Candidíase vulvovaginal em portadoras de lúpus eritematoso sistêmico atendidas em um hospital-escola de Alagoas: um estudo de caso-controle

Abstract

Vulvovaginal candidiasis (VVC) is caused by Candida species and is often characterized by discharge that may be accompanied by itching and burning, with recurrent cases (CVVR) mainly in immunocompromised patients. Chronic autoimmune diseases such as Systemic Lupus Erythematosus (SLE) generate deficiency in immunoregulatory control and inflammation in multiple systems, and treatment requires prolonged use of immunosuppressants and corticosteroids, which increases the risk of infections. Therefore, the objective was to investigate the frequency of vulvovaginal candidiasis (VVC) and Candida ssp. in patients with Systemic Lupus Erythematosus (SLE), identifying recurrences (RVVC) and correlation with clinical status. A descriptive (case-control), observational and cross-sectional study with a group of 30 SLE patients (GSLE) and 30 women without any autoimmune disease (control/CG). After data collection, anamnesis and gynecological examinations, each vaginal secretion was cultured on Sabouraud Dextrose agar with chloramphenicol, with light microscopy of yeast and subculture on Chromagar®Candida for species identification, followed by SLEDAI correlation. SLE-women (30) ranged from 19 to 60 years old, while non-SLE was from 16 to 55 years old. In 60 patients, the majority did not use any contraceptive method, and in GSLE a continuous use of prednisone (66.66%), azathioprine (60%) and hydroxychloroquine/reuquinol (86.66%) was observed. Candidiasis was diagnosed in 7 of GSLE (23.33%) and 1 of GC (3.33%), with 95% confidence interval (CI) of 1.02 to 77. C. albicans and C. glabrata were isolated in SLE women, which had an 8.8-fold higher risk of developing VVC and a greater tendency to RVVC (33.33%). Three patients with SLE/VVC had 0 score in SLEDAI/SLEDAI-2k, indicating the absence of active disease; the loss of data from the remaining patients prevented a complete assessment of SLE activity. Conclusion: Women with SLE have an increased risk of acquiring VVC, likely due to chronic immune impairment, with a slightly higher frequency of recurrence. C. albicans was the most isolated agent, and the presence of Candida non-albicans highlights the importance of species identification when symptoms of candidiasis appear. Preventive strategies for candidiasis in patients with SLE contribute to improved quality of life, and further studies are needed to clarify how SLE influences the vaginal microbiota and the risk of VVC/RVVC.