Skip to main content

Advertisement

SpringerLink
Log in

In Vitro Antifungal Activity of Azoles and Other Antifungal Agents Against Pathogenic Yeasts from Vulvovaginal Candidiasis in China

  • Original Article
  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

Background

Vulvovaginal candidiasis (VVC) is a public health issue worldwide. Little is known of the optimal treatment of recurrent VVC (RVVC) has not been established.

Objective

Through the in vitro antifungal susceptibility profiling of VVC isolates, we hope to foster significant improvements in the control and treatment of this disease.

Methods

Candida isolates from VVC patients were collected from 12 hospitals in 10 cities across China. Species were identified by phenotype analysis and DNA sequencing. Species were identified by phenotype analysis and DNA sequencing. Susceptibilities to 11 drugs were determined by Clinical and Laboratory Standards Institute broth microdilution.

Results

543 strains were isolated from those VVC patients enrolled in this study, of which, 15.7% were from RVVC. The most commonly identified species was C. albicans (460, 84.71%), and the most commonly non-albicans Candida spp. (NAC) was C. glabrata (47, 8.66%). NAC also included C. Krusei, Meyerozyma Guillermondii, Meyerozyma Caribbica, C. Tropicalis, C. Parapsilosis, and C. Nivariensis. Most C. albicans isolates were susceptible to caspofungin (99.8%), followed by fluconazole (92%) and voriconazole (82.6%). The proportion of C. albicans strains with wild type (WT) MICs that were susceptible to amphotericin B and caspofungin were 98%, followed by posaconazole at 95%, itraconazole at 86%, fluconazole at 74% and voriconazole at 54%. The fluconazole MICs for C. albicans were lower than those for NAC (P < 0.05), while the itraconazole MICs showing no significant difference (P > 0.05). The susceptible rate of uncomplicated VVC to fluconazole was 92%. The proportion of WT strains to fluconazole in RVVC was much lower than that in other types of VVC (67 vs. 77%, P < 0.05). However, the proportions of WT strains to itraconazole in RVVC was over 85%, which was much higher than that to fluconazole (87 vs. 67%, P < 0.05).

Conclusions

C. albicans was still the predominant pathogen for VVC in China, while C. glabrata was the main species in NAC. Fluconazole could still be used as an empirical treatment for uncomplicated VVC. However, fluconazole may not be the first choice for the therapy of RVVC. In such cases, itraconazole appears to be the more appropriate treatment. As for VVC caused by NAC, nonfluconazole drugs, such as itraconazole, may be a good choice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Brandolt TM, Klafke GB, Goncalves CV, Bitencourt LR, Martinez AM, Mendes JF, et al. Prevalence of Candida spp. in cervical-vaginal samples and the in vitro susceptibility of isolates. Braz J Microbiol. 2017;48(1):145–50. https://doi.org/10.1016/j.bjm.2016.09.006.

    Article  PubMed  Google Scholar 

  2. Sobel JD. Vulvovaginal candidosis. Lancet. 2007;369(9577):1961–71. https://doi.org/10.1016/S0140-6736(07)60917-9.

    Article  PubMed  Google Scholar 

  3. Hazra A, Collison MW, Davis AM. CDC Sexually transmitted infections treatment guidelines, 2021. JAMA. 2022;327(9):870–1. https://doi.org/10.1001/jama.2022.1246.

    Article  PubMed  Google Scholar 

  4. Luo X, Dong X, Pen Z. Distribution and drug susceptibility of Candida spp. associated with female genital tract infection, Chongqing, China. Jundishapur J Microbiol. 2016;9(10):e19386. https://doi.org/10.5812/jjm.19386.

    Article  CAS  PubMed  Google Scholar 

  5. Beikert FC, Le MT, Koeninger A, Technau K, Clad A. Recurrent vulvovaginal candidosis: focus on the vulva. Mycoses. 2011;54(6):e807–10. https://doi.org/10.1111/j.1439-0507.2011.02030.x.

