelvic pain accompanied by itching, creamy white vaginal discharges, burning sensation, dyspareunia (if married) and redness and swelling of external genitalia. A 37 years old married woman used to intake a lot of antibacterial agents for her refractory periodontitis, has been frequently suffering from the above mentioned symptoms for three years. She received many types of commercially available antifungal agents without any improvement. She delivered two higher vaginal swabs for performing culture and sensitivity. Direct microscopic examination of the wet sample revealed yeast and filamentous forms of Candida. Gram staining showed violet round to oval colonies with budding. Direct cultivation on Sabouraud dextrose agar (SDA) revealed very small pale white colonies. CHROMagar plates streaked with the grown colonies from SDA showed two different colored colonies (green; G and rose; R). Germ tube test for G and R colonies was separately done and germ tube formation appeared only with G colonies. Rice extract agar test performed for G and R colonies separately revealed chlamydospores (terminal) formation only with G colonies. API 20 C AUX used for G and R colonies separately, showed Candida albicans (99.3%) and Candida krusei (85.8%) respectively. Upon carrying out in vitro antifungal susceptibility test, Candida krusei colonies were sensitive to nystatin and fluconazole however, Candida albicans colonies were sensitive to nystatin but resistant to fluconazole. This case of mixed infection of VVC was very difficult to be treated with the commercially available fluconazole alone and there is no available systemic nystatin.