Original Study
Frequency of Vagınal Candida Colonization and Relationship between Metabolic Parameters in Children with Type 1 Diabetes Mellitus

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Abstract

Objectives

Patients with diabetes mellitus (DM) are at risk for vulvovaginal candidasis. The aim of this study was to determine the species-specific prevalence rate and risk of candidiasis in patients with type 1 DM.

Methods

Children aged between 8-16 years were included in the study. Clinical and laboratory features of diabetes and evidence of genital symptoms were recorded. Vaginal swabs were taken from patients and placed on Sabouraud’s dextrose agar and incubated. Following fasting overnight for 12 hours venous blood samples were taken simultaneously for analyses of blood glucose, HbA1c, and lipid profile. A simple 1-time fluconazole treatment regimen was used to treat patients with vulvo-vaginal candidiasis.

Results

Candida species were isolated in 30 of 76 (39%) swabs of patients with type 1 DM. Subjects who had candida colonization and candidiasis were all acute. The predominant candida species isolated from patients with type 1 DM were C.albicans 50%, C. glabrata 36.6%, C.crusei 3.3%, C.spesies 6.6%, and C.dubliniensis 3.3%. 42 patients had symptoms.The prevalence of candidiasis in symptomatic patients was 59.2%. Subjects with vulvo-vaginal candidiasis had higher mean HbA1c when compared to those who had no such infection (P = .047).

Conclusions

There seems to be a significant link between hyperglycemia and vulvo-vaginal candidiasis in patients with type 1 DM. Improving glucose control may reduce the risk of candidiasis and potentially symptomatic infection among children with diabetes. Because of high rate of colonization with candida species in diabetes, patients should undergo periodic screening for genital candidiasis.

Introduction

Diabetes mellitus predisposes individuals to bacterial and fungal infections, including those caused by Candida species. Many investigators have suggested that vulvovaginal candidiasis (VVC) occurs more frequently in diabetics.1

Candida albicans is the most common species isolated in such infections in patients both with and without diabetes.2 The dominant non-albicans candida species reported is C. glabtara.3

Potential risk factors for VVC include diabetes type, severity, and degree of glucose control.4

However, all these studies and observations come from adult groups. There are few studies on this subject in children. In this study we aimed to evaluate species-specific prevalence, rate of vulvo-vaginal candidiasis, as determined by fungal culture, among children with diabetes mellitus and its association with their glycemic status.

Section snippets

Subjects

This study was performed prospectively between February 2011 and December 2011 at the Necmettin Erbakan University School of Medicine. The study was approved by the local ethics committee. Children 8-16 years old who were already being followed by the Pediatric Endocrinology Outpatient Clinic were consecutively enrolled in this study.

Procedure

All children's heights were measured with a Harpenden Stadiometer and their weights were measured while clothed with underwear. Body mass index was measured as

Results

Demographic, anthropometric, clinical, and laboratory features of the cases are presented in Table 1.

It was found that 5.3% of the patients had hypertension and 20% had dyslipidemia.

Candida species were isolated from 30 of 76 (39.4%) patients with type 1 diabetes mellitus (DM).

The predominant candida species isolated from patients with type 1 DM was C. albicans 50.2% (Fig. 1). All candida species were sensitive to fluconazole.

82.6% of patients with candidiasis had at least 1 symptom: pruritus

Discussion

This study confirms that children and adolescents with diabetes have a high rate of colonization with candida species. We estimated that candida species were isolated in 30 of 76 (39%) patients with type 1 DM. The predominant candida species isolated from patients with type 1 DM was C. albicans (50%). Subjects with vulvo-vaginal candidiasis had higher mean HbA1c than patients who had no colonization.

These results show that among patients with type 1 DM those with higher HbA1c are more likely to

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    The authors indicate no conflicts of interest.

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    Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.