    Article  PubMed  Google Scholar 

  6. Erdem H, Cetin M, Timuroglu T, Cetin A, Yanar O, Pahsa A. Identification of yeasts in public hospital primary care patients with or without clinical vaginitis. Aust N Z J Obstet Gynaecol. 2003;43(4):312–6. https://doi.org/10.1046/j.0004-8666.2003.00089.x.

    Article  PubMed  Google Scholar 

  7. Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the infectious diseases Society of America. Clin Infect Dis. 2009;48(5):503–35. https://doi.org/10.1086/596757.

    Article  CAS  PubMed  Google Scholar 

  8. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1-50. https://doi.org/10.1093/cid/civ933.

    Article  PubMed  Google Scholar 

  9. Workowski KA, Berman S. CDC prevention Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(12):1–110.

    PubMed  Google Scholar 

  10. Fan SR, Liu XP, Li JW, Xu AP, Liu M. Study on classification and treatment of vulvovaginal candidiasis. Zhonghua Fu Chan Ke Za Zhi. 2005;40(8):532–5.

    PubMed  Google Scholar 

  11. Hillier SL, Austin M, Macio I, Meyn LA, Badway D, Beigi R. Diagnosis and treatment of vaginal discharge syndromes in community practice settings. Clin Infect Dis. 2021;72(9):1538–43. https://doi.org/10.1093/cid/ciaa260.

    Article  CAS  PubMed  Google Scholar 

  12. Benedict K, Singleton AL, Jackson BR, Molinari NAM. Survey of incidence, lifetime prevalence, and treatment of self-reported vulvovaginal candidiasis, United States, 2020. BMC Womens Health. 2022;22(1):147. https://doi.org/10.1186/s12905-022-01741-x.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Yano J, Sobel JD, Nyirjesy P, Sobel R, Williams VL, Yu Q, et al. Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes. BMC Womens Health. 2019;19(1):48. https://doi.org/10.1186/s12905-019-0748-8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Benedict K, Lyman M, Jackson BR. Possible misdiagnosis, inappropriate empiric treatment, and opportunities for increased diagnostic testing for patients with vulvovaginal candidiasis-United States, 2018. PLoS ONE. 2022;17(4):e0267866. https://doi.org/10.1371/journal.pone.0267866.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Chen J, Hu N, Xu H, Liu Q, Yu X, Zhang Y, et al. Molecular epidemiology, antifungal susceptibility, and virulence evaluation of candida isolates causing invasive infection in a tertiary care teaching hospital. Front Cell Infect Microbiol. 2021;11:721439. https://doi.org/10.3389/fcimb.2021.721439.

    Article  PubMed  PubMed Central  Google Scholar 

  16. van Schalkwyk J, Yudin MH, Infectious DC. Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis. J Obstet Gynaecol Can. 2015;37(3):266–74. https://doi.org/10.1016/S1701-2163(15)30316-9.

    Article  PubMed  Google Scholar 

  17. Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1–187. https://doi.org/10.15585/mmwr.rr7004a1.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Nadeem SG, Hakim ST, Kazmi SU. Use of CHROMagar Candida for the presumptive identification of Candida species directly from clinical specimens in resource-limited settings. Libyan J Med. 2010. https://doi.org/10.3402/ljm.v5i0.2144.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Song N, Kan S, Pang Q, Mei H, Zheng H, Li D, et al. A prospective study on vulvovaginal candidiasis: multicentre molecular epidemiology of pathogenic yeasts in China. J Eur Acad Dermatol Venereol. 2022;36(4):566–72. https://doi.org/10.1111/jdv.17874.

    Article  CAS  PubMed  Google Scholar 

  20. Wayne P. Reference method for broth dilution antifungal susceptibility testing of yeasts. 4th ed. Document M27-E4. Clinical Laboratory Standard Institute; 2017.

  21. Wayne P. Epidemiological cutoff values for antifungal susceptibility testing. 2nd ed. Clinical and Laboratory Standards Institute; 2018.

