The Role of PCR in the Diagnosis of Candida Vulvovaginitis—a New Gold Standard?

Genitourinary Infections (J Sobel, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Genitourinary Infections

Abstract

PCR is recognized as a reliable technique for detection of all types of microorganisms. Being highly objective and reproducible also sensitive and specific, PCR is now widely used for sexually transmitted infection (STI) diagnosis. Potential, however, exists for detecting non-pathogens, and not identifying a pathogenic state decreases specificity or clinical significance. PCR Candida tests of vaginal specimens are now widely available and frequently used offering a modest to moderate increase in sensitivity and are likely to replace traditional culture and DNA homology testing. Nevertheless, there remain considerable gaps in our knowledge regarding the usefulness and applications of these expensive tests.

Keywords

Diagnosis Candida Vulvovaginitis PCR Vulvovaginal 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Nyirjesy P, Alexander AB, Weitz MV. Vaginal Candida parapsilosis: pathogen or bystander? Infect Dis Obstet Gynecol. 2005;13:37–41.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA. 2004;291:1368–79.CrossRefPubMedGoogle Scholar
  3. 3.
    Liu XP, Fan SR, Peng YT, Zhang HP. Species distribution and susceptibility of Candida isolates from patient with vulvovaginal candidiasis in Southern China from 2003 to 2012. J Med Mycol. 2014;24:106–11.Google Scholar
  4. 4.
    Senterre JM, Carpentier M, Foidart JM. [Vulvovaginal candidiasis: prevalence of different Candida species in the Liege region]. Rev Med Liege. 2005;60:882–4.PubMedGoogle Scholar
  5. 5.
    Vermitsky JP, Self MJ, Chadwick SG, Trama JP, Adelson ME, Mordechai E, et al. Survey of vaginal-flora Candida species isolates from women of different age groups by use of species-specific PCR detection. J Clin Microbiol. 2008;46:1501–3.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Zhang JY, Liu JH, Liu FD, Xia YH, Wang J, Liu X, Huang XT, et al. Vulvovaginal candidiasis: species distribution, fluconazole resistance and drug efflux pump gene overexpression. Mycoses. 2014;57:584-91.Google Scholar
  7. 7.
    Schwiertz A, Taras D, Rusch K, Rusch V. Throwing the dice for the diagnosis of vaginal complaints? Ann Clin Microbiol Antimicrob. 2006;5:4.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Lowe NK, Neal JL, Ryan-Wenger NA. Accuracy of the clinical diagnosis of vaginitis compared with a DNA probe laboratory standard. Obstet Gynecol. 2009;113:89–95.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Odds FC, Bernaerts R. CHROMagar Candida, a new differential isolation medium for presumptive identification of clinically important Candida species. J Clin Microbiol. 1994;32:1923–9.PubMedCentralPubMedGoogle Scholar
  10. 10.
    Gultekin B, Yazici V, Aydin N. Distribution of Candida species in vaginal specimens and evaluation of CHROMagar Candida medium. Mikrobiyol Bul. 2005;39:319–24.PubMedGoogle Scholar
  11. 11.
    Guzel AB, Ilkit M, Akar T, Burgut R, Demir SC. Evaluation of risk factors in patients with vulvovaginal candidiasis and the value of chromID Candida agar versus CHROMagar Candida for recovery and presumptive identification of vaginal yeast species. Med Mycol. 2011;49:16–25.CrossRefPubMedGoogle Scholar
  12. 12.
    Houang ET, Chu KC, Koehler AP, Cheng AF. Use of CHROMagar Candida for genital specimens in the diagnostic laboratory. J Clin Pathol. 1997;50:563–5.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Ozcan K, Ilkit M, Ates A, Turac-Bicer A, Demirhindi H. Performance of Chromogenic Candida agar and CHROMagar Candida in recovery and presumptive identification of monofungal and polyfungal vaginal isolates. Med Mycol. 2010;48:29–34.CrossRefPubMedGoogle Scholar
