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Vaginitis due to Saccharomyces cerevisiae: epidemiology, clinical aspects and therapy
Abstract
Vaginitis due to Saccharomyces species is extremely rare. Nine patients with 20 vaginal isolates of Saccharomyces cerevisiae who presented with either asymptomatic vaginal colonization or symptomatic vaginitis indistinguishable from that caused by Candida albicans are described. All patients had a history of chronic or recurrent vaginitis, and all but two had systemic or local predisposing factors. In vitro tests of antimycotic sensitivity revealed reduced susceptibility of S. cerevisiae to the majority of available azole agents, with outright resistance to fluconazole. In accordance with these findings, the clinical response to conventional topical and oral antimycotic drugs was frequently suboptimal and incomplete. Electrophoretic karyotyping of strains revealed several distinct types of S. cerevisiae; this information permitted both longitudinal follow-up and differentiation of relapse from reinfection. In three patients with recurrent vaginitis, a unique epidemiological relationship was documented between S. cerevisiae and Torulopsis glabrata, another unusual and resistant vaginal pathogen. Isolation of S. cerevisiae from the vagina of symptomatic patients should not be ignored; treatment of vaginal infection with this yeast requires selected, often prolonged therapy.
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“the resistance of S. cerevisiae to certain antifungal agents has been also repeatedly observed.2,26,36,38”
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Saccharomyces boulardii Is Not Saccharomyces cerevisiae
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“(15) found that this condition was indistinguishable from the vulvovaginitis caused by the more commonly identified fungal pathogens belonging to the genus Candida.”
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Willems, H. M. E., Lowes, D. J., Barker, K. S., Palmer, G. E., & Peters, B. M. (2018) · Infection and Immunity · doi:10.1128/iai.00527-18 · Cited by 56
“cerevisiae has been isolated as a causative agent of vaginitis (58).”
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Zerva, L., Hollis, R. J., & Pfaller, M. A. (1996) · Journal of Clinical Microbiology · doi:10.1128/jcm.34.12.3031-3034.1996 · Cited by 54
“cerevisiae obtained from patients with vaginal infections (15) or oropharyngeal colonization (17).”
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Quan, M. A. (2010) · Postgraduate Medicine · doi:10.3810/pgm.2010.11.2229 · Cited by 50
“If only budding spores (Figure 6) are seen in the absence of pseudohyphae in a symptomatic patient, the possibility of involvement of a non-albicans species, such as C glabrata and S cerevisiae, should be suspected.(49)”
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Posteraro, B., Sanguinetti, M., Romano, L., Torelli, R., Novarese, L., & Fadda, G. (2005) · International Journal of Food Microbiology · doi:10.1016/j.ijfoodmicro.2004.12.031 · Cited by 42
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Nyirjesy, P., VAZQUEZ, J., Ufberg, D., Sobel, J. D., Boikov, D. A., & BUCKLEY, H. R. (1995) · Obstetrics and Gynecology · doi:10.1016/0029-7844(95)00174-p · Cited by 39
Self-citationde Llanos, R., Llopis, S., Molero, G., Querol, A., Gil, C., & Fernández-Espinar, M. T. (2010) · International Journal of Food Microbiology · doi:10.1016/j.ijfoodmicro.2010.10.025 · Cited by 37
“…(Enache-Angoulvant and Hennequin, 2005; Lolis et al., 2008; Montineri et al., 2008; Muñoz et al., 2005; Swinne et al., 2009; Williams et al., 2007); furthermore, it can sometimes even affect patients showing no obvious predisposition (Jensen et al., 1976; Smith et al., 2002; Sobel et al., 1993).”
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“Copyright © 2019 by the American Sexually Transmitted Diseases As use of longer term (over months) maintenance BA; however, regimens varied.(3,12) One study of intermittent therapy treated 92 women with refractory VVCwith 600-mg BA for 14 days, followed by once daily BA during menstruation for 4 months in 38 of the pa…”
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Posteraro, B., Sanguinetti, M., D’Amore, G., Masucci, L., Morace, G., & Fadda, G. (1999) · Journal of Clinical Microbiology · doi:10.1128/jcm.37.7.2230-2235.1999 · Cited by 34
“The increased use of vaginal and systemic azole agents, particularly fluconazole, which exhibits poor activity against this organism, has been reported as one of the major factors that may contribute to disease development (34).”