  22. Wayne P. Performance standards for antifungal susceptibility testing of yeasts. 1st ed. Document M60. Clinical and Laboratory Standards Institute; 2017.

  23. Wayne P. Principles and procedures for the development of epidemiological cutoff values for antifungal susceptibility testing.1st ed. CLSI guideline M57. Clinical and Laboratory Standards Institute; 2016.

  24. Maraki S, Mavromanolaki VE, Stafylaki D, Nioti E, Hamilos G, Kasimati A. Epidemiology and antifungal susceptibility patterns of candida isolates from greek women with vulvovaginal candidiasis. Mycoses. 2019;62(8):692–7. https://doi.org/10.1111/myc.12946.

    Article  CAS  PubMed  Google Scholar 

  25. Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis. 2018;18(11):e339–47. https://doi.org/10.1016/S1473-3099(18)30103-8.

    Article  PubMed  Google Scholar 

  26. 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(4):1501–3. https://doi.org/10.1128/JCM.02485-07.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 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 Mycol Med. 2014;24(2):106–11. https://doi.org/10.1016/j.mycmed.2014.01.060.

    Article  CAS  PubMed  Google Scholar 

  28. Shi XY, Yang YP, Zhang Y, Li W, Wang JD, Huang WM, et al. Molecular identification and antifungal susceptibility of 186 Candida isolates from vulvovaginal candidiasis in southern China. J Med Microbiol. 2015;64(Pt 4):390–3. https://doi.org/10.1099/jmm.0.000024.

    Article  CAS  PubMed  Google Scholar 

  29. Gamarra S, Morano S, Dudiuk C, Mancilla E, Nardin ME, de Los Angeles Mendez E, et al. Epidemiology and antifungal susceptibilities of yeasts causing vulvovaginitis in a teaching hospital. Mycopathologia. 2014;178(3–4):251–8. https://doi.org/10.1007/s11046-014-9780-2.

    Article  CAS  PubMed  Google Scholar 

  30. Kalkanci A, Guzel AB, Jabban II, Aydin M, Ilkit M, Kustimur S. Candida vaginitis in non-pregnant patients: a study of antifungal susceptibility testing and virulence factors. J Obstet Gynaecol. 2013;33(4):378–83. https://doi.org/10.3109/01443615.2013.767323.

    Article  CAS  PubMed  Google Scholar 

  31. Konate A, Yavo W, Kassi FK, Djohan V, Angora EK, Barro-Kiki PC, et al. Aetiologies and contributing factors of vulvovaginal candidiasis in Abidjan (Cote d’Ivoire). J Mycol Med. 2014;24(2):93–9. https://doi.org/10.1016/j.mycmed.2013.11.006.

    Article  CAS  PubMed  Google Scholar 

  32. Mahmoudi Rad M, Zafarghandi A, Amel Zabihi M, Tavallaee M, Mirdamadi Y. Identification of Candida species associated with vulvovaginal candidiasis by multiplex PCR. Infect Dis Obstet Gynecol. 2012;2012:872169. https://doi.org/10.1155/2012/872169.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Vijaya D, Dhanalakshmi TA, Kulkarni S. Changing trends of vulvovaginal candidiasis. J Lab Physicians. 2014;6(1):28–30. https://doi.org/10.4103/0974-2727.129087.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Makanjuola O, Bongomin F, Fayemiwo SA. An update on the roles of Non-albicans Candida species in vulvovaginitis. J Fungi (Basel). 2018. https://doi.org/10.3390/jof4040121.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Fan SR, Liu XP. In vitro fluconazole and nystatin susceptibility and clinical outcome in complicated vulvovaginal candidosis. Mycoses. 2011;54(6):501–5. https://doi.org/10.1111/j.1439-0507.2010.01887.x.