  14. 14.
    Gorton RL, Ramnarain P, Barker K, Stone N, Rattenbury S, McHugh TD, et al. Comparative analysis of Gram’s stain, PNA-FISH and Sepsityper with MALDI-TOF MS for the identification of yeast direct from positive blood cultures. Mycoses. 2014;57:592–601.CrossRefPubMedGoogle Scholar
  15. 15.
    Stone NR, Gorton RL, Barker K, Ramnarain P, Kibbler CC. Evaluation of PNA-FISH yeast traffic light for rapid identification of yeast directly from positive blood cultures and assessment of clinical impact. J Clin Microbiol. 2013;51:1301–2.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Crampin AC, Matthews RC. Application of the polymerase chain reaction to the diagnosis of candidosis by amplification of an HSP 90 gene fragment. J Med Microbiol. 1993;39:233–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Chen YC, Eisner JD, Kattar MM, Rassoulian-Barrett SL, LaFe K, Yarfitz SL, et al. Identification of medically important yeasts using PCR-based detection of DNA sequence polymorphisms in the internal transcribed spacer 2 region of the rRNA genes. J Clin Microbiol. 2000;38:2302–10.PubMedCentralPubMedGoogle Scholar
  18. 18.
    Luo G, Mitchell TG. Rapid identification of pathogenic fungi directly from cultures by using multiplex PCR. J Clin Microbiol. 2002;40:2860–5.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Landlinger C, Preuner S, Willinger B, Haberpursch B, Racil Z, Mayer J, et al. Species-specific identification of a wide range of clinically relevant fungal pathogens by use of Luminex xMAP technology. J Clin Microbiol. 2009;47:1063–73.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Preuner S, Lion T. Species-specific identification of a wide range of clinically relevant fungal pathogens by the Luminex(®) xMAP technology. Methods Mol Biol. 2013;968:119–39.PubMedGoogle Scholar
  21. 21.
    Baskova L, Landlinger C, Preuner S, Lion T. The Pan-AC assay: a single-reaction real-time PCR test for quantitative detection of a broad range of Aspergillus and Candida species. J Med Microbiol. 2007;56:1167–73.CrossRefPubMedGoogle Scholar
  22. 22.
    Elie CM, Lott TJ, Reiss E, Morrison CJ. Rapid identification of Candida species with species-specific DNA probes. J Clin Microbiol. 1998;36:3260–5.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Jordan JA. PCR identification of four medically important Candida species by using a single primer pair. J Clin Microbiol. 1994;32:2962–7.PubMedCentralPubMedGoogle Scholar
  24. 24.
    Klingspor L, Jalal S. Molecular detection and identification of Candida and Aspergillus spp. from clinical samples using real-time PCR. Clin Microbiol Infect. 2006;12:745–53.CrossRefPubMedGoogle Scholar
  25. 25.
    Maaroufi Y, Heymans C, De Bruyne JM, Duchateau V, Rodriguez-Villalobos H, Aoun M, et al. Rapid detection of Candida albicans in clinical blood samples by using a TaqMan-based PCR assay. J Clin Microbiol. 2003;41:3293–8.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Martin C, Roberts D, van Der Weide M, Rossau R, Jannes G, Smith T, et al. Development of a PCR-based line probe assay for identification of fungal pathogens. J Clin Microbiol. 2000;38:3735–42.PubMedCentralPubMedGoogle Scholar
  27. 27.
    Posteraro B, Sanguinetti M, Masucci L, Romano L, Morace G, Fadda G. Reverse cross blot hybridization assay for rapid detection of PCR-amplified DNA from Candida species, Cryptococcus neoformans, and Saccharomyces cerevisiae in clinical samples. J Clin Microbiol. 2000;38:1609–14.PubMedCentralPubMedGoogle Scholar
  28. 28.