BackgroundInfluentialRamazzotti, M., Stefanini, I., Paola, M. D., Filippo, C. D., Rizzetto, L., Berná, L., Dapporto, L., Rivero, D., Tocci, N., Weil, T., et al. (2018) · Environmental Microbiology · doi:10.1111/1462-2920.14422 · Cited by 35
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“…, teleomorfo de C. robusta , se ha implicado en endocarditis, peritonitis, infección del tracto urinario, vulvo-vaginitis, empiema, neumonía y fungemia 77-83 ; y T. beige-lii ( T. cutaneum ), recientemente clasificado en 5 especies, se ha descrito en casos de endocarditis y fungemia 84-87 .”
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Quantitative agar-invasion assay
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“Symptoms are indistinguishable from those of invasive candidiasis (EnacheAngoulvant and Hennequin, 2005) and the fact that some strains can be resistant to fluconazole (Kontoyiannis and Rupp, 2000; Sobel et al., 1993) complicates treatment of invasive Saccharomyces infections.”
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“Saccharomyces invasive infections are often clinically similar to invasive candidiasis.(3) Clinical S.”
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“Notably, S. cerevisiae infections are indistinguishable from those caused by the most widely recognized fungal pathogen Candida albicans (Sobel et al. 1993; McNeil et al. 2001; Zaoutis et al. 2005).”
BackgroundAssessment and Treatment of Vaginitis
Mitchell, C. M. (2024) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000005673 · Cited by 22
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“Saccharomyces cerevisiae ist grundsätzlich apathogen und verursacht daher keine Beschwerden [20,21], auch wenn dieser im Sinne eines Kommensalismus in 1–2% der vaginalen Kulturen identifiziert werden kann [8,15].”
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“Besides, a resistance to some antifungal drugs, such as fluconazole, complicates the treatment (EnacheAngoulvant and Hennequin, 2005; Kontoyiannis and Rupp, 2000; Sobel et al., 1993).”
BackgroundVaginal Mucormycosis: A Case Report
Sobel, J. D. (2001) · Infectious Diseases in Obstetrics and Gynecology · doi:10.1155/s1064744901000205 · Cited by 19
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Sexual forms of yeasts in clinical samples
García-Martos, P., Mira, J., Galán‐Sánchez, F., & Hernández, J. M. (1996) · Mycopathologia · doi:10.1007/bf00437497 · Cited by 16
“Saccharomyces cerevisiae, whose anamorphic state is Candida robusta, has been implicated in isolated cases of respiratory infection [23, 31, 36-38], infection of the urinary tract [31 ], vulvovaginitis [25, 35, 40, 42], peritonitis [29, 30], empyema [41], endocarditis [24, 26] and fungemia [24, 26-28, 32-34, 37, 39].”
BackgroundUncommon Yeasts and Molds Causing Human Disease
Shoff, C. J., & Perfect, J. R. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-809633-8.21023-6 · Cited by 16
Identificación de especies de Candida causantes de vaginitis en la población mexicana
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Data on Safety of Intravaginal Boric Acid Use in Pregnant and Nonpregnant Women: A Narrative Review
Mittelstaedt, R., Kretz, A., Levine, M., Handa, V. L., Ghanem, K. G., Sobel, J. D., Powell, A., & Tuddenham, S. (2021) · Sexually Transmitted Diseases · doi:10.1097/olq.0000000000001562 · Cited by 14
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Sasivimolrattana, T., Chantratita, W., Sensorn, I., Chaiwongkot, A., Oranratanaphan, S., Bhattarakosol, P., & Bhattarakosol, P. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192214716 · Cited by 14
“infection caused vaginitis, but most of the cases were caused by Saccharomyces cerevisiae [53].”