    Article  CAS  PubMed  Google Scholar 

  36. Dota KF, Consolaro ME, Svidzinski TI, Bruschi ML. Antifungal activity of brazilian propolis microparticles against yeasts isolated from vulvovaginal candidiasis. Evid Based Complement Alternat Med. 2011;2011: 201953. https://doi.org/10.1093/ecam/neq029.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ge SH, Wan Z, Li J, Xu J, Li RY, Bai FY. Correlation between azole susceptibilities, genotypes, and ERG11 mutations in Candida albicans isolates associated with vulvovaginal candidiasis in China. Antimicrob Agents Chemother. 2010;54(8):3126–31. https://doi.org/10.1128/AAC.00118-10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Alfouzan W, Dhar R, Ashkanani H, Gupta M, Rachel C, Khan ZU. Species spectrum and antifungal susceptibility profile of vaginal isolates of candida in Kuwait. J Mycol Med. 2015;25(1):23–8. https://doi.org/10.1016/j.mycmed.2014.10.021.

    Article  CAS  PubMed  Google Scholar 

  39. Tietz HJ. Treatment of chronic vulvovaginal candidiasis with posaconazole and ciclopiroxolamine. Health. 2010;2:513–8. https://doi.org/10.4236/HEALTH.2010.26077.

    Article  Google Scholar 

  40. Davis MR, Donnelley MA, Thompson GR. Ibrexafungerp: a novel oral glucan synthase inhibitor. Med Mycol. 2020;58(5):579–92. https://doi.org/10.1093/mmy/myz083.

    Article  CAS  PubMed  Google Scholar 

  41. Phillips AJ. Treatment of non-albicans Candida vaginitis with amphotericin B vaginal suppositories. Am J Obstet Gynecol. 2005;192(6):2009–12. https://doi.org/10.1016/j.ajog.2005.03.034.

    Article  CAS  PubMed  Google Scholar 

  42. White DJ, Habib AR, Vanthuyne A, Langford S, Symonds M. Combined topical flucytosine and amphotericin B for refractory vaginal Candida glabrata infections. Sex Transm Infect. 2001;77(3):212–3. https://doi.org/10.1136/sti.77.3.212.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Hettiarachchi N, Ashbee HR, Wilson JD. Prevalence and management of non-albicans vaginal candidiasis. Sex Transm Infect. 2010;86(2):99–100. https://doi.org/10.1136/sti.2009.040386.

    Article  PubMed  Google Scholar 

  44. Dias LB, de Souza Carvalho Melhem M, Szeszs MW, Filho JM, Hahn RC. Vulvovaginal candidiasis in Mato Grosso, Brazil: pregnancy status, causative species and drugs tests. Braz J Microbiol. 2011;42(4):1300–7. https://doi.org/10.1590/S1517-83822011000400009.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Nagashima M, Yamagishi Y, Mikamo H. Antifungal susceptibilities of candida species isolated from the patients with vaginal candidiasis. J Infect Chemother. 2016;22(2):124–6. https://doi.org/10.1016/j.jiac.2015.08.008.

    Article  CAS  PubMed  Google Scholar 

  46. Choukri F, Benderdouche M, Sednaoui P. In vitro susceptibility profile of 200 recent clinical isolates of Candida spp. to topical antifungal treatments of vulvovaginal candidiasis, the imidazoles and nystatin agents. J Mycol Med. 2014;24(4):303–7. https://doi.org/10.1016/j.mycmed.2014.05.001.

    Article  CAS  PubMed  Google Scholar 

  47. Richter SS, Galask RP, Messer SA, Hollis RJ, Diekema DJ, Pfaller MA. Antifungal susceptibilities of candida species causing vulvovaginitis and epidemiology of recurrent cases. J Clin Microbiol. 2005;43(5):2155–62. https://doi.org/10.1128/JCM.43.5.2155-2162.2005.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Saxon G, Edwards A, Rautemaa-Richardson R, Owen C, Nathan B, Palmer B, et al. British association for sexual health and HIV national guideline for the management of vulvovaginal candidiasis (2019). Int J STD AIDS. 2020;31(12):1124–44. https://doi.org/10.1177/0956462420943034.

