International Research Journal of Environment Sciences________________________________ ISSN 2319–1414Vol. 3(4), 101-104, April (2014) Int. Res. J. Environment Sci. International Science Congress Association 101 The Incidence and Prevalence of Candida albicans infection of the urogenital tract of females between the ages of 18 and 45 years old: A Case study of Patients receiving treatment in Ashford and Patrice clinic in Port HarcourtOnianwah I.F. Rexall Research Services, Port Harcourt, NIGERIAAvailable online at: www.isca.in, www.isca.me Received 7th March 2014, revised 23rd March 2014, accepted 20th April 2014 AbstractThe incidence and prevalence of Candida albicans infection of females urogenital tract in Port Harcourt Urban area is quite high representing 18.9% of women investigated. It is more of an infection of those queried for urogenital tract infection than in pregnant and diabetic women, with a recorded 10.3%, 5.6% and 3.0% respectively. It was equally found to be high in sexually active women within the ages of 18 and 35. Analysis of variance (ANOVA) carried out on the various treatment options (i.e UTI, Pregnancy and diabetes) showed no significant difference at 95% probability level with respect to Candida albicans infection. Besides, antibiotics treatment also enhances the proliferation of the yeast. The incidence and prevalence of the infection was quite high but can be reduced in Port Harcourt Urban with an improved personal hygiene and adequate medical services available. Keywords: Incidence, Prevalence, Candidaalbicans, urogenital tract and infection. Introduction The Candida Albicans infection is a yeast infection of the mouth, skin and urogenital tract of men and women, young and old. It is the genus mostly incriminated in candidiasis of the urogenital tract. Other species of Candida incriminated in this disease condition are Candida tropicalis, Candida stellatoides, Candida parapsilosis and Candida crusei. According to report of the centre for disease control and prevention, in 2001, there are more than twenty (20) species of genius Candida that can caused infection in human. The distribution of Candida albicans is widely in normal and healthy individuals, and is usually found in mouth, gastrointestinal and urogenital tracts of females where they exist as normal flora. Yeast infections usually occur in warm and moist parts of the body. It flourishes in individuals with high blood sugar, and can also be found in other dark areas of the body. Clothing that is too tight or made of nylon materials that can trap heat and moisture may lead to yeast infection. Other predisposing factors such as pregnancy, diabetes, broad-spectrum antibiotics therapy4,5, administration of corticosteroids or immunosuppressive drugs, drug addiction and immunological deficiencies support the growth of Candida6-10. Besides, systematic conditions such as vitamin B deficiency, hypothyroidism and lymphoblastoma favours Candida infection11-13. From the fore going, it is evident that the treatment of other infections with broad spectrum antibiotics increases the number of persons habouring Candida in their intestine, vagina and perianal sites13-16. The effect of antibiotics on proliferation of Candidais based on the fact that these drugs militate against susceptible microflora antagonistic to the fungi17, thereby enhancing their growth. Traumatic ulceration, postoperative situations, malnutrition, malignancy and aneamia also predisposes Candidiasis. Candida albicans infection manifests in different parts of the body. In the vagina are found,itching, redness and a thick white vaginal discharge with occasional white patches on the skin of the vaginal area18. The irritation from vaginal Candidiasis is responsible for the physical discomfort experienced by some patients. The offensive vaginal discharge is a product of organic decomposition of the proteinous component on the vaginal mucosa. Vaginal Candidiasis of pregnant women may occur as mild vaginal infection and may not be connected with infection of the anus. Vaginal and vulva Candidiasisis also found at high frequency among sexually active people hence, the choice of the age bracket under study. Accordingly, as a girl matures, hormonal changes takes place making them more vulnerable to Candidainfection19. Prevention of Candidiasis can be by employing the use of unscented bath soaps, lotions, laundry detergents and gels. It is suggested that less fragrance free bath and cleansing products can be used17,19. This research focused on the incidence and prevalence of Candida albicans infectiomn of the urogenital tract of female of International Research Journal of Environment Sciences______________________________________________ ISSN 2319–1414 Vol. 3(4), 101-104, April (2014) Int. Res. J. Environment Sci. International Science Congress Association 102 age 18 to 45 in Port Harcourt Urban Area and is limited to