BackgroundTreatment of vaginitis caused by non-albicans Candida species
Sobel, J. D. (2024) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2024.2347953 · Cited by 14
“Successful therapy with boric acid, often prolonged, is described [66].”
BackgroundSelf-citationMolecular epidemiology of Saccharomyces cerevisiae in an immunocompromised host unit
Clemons, K. V., Salonen, J. H., Issakainen, J., NIKOSKELAINEN, J., McCullough, M. J., Jorge, J., & Stevens, D. A. (2010) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2010.06.010 · Cited by 14
“010 with increasing frequency as a cause of clinically relevant disease (Aucott et al., 1990; Cimolai et al., 1987; Clemons et al., 1997; Doyle et al., 1990; Eng et al., 1984; McCullough et al., 1998a; Nielsen et al., 1990; Nyirjesy et al., 1995; Olver et al., 2002; Ponton et al., 2000; Salonen et al., 2000; Sobel et…”
BackgroundInfluentialOtero, L., Palacio, V., Méndez, F. J., & Vazquez, F. (2002) · Medical Mycology · doi:10.1080/714031106 · Cited by 14
Brewer's Yeast as a Cause of Infection
Smith, D. L. (1996) · Clinical Infectious Diseases · doi:10.1093/clinids/22.1.201 · Cited by 12
“[12] described nine patients with vaginitis due to S.”
BackgroundEmerging Pathogens of the Candida Species
Yang, B., & Rao, R. P. (2019) · IntechOpen eBooks · doi:10.5772/intechopen.80378 · Cited by 10
“Although the recent rise in the number of these infections [5] is mainly associated to C.”
Backgroundde Llanos, R., Hernández‐Haro, C., Barrio, E., Querol, A., Fernández-Espinar, M. T., & Molina, M. (2010) · Yeast · doi:10.1002/yea.1799 · Cited by 10
“Nevertheless, there are some cases where infections have been recorded in patients showing no obvious predisposition (Sobel et al., 1993; Smith et al., 2002).”
BackgroundSaccharomyces Cerevisiae Oesophagitis in an HIV-Infected Patient
Koneçny, P., Drummond, F., Tish, K. N., & TAPSALL, J. W. (1999) · International Journal of STD & AIDS · doi:10.1258/0956462991913475 · Cited by 10
Properties of Sustained-Release Single-Dose Formulations for Vulvovaginal Candidiasis
Henzl, M. R. (2005) · American Journal of Drug Delivery · doi:10.2165/00137696-200503040-00003 · Cited by 9
Saccharomyces cerevisiae show low levels of traversal across human endothelial barrier in vitro
Pérez‐Torrado, R., & Querol, A. (2017) · F1000Research · doi:10.12688/f1000research.11782.2 · Cited by 8
Rhodotorula, Saccharomyces, Malassezia, Trichosporon, Blastoschizomyces, and Sporobolomyces
Vazquez, J. A. (2010) · Springer eBooks · doi:10.1007/978-1-4419-6640-7_13 · Cited by 8
Self-citationMulinganya, G. M., Keyser, K. D., Mongane, J., Kampara, F., Vulder, A. D., Boelens, J., Duyvejonck, H., Hendwa, E., Kujirakwinja, Y., Bisimwa, G. B., et al. (2024) · Frontiers in Global Women s Health · doi:10.3389/fgwh.2024.1339821 · Cited by 7
“Other species found in our study, C. famata , C. inconspicua , C. kefyr and S. cerevisiae , are less common to (very) rare causes of vaginitis (45, 46).”