    Article  Google Scholar 

  49. Spitzer M, Wiederhold NP. Reduced antifungal susceptibility of vulvovaginal candida species at normal vaginal pH levels: clinical implications. J Low Genit Tract Dis. 2018;22(2):152–8. https://doi.org/10.1097/LGT.0000000000000383.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all patients that took part in this survey and the doctors who collected specimens and data. We thank Prof. Shen yongnian for his guidance on the experiment.

Funding

This study was supported by the National Science and Technology Major Project (No. 2018ZX10734404), the CAMS Initiative for Innovative Medicine (No. 2016-I2M-3-021), National Natural Science Foundation of China (No. 81573059), the Basical Scientific Research Fund Projects of Chinese Academy of Medical Sciences (No. 2018PT31013) and Nanjing Clinical Medicine Research Center Project (No.2019060001).

Author information

Author notes

  1. Siyue Kan, Nana Song and Qiuyu Pang have contributed equally to this work.

Authors and Affiliations

  1. Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, China

    Nana Song, Huan Mei, Hailin Zheng, Guixia Lv, Xiaofang Li & Weida Liu

  2. Department of Medical Mycology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China

    Siyue Kan

  3. Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, 610041, China

    Qiuyu Pang

  4. Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, Jiangsu, People’s Republic of China

    Hailin Zheng, Xiaofang Li & Weida Liu

  5. Department of Microbiology/Immunology, Georgetown University, Washington, DC, 20057, USA

    Dongmei Li

  6. Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32, Western 2nd Section, 1st Ring Road, Chengdu, Sichuan, China

    Fan Cui

  7. The First Affiliated Teaching Hospital of Xi’an Jiaotong University, Xi’an, 710061, China

    Ruifang An

  8. Nanjing Maternity and Child Health Care Hospital, Women’s Hospital of Nanjing Medical University, Nanjing, 210004, China

    Ping Li

  9. The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China

    Zhengai Xiong

  10. Peking University Shenzhen Hospital, Shenzhen, 518035, China

    Shangrong Fan

  11. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China

    Mengzhen Zhang

  12. The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China

    Yanhong Chen

  13. The Affiliated Hospital of Inner Mongolia Medical University, Huhehaote, 010050, China

    Qiao Qiao

  14. Peking University People’s Hospital, Beijing, 100044, China

    Xudong Liang

  15. Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, 130041, China

    Manhua Cui

  16. The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China

    Dongyan Li

  17. Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medical, Tsinghua University, Beijing, 102218, China

    Qinping Liao

  18. Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China

    Weida Liu

Authors
  1. Siyue Kan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nana Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qiuyu Pang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Huan Mei
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hailin Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dongmei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fan Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Guixia Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ruifang An
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ping Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Zhengai Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Shangrong Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Mengzhen Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yanhong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Qiao Qiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Xudong Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Manhua Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Dongyan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Qinping Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Xiaofang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Weida Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LXF, LWD, LQP, and SYN designed the study. ARF, LP, XZG, FSR, ZMZ, CYH, QQ, LXD, CMH, and LDY collected samples and data. KSY, PQY, SNN, ZHL, MH, and LGX did culture, identification of Candida spp. and drug susceptibility test. SNN did PCR, sequencing, and blast. KSY analyzed data and wrote the article. LXF, LWD, and LDM provided revisions.

Corresponding authors

Correspondence to Xiaofang Li or Weida Liu.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interest.

Additional information

Handling Editor: Jianjun Qiao.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kan, S., Song, N., Pang, Q. et al. In Vitro Antifungal Activity of Azoles and Other Antifungal Agents Against Pathogenic Yeasts from Vulvovaginal Candidiasis in China. Mycopathologia 188, 99–109 (2023). https://doi.org/10.1007/s11046-022-00687-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-022-00687-w

Keywords

Search

Navigation