patients being treated in Ashford and Patrice Clinic for urogenital tract infection, antenatal and diabetic cases. It determined the influence of pregnancy and diabetes on Candidiasis. Material and MethodsCultural Materials: The culture media used were sabour and Dextros Agar (SDA), Blood Agar (BA), MacConkey Agar (MAC) and Corn Meal Agar (CMA) and were prepared according to manufacturers instruction 20, 21, 22. Stains and other chemical used were those of Difco and were of international standard. Isolation and Identification Methods: The streak plate method was used23-25 and characterization was done based on colonial and cell morphogy25, germ tube formation and pseudohyphae and/or chlamyalospore formation on corn meal agar23, 26, 27. The staining methods were based on the work of Baker and Silverton26. Sample Collection: The samples collected for analysis were high vaginal swab (HVS) cervical swab (CS) and mid-stream urine. These samples were collected from hospital patients on antenatal, diabetes, vaginitis, virginal rash and pains, pelvis inflammatory diseases (PID) dysuria and septic abortion. Urine samples were collected in 10mls sterile universal containers devoid of chemicals and detergents. The samples were taken to the laboratory for immediate analysis. A total of two hundred and sixty-seven patients were investigated in four months covering September to December, 2013. All patients queried for the above stated cases were examined. Results and Discussion Table-1 represented the distribution of various samples sent to the laboratory for examination. A total of two hundred and sixty seven samples were collected and examined. Of these samples, twenty four (24) were collected from diabetic patients, sixty-five (65) from antenatal clinic and One hundred and seventy eight (178) from patients with symptoms of urogenital tract infection who were neither diabetic or pregnant. Table-2 showed the distribution of different micro organisms isolated from different groups of patients (treatment options) that were examined. Table-1 Distribution of Samples Examined Month Total No of Samples Collected Samples from Diabetics Samples From Antenatal Clinic Samples From UTI Patients September 54 8 8 38 October 64 4 12 48 November 85 10 20 55 December 62 2 15 45 Total 267 24 65 178 Table-2 Isolates From the Different Treatment Groups Groups Total No. of Samples Candida albicans Other Yeasts Bacteria Protogoa Diabetic Patient 24 8 5 11 - Antenal Patient 65 15 14 34 2 UTI Patients 178 18 23 114 14 Total 267 41 42 159 16 A total of 41 patients were diagnosed of Candidaalbicansinfection representing 18.9% of the total number of patients examined. Of this percentage, UTI patients had the highest percentage of Candida albicansinfection (10.3%). Diabetic patients and patients from antenatal clinic recorded 3.0 and 5.6% respectively. Bacteria were the most causative agents of urogenital tract infection (table-3) with a recorded 42,7%. Other Yeasts and Protozoa had 8.6% and 5.2 respectively for urogenital tract infection, 5.2% and 0.7% respectively from antenatal clinic while other yeasts recorded 1.9% from diabetic patients examined. However, no protozoan was isolated from patients suffering from diabetes. From table-3 and figure-3 pregnant women appears to be more disposed to candidaisis than diabetic patients. The analysis of variance done showed that there is no significant difference at 95%probability level for the different treatment option with respect to Candida albicausinfection. Table-3 Percentage of Candida albicansin Relation to Other Isolates from the Diagnosed Samples Groups Total No. of Samples Candida albicans Other Yeasts Bacteria Protogoa Diabetic Patient 9.0 3.0 1.9 4.1 - Antenal Patient 24.3 5.6 5.2 12.7 0.7 UTI Patients 66.7 10.3 8.6 42.7 5.2 Total 100 18.9 15.7 59.5 5.9 International Research Journal of Environment Sciences______________________________________________ ISSN 2319–1414 Vol. 3(4), 101-104, April (2014) Int. Res. J. Environment Sci. International Science Congress Association 103 Figure-1 Treatment Options Discussion: This research put the incidence of Candida albicans infection of the urogenital tract of females age 18 to 45 in Port Harcourt Urban Area at 18.9%.This is in line with previous works done in some localities, which put the incidence at between 10 and 55%16. The isolates were found more in patients with symptoms of urogenital tract infection. The presence of some microorganisms (eg bacteria) may have provided a synergy that facilitated the growth of the fungi. This may be by generation of intermediate metabolites, which may alter the microbial environment eliminating some microbial flora and reducing competition for the limiting nutrients. The proliferation of Candida in diabetic patients may be attributed to high level of blood sugar, which acts as energy source to the yeasts. In pregnancy, the hormonal change that goes