Recurrent Vulvovaginal Candidiasis: Could It Be Related to Cell-Mediated Immunity Defect in Response to Candida Antigen?

Objective Recurrent vulvovaginal candidiasis (RVVC) is a common cause of morbidity affecting millions of women worldwide. Patients with RVVC are thought to have an underlying immunologic defect. This study has been established to evaluate cell mediated immunity defect in response to candida antigen in RVVC cases. MaterialsAndMethods Our cross sectional study was performed in 3 groups of RVVC patients (cases), known cases of chronic mucocutaneous candidiasis (CMC)(control I) and healthy individuals (control II). Patients who met the inclusion criteria of RVVC were selected consecutively and were allocated in the case group. PBMCs were isolated and labeled with CFSE and proliferation rate was measured in exposure to candida antigen via flow cytometry. Results T lymphocyte proliferation in response to candida was significantly lower in RVVC cases and CMC patients compared to healthy individuals (p< 0.001), but no statistically difference was seen between cases and patients with CMC (p>0.05). Family history of primary immunodeficiency disease differ significantly between groups and was observed in 29.2% of RVVC patients and 42.9%, and 0 % of control groups I and II, respectively(p=0.008). Prevalence of atopy was greater in RVVC cases compared to healthy individuals (41.3% vs. 15%,p=0.054).Lymphoproliferative activity and vaginal symptoms was significantly different among RVVC cases with and without allergy(p=0.01, p=0.02). Conclusion Our findings revealed that T cells did not actively proliferate in response to Candida Ag in some RVVC cases, however; normal function of T cells in the other cases of RVVC was seen. .So patients with cell-mediated immunity defect are more susceptible to recurrent fungal infections of vulva and vagina. It has been hypothesized that higher frequency of vulvovaginal candidiasis in patients with history of atopy might be due to allergic response in mucocutaneous membranes rather than a functional impairment in immune system components.