ResultBırıncı, A., Saniç, A., & Durupınar, B. (2001) · Journal of Chemotherapy · doi:10.1179/joc.2001.13.1.43 · Cited by 7
Müller, M. L., Petersen, C. D., & Saunte, D. M. L. (2024) · Dermatologic Therapy · doi:10.1155/2024/2807070 · Cited by 6
Saccharomyces cerevisiae show low levels of traversal across the human blood brain barrier in vitro
Pérez‐Torrado, R., & Querol, A. (2017) · F1000Research · doi:10.12688/f1000research.11782.1 · Cited by 6
McCormack, W. M., & Augenbraun, M. H. (2015) · Elsevier eBooks · doi:10.1016/b978-1-4557-4801-3.00110-7 · Cited by 7
Quindós, G., Marcos‐Arias, C., Miranda-Cadena, K., Sevillano, E., Jauregizar, N., Schneider, J., & Eraso, E. (2025) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2025.2516554 · Cited by 5
Phytochemical Screening and Antibacterial/Antifungal Activities of Ginkgo biloba Extract EGb 761
Ibrahim, M. P., & Nuhu, A. A. (2016) · Cited by 5
Silva, J. O., Franceschini, S. A., & Cândido, R. C. (2002) · REVISTA DO INSTITUTO ADOLFO LUTZ · doi:10.53393/rial.2002.61.34994 · Cited by 5
Spaggiari, L., Tedeschi, G., Benatti, G., Benedittis, M. D., Franzè, M. T., Pinetti, D., Pericolini, E., & Ardizzoni, A. (2026) · Journal of Fungi · doi:10.3390/jof12020081 · Cited by 4
“…of S. cerevisiae in human-related environments and its wide employment in the food industry allowed it to adapt to several body sites where it normally dwells as a commensal, such as skin [9], mucosal membranes [10,11], breast milk [12], and respiratory [13,14] and intestinal tracts [11,15,16].”
Fungal infections of the genitourinary tract
Sobel, J. D. (2009) · Elsevier eBooks · doi:10.1016/b978-1-4160-5680-5.00026-8 · Cited by 4
Self-citationBowen, C., Marcos‐Arias, C., Checa, C., Castellanos, M. E., Miranda-Cadena, K., Eraso, E., & Quindós, G. (2025) · Journal of Fungi · doi:10.3390/jof11100742 · Cited by 4
“Some studies suggest that its virulence may be due to its association with C. albicans as a co-pathogen, similar to C. glabrata [49,54].”
Almanza, L., Debien, B., Fontaine, B., & Brinquin, L. (1998) · Annales Françaises d Anesthésie et de Réanimation · doi:10.1016/s0750-7658(98)80061-0 · Cited by 3
(2016) · doi:10.1128/9781555819071.ch12 · Cited by 3
Immunoproteomic profiling of Saccharomyces cerevisiae systemic infection in a murine model
Hernández‐Haro, C., Llopis, S., Molina, M., Monteoliva, L., & Gil, C. (2014) · Journal of Proteomics · doi:10.1016/j.jprot.2014.08.008 · Cited by 3
Mycotoxins, fungus and ‘electrohypersensitivity’
Anttila, K. (2000) · Medical Hypotheses · doi:10.1054/mehy.1999.1045 · Cited by 3
Metadata
- Authors
- Sobel, J. D., Vazquez, J., Lynch, M., Meriwether, C., & Zervos, M. J.
- Affiliations
- Wayne State University (US)
- Corresponding author
- Sobel, J. D.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 1993-01-01
- Volume
- 16
- Issue
- 1
- Pages
- 93-99
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2109797093
- Cited by
- 117
- References
- 19
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 5 · 2022: 1 · 2021: 5 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 6 · 2014: 3 · 2013: 1 · 2012: 4
- FWCI
- 4.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Immunology and Microbiology › Microbiology › Yeasts and Rust Fungi Studies
- Health Sciences › Medicine › Infectious Diseases › Fungal Infections and Studies
- Keywords
- Saccharomyces cerevisiae, vaginal candidiasis, vaginal infection, recurrent vaginitis, Candida albicans, azole resistance, fluconazole resistance, Candida glabrata, relapse versus reinfection, vaginal colonization, antifungal therapy
- MeSH terms
- Adult, Antifungal Agents, Female, Humans, Microbial Sensitivity Tests, Middle Aged, Mycoses, Recurrence, Saccharomyces cerevisiae, Vagina, Vaginitis
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