with the condition may be responsible for the growth of the fungi. Larissa19 pointed out that hormonal changes that take place in women make them more vulnerable to Candida infection. Also, antibiotics treatment reduces the number of susceptible bacteria species that may be antagonistic to the fungi thereby enhancing their growth. Although Candidaalbicans infection is not a classical sexually transmitted disease, it is known to be transmitted, in some cases, through sexual intercourse especially among sexually active persons and sex workers. This has been reported in cases of unprotected sex and person with multiple sex partners. Despite the predisposing factors enhancing the growth of this yeast, improved personal hygiene can further reduce the incidence. Conclusion The incidence and prevalence of Candida albricans infection in Port Harcourt Urban Areas was quite high. Of the total number of females examined, 18.9% showed evidence of the disease. The infection was more among patients queried for urogenital tract infection. However, diabetes, pregnancy and antibiotics treatment proved to support the growth of the yeasts. Improved personal hygiene and sexual discipline can help reduce the incidence of this disease. References1.Berual S., Maznelos E., Garcia M., Aller A., Martinez M. and Gutierrez M., Evaluation of Chromagor Candidamedium for the isolation of presumptive identification of species of Candida of clinic importance, Diagn. Miciobiol. Infection. Dis., 24, 201-204 (1996)2.Soble J.D., Vulvovaginal Candidosis,Laucet, 369(9577), 1961-71 (2007)3.Pappas P.G., Invasive Candidiasis, Infect. Dis. Clin. North-Am.,20(3), 485-506 (2006)4.American academy of Pediatrics, Immunizations and Infections Disease: an informed patients guide (2006)5.Pulakila Worley R., Ausubel F.M, Mylonakis E., Candida albicansinfection of caeriorhabditis Elegans Induces antifungal inomune defenses, Plos Path og, 7(6): e1002074. Doi 10.1372/Journal.ppat. (2011) International Research Journal of Environment Sciences______________________________________________ ISSN 2319–1414 Vol. 3(4), 101-104, April (2014) Int. Res. J. Environment Sci. International Science Congress Association 104 6.Priotta M.V. and Garland M., Genital Candidaspecies detected in samples from women in Melbourne, Australi before and after treatment with antibiotics, J. of clinical Microbiology,10(2), 16–25 (2006)7.Aniebo, V., The effect of some Medicinal plants on Pathogenic fungi ion Rivers State, University of Port Harcourt, J. of Med. Sc.,2, 1-10 (1984)8.Yang Y.I., virvulence factors of candida species J., Microbiol Immunol. Infect., 36(4), 223–228 (2003)9.Uyawah P.O., A preliminary study of an open clinical comparative evaluation of Ticonzole (trosyd) vaginal cream and tablet, N.J. Microbiol,, 29 – 33 (1984)10.Centre for disease control and prevention, Proceedings of an international conference on HIV prevention (2001)11.Pfaller M.A., Diekema D.J., Epidermology of invasive candidiasis: a persistent public health problem, Chin. Microbiol Rev.,20(1), 133–63 (2007)12.de Repentigny L., Lewand owski D., Jolicosur P., Immuno-pathogenesis of oropharyngeal Candidiasisin human immunodeficiency virus infection, Clinic microbial. Rev,17(4), 729–59 (2004)13.Morgan J., Global trends in Cadidermia: review of report from 1995-2005, Curr. Infect. Dis. Rep.,7(6), 429–39 (2005)14.Malani A.N. and Kauffman C.A., CandidaUrinary tract infections: treatment options Experts Rev, Anti Infect Ther.,19(6), 693–7 (2007)15.Otokunefor T.V. and Udujih S.O., Aeriology an antimycotic susceptibility of vaginal candidiasis in pregnant women, Biomedical letter,46, 273 – 277 (1991)16.Hidalgo J.A., Candidiasis, Emedicine Medscape News (2013)17.Cheesbrough M., Medical Laboratory Manual for tropical counties, Microbiology educational book scheme, 11, 389 – 90 (1991)18.Lavissa H., Vaginal Yeast infection, Ed Kids Health (2012)19.Lowes R., Come Down and on Oral Ketoconazole, Midsacpe Medical News August (2013)20.Oxoid Manual (1981)21.Stanley H.O. and Onianwah F.I., Microbiological characteristics of solid waste from selected Hospitals in Port Harcourt Urban, Journal of Nigerian Environ. Society,5(3), 139 – 146 (2010)22.Onianwah F.I., Stanley H.O. and Stanley C.N., Bioremoval of Cadmium; Mercuriy, Nickel and Zinc from leachate sample collected from Refuse dump on Obiri Ikwerre/ Airport Link Road in Port Harcourt using living cells of Aspergellus niger and Rhizopus stolonifer,Int. Res. J. of Environ sc.,2(11), 1-8 (2013)23.Odu C.T.I., Babalola O., Udo E.J., Ogunkunle A.O., Bakare T.A. and Adeoye G.O., Laboratory Manual for agronomic students in soils, plants and microbiology. Dept of Agronomy, University of Ibadan, 83 (1956)24.Baker F.J and Silverton R.E, Introduction to medical Laboratory technology, Sixthe ediction, Butterworths London, (1985) 25.Larone D.H., Medically Important Fungi. A guide to identification, Harper and Roro- Maryland (1976)