Background Candida krusei is an unusual cause of fungal vaginitis. Conventional antimycotic treatments, including azoles, are less active in vitro against C. krusei than C. albicans. Amphotericin B has demonstrated favourable in vitro antifungal activity but is not available as topical preparations.

Purpose To describe a case of persistent vaginal candidiasis due to C. kusei unresponsive to conventional antifungal therapy, treated with topical Amphotericin B.

Material and methods A 61-year-old woman, presented with vulvo-vaginitis with vaginal culture isolation of C. lrusei. She was treated with ketoconazole ovules 400 mg per day for four days. Twenty days later, the patient came to the medical consultation with a labia majora lesion. Furthermore, the vaginal culture remained positive for C. krusei, with a higher yeast proportion than in normal flora. Consensually between Nephrology, infectious diseases and the pharmacy service, it was decided to develop a topical formulation of amphotericin 3% for vaginal application. Effectiveness was assessed by the presence of clinical symptoms and vaginal culture one month later. Information was compiled from digital medical records.

Results To prepare this formulation, amphotericin B deoxicolate was combined in Aquagel lubricating jelly. As amphotericin is lipid soluble propylene glycol was used for lubricant incorporation. 1.4 grams of this formulation was applied daily at night for 14 days. This preparation has an unknown shelf life and is obtainable from the pharmacy manufacturing unit. One month after, the patient’s symptoms had resolved, but the vaginal cultures continued positive.

Conclusion Despite the vaginal cultures remaining positive, the symptoms had resolved, showing that amphotericin in lubricating jelly may be effective in vaginal C. krusei infection where conventional azole treatment has failed. This topical formulation has emerged as a potentially effective regimen but more studies are needed to set the optimal dosing regimen. Vaginitis caused by C. Krusei demands special efforts, and additional treatments must be developed.

Reference

1. Clin Infect Dis 2002;35:1066–70

ReferenceNo conflict of interest.