    Shin JH, Nolte FS, Morrison CJ. Rapid identification of Candida species in blood cultures by a clinically useful PCR method. J Clin Microbiol. 1997;35:1454–9.PubMedCentralPubMedGoogle Scholar
  29. 29.
    Wahyuningsih R, Freisleben HJ, Sonntag HG, Schnitzler P. Simple and rapid detection of Candida albicans DNA in serum by PCR for diagnosis of invasive candidiasis. J Clin Microbiol. 2000;38:3016–21.PubMedCentralPubMedGoogle Scholar
  30. 30.
    Xiang H, Xiong L, Liu X, Tu Z. Rapid simultaneous detection and identification of six species Candida using polymerase chain reaction and reverse line hybridization assay. J Microbiol Methods. 2007;69:282–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Arancia S, Sandini S, De Bernardis F, Fortini D. Rapid, simple, and low-cost identification of Candida species using high-resolution melting analysis. Diagn Microbiol Infect Dis. 2011;69:283–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Dunyach C, Bertout S, Phelipeau C, Drakulovski P, Reynes J, Mallie M. Detection and identification of Candida spp. in human serum by LightCycler real-time polymerase chain reaction. Diagn Microbiol Infect Dis. 2008;60:263–71.CrossRefPubMedGoogle Scholar
  33. 33.
    Khan Z, Mustafa AS, Alam FF. Real-time LightCycler polymerase chain reaction and melting temperature analysis for identification of clinically important Candida spp. J Microbiol Immunol Infect. 2009;42:290–5.PubMedGoogle Scholar
  34. 34.
    Mandviwala T, Shinde R, Kalra A, Sobel JD, Akins RA. High-throughput identification and quantification of Candida species using high resolution derivative melt analysis of panfungal amplicons. J Mol Diagn. 2010;12:91–101.CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    Trama JP, Mordechai E, Adelson ME. Detection and identification of Candida species associated with Candida vaginitis by real-time PCR and pyrosequencing. Mol Cell Probes. 2005;19:145–52.CrossRefPubMedGoogle Scholar
  36. 36.
    Giraldo P, von Nowaskonski A, Gomes FA, Linhares I, Neves NA, Witkin SS. Vaginal colonization by Candida in asymptomatic women with and without a history of recurrent vulvovaginal candidiasis. Obstet Gynecol. 2000;95:413–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Weissenbacher T, Witkin SS, Ledger WJ, Tolbert V, Gingelmaier A, Scholz C, Mylonas I, et al. Relationship between clinical diagnosis of recurrent vulvovaginal candidiasis and detection of Candida species by culture and polymerase chain reaction. Arch Gynecol Obstet. 2009;279:125–129.Google Scholar
  38. 38.•
    Cartwright CP, Lembke BD, Ramachandran K, Body BA, Nye MB, Rivers CA, et al. Comparison of nucleic acid amplification assays with BD Affirm VPIII for diagnosis of vaginitis in symptomatic women. J Clin Microbiol. 2013;51:3694–9. This large review compares PCR with the widely used BD Affirm VPIII test, finding the latter wanting.Google Scholar
  39. 39.
    Mardh PA, Novikova N, Witkin SS, Korneeva I, Rodriques AR. Detection of candida by polymerase chain reaction vs microscopy and culture in women diagnosed as recurrent vulvovaginal cases. Int J STD AIDS. 2003;14:753–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Lopez-Monteon A, Gomez-Figueroa FS, Ramos-Poceros G, Guzman-Gomez D, & Ramos-Ligonio A. Codetection of Trichomonas vaginalis and Candida albicans by PCR in urine samples in a low-risk population attended in a clinic first level in central Veracruz, Mexico. Biomed Res Int. 2013;2013:281892.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Division of Infectious Diseases, Department of Internal MedicineWayne State University School of MedicineDetroitUSA
  2. 2.Department of Biochemistry & Molecular BiologyWayne State University School of MedicineDetroitUSA

Personalised recommendations