Journal of Biology and today's world 2013, volume 2, issue 9, pages: Probiotics for prevention of Candida Infections

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1 CNB Scholar Journals Available online: Journal of Biology and today's world ISSN Review Article Probiotics for prevention of Candida Infections Mohammad Mohammad Doost Chakoosari Department of Microbiology, Faculty of Science, Lahijan Branch, Islamic Azad University, Lahijan, Iran Received: 21 September 2013 / Accepted: 28 September 2013 / Published: 19 October 2013 Copyright 2013 Mohammad Mohammad Doost Chakoosari. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract The yeast Candida albicans is present on or in most humans as a harmless commensal organism. C. albicans is a diploid fungus that grows both as yeast and filamentous cells and a causal agent of opportunistic oral and genital infections in humans. Probiotics are defined as the viable microorganisms that exhibit a beneficial effect on the health of the host by improving its intestinal microbial balance. Probiotics are increasingly being used to treat and prevent urogenital infections. The aim of this review is to consider the current evidence on the effects of probiotics on human health and decrease Candida Infections. Keywords: Candida, Probiotic, Vagina Correspondence should be addressed to Mohammad Mohammad Doost Chakoosari, Department of Microbiology, Faculty of Science, Lahijan Branch, Islamic Azad University, Lahijan, Iran, Chakoosari@hotmail.com Tel: P a g e

2 1. Introduction The term probiotics was first coined by Lilly and Stillwell in 1965 in reference to substances produced by protozoa, which stimulated the growth of other organisms. Probiotics are defined as the viable microorganisms that exhibit a beneficial effect on the health of the host by improving its intestinal microbial balance [1,2]. A probiotic organism should be nonpathogenic and non-toxic, and also resistant to low ph and to bile salts to improve its chances of survival in the gastrointestinal tract [3]. Probiotics, microorganisms that have antagonist activity against pathogens in vivo, have long been promoted as health enhancing in general and specifically as useful for vaginal problems [4]. There is strong evidence that Lactobacillus rhamnosus GG is effective for the treatment of acute rotavirus diarrhoea in children, causing a significant reduction of its duration. In addition, their usefulness for the prevention and/or treatment of many other diseases, such as antibiotic-associated diarrhoea (Saccharomyces boulardii), Helicobacter pylori infections, inflammatory bowel diseases, allergy, cancer, urinary tract infections and bacterial vaginosis [5]. Urogenital infections are a major reason for women to visit their family s physician and are generally derived to gastroenterology, gynecology, urology, and infectious diseases specialists. Candida Albicans is the main cause of the majority of fungal infection in oral cavity. Oropharyngeal candidiasis is a common infection and currently ranks as the most common human fungal disease. C. albicans, the major human pathogen of the genus candida, is a commensal yeast of the oral, gastrointestinal, and vaginal mucosa in healthy individuals and seems to be almost universally present. But this microorganism may change from commensal to pathogenic microorganism [6]. There are several antifungal medications but the patients are mostly convenience using natural or herbal ones. Several lactobacillus species are currently used as probiotics, i.e., live bacteria used as food supplements to provide beneficial effects to the host. Probiotic bacteria can produce bacteriocin-like compounds that inhibit infectious microorganisms [7]. They can adhere to epithelium of the alimentary tract and block adherence of pathogens and they can stimulate host defense mechanisms [8, 9]. Lactobacillus acidophilus is an important probiotic species, which has been reported to immunedeficient mice from orogastric candidiasis and protect humans from C. albicans vaginitis [8]. In-vitro treatment with yoghurt or exogenous lactobacillus species has been reported to alleviate the symptoms of vaginal candidosis, but few reports have investigated in-vitro effect of yoghurt on C.albicans [9,10]. The aim of this review is to consider the current evidence on the effects of probiotics on human health and decrease Candida Infections. 2. Vaginal Lactobacilli Lactobacilli, especially Lactobacillus crispatus, Lactobacillus jensenii and Lactobacillus iners are most commonly the dominant microorganisms in the vagina of healthy premenopausal women. Lactobacilli produce lactic acid and other substances, which maintain a low ph in the vagina, thus preventing the overgrowth of pathogens, at least those causing bacterial vaginosis (BV) and gonorrhoea. C. albicans may also be found in the vagina of healthy premenopausal women [5]. C. albicans is the major species associated with Vulvo- 413 P a g e

3 vaginal candidiasis and is responsible for approximately 80% of the cases, In vitro experiments have shown a reduced adherence of C. albicans to VECs(vaginal epithelial cells) when they are mixed with Lactobacillus than in mixtures without Lactobacillus. Furthermore, specific Lactobacillus strains produce metabolites that are toxic to C. albicans. However, there is a lack of large clinical studies that investigate the significance of the Lactobacillus flora or possible treatment effects with exogenous Lactobacillus therapy [11,12]. In a study by Hilton et al, 33 women were initially assigned to either a yogurt-free or a yogurtcontaining diet group for a 6-month period, then switched to the opposite group for the subsequent 6 months. Cultures of both stool and vaginal specimens were taken at various times during the study. Positive vaginal cultures for L. acidophilus were found 54.8% of the time when stool cultures tested positive for this species. In contrast, if L. acidophilus was not detected in the rectum, vaginal colonization was seen only 15.5% of the time [13]. In a similar controlled study by Shalev et al, levels of both rectal and vaginal L. acidophilus colonization were shown to increase after 1 and 2 months of treatment with oral L. acidophilus. These data suggest the presence of some form of gastrointestinal to vaginal transmission and colonization, although they do not confirm this transmission nor elucidate the precise mechanisms of the process by which it may occur [14]. 3. Modes of action Probiotics for prevention of Candida Infections 3.1. Growth inhibitory substances This group includes organic acids, fatty acids, hydrogen peroxide, biosurfactants, bacteriocins and bacteriocin-like substances (BLSs). Antimicrobial acids, H 2 O 2 and BLSs are, through different mechanisms, the primary metabolites produced by probiotics associated with inhibition and the control of pathogens Adherence and competition Adherence to VECs by lactobacilli and the out-competition of vaginal pathogens on VECs is believed to be of major importance in the control of pathogenic species in the genital tract Growth, stability and resistance to antimicrobial agents and spermicidals Good technical growth and stability are two of the most important properties that a probiotic strain must comprehend. Sufficient growth capacity in small production systems does not always correspond to the result in up-scaled production systems. Despite the enhanced results achieved in high technological fermentors, a good inherent growth capability of the strain is preferred. 4. Other mechanisms At present, there is a great deal of interest in investigations regarding cytokine induction by probiotic bacteria and commensal microbiota in general. The major part of the effort is put into the microflora of the intestinal tract [15]. 414 P a g e

4 5. Yeast Vaginitis C. albicans is the major cause of infections (around 85%), other yeast such as Candida glabrata, Candida krusei and Candida tropicalis infect the host. In a study of premenopausal women by Sobel et al., C. albicans was isolated from25% of 20 healthy women and found that lactobacilli were the dominant vaginal microorganisms in 90% of 20 healthy premenopausal women and in 96% of 24 premenopausal women with acute exacerbations of recurrent Vulvovaginal candidiasis (VVC ) [16]. Demirezen et al. found that presence of lactobacilli was more common among 59 studied women with VVC than among 391 healthy women [17]. Osset et al. found that 8 of 15 studied lactobacilli inhibited significantly the adhesion of C. albicans Y18 to vaginal cells. They also found that some lactobacilli inhibited the growth of C. albicans Y18 in liquid assays [18]. 6. Conclusions Probiotics are generally considered to be safe. However, there are still many questions to be answered before probiotics can be used routinely as therapy. Some in vitro studies and clinical trials had positive results regarding the effectiveness of some specific lactobacilli strains against C. albicans. Probiotics, especially L. acidophilus, L. rhamnosus and L. fermentum. with increasing of the antibiotic resistance and side effects of chemical drugs, it seems, we need to use alternative remedies. Probiotics and their produced metabolites can have therapeutic application in future. References [1] Zerehpoosh, S., R. Kazemi Darsanaki, Probiotics and Health. Journal of Biology and today's world., 2(1): [2] Kazemi Darsanaki, R., K. Issazadeh, M.R.M. Khoshkholgh Pahlaviani and M. Azizollahi Aliabadi, Antimutagenic Activity of Lactobacillus spp. Isolated from Fresh Vegetables against Sodium Azide and 2-Nitrofluorene. J Pure Appl Microbio., 6: [3] Suvarna, V.C. and V.G. Boby, Probiotics in human health. A current assessment, Current science.,88: [4] Mombelli, B., M.R. Gismondo, The use of probiotics in medical practice. Int J Antimicrob.,16: [5] Falagas, M.E., G.I. Betsi, S. Athanasiou, Probiotics for prevention of recurrent vulvovaginal candidiasis: a review. Journal of Antimicrobial Chemotherapy., 58: [6] Akpan, A., R. Morgan, Oral candidiasis. Postgrad Med J., 78: P a g e

5 [7] Reid, G., J. Jass., M.T. Sebulsky, J.K. McCormick, Potential uses of probiotics in clinical practice. Clin Microbiol Rev., 16: [8] Miettinen, M., J. Vuopio-Varkila, K. Varkila, Production of human tumor necrosis factor alpha, interleukin-6, and interleukin-10 is induced by lactic acid bacteria. Infect Immun 64: [9] Wagner, R.D., C. Pierson, T. Warner, M. Dohnalek, J. Farmer, L. Roberts, Biotherapeutic effects of probiotic bacteria on candidiasis in immunodeficient mice. Infect Immun., 65: [10] Williams, A.B., C. Yu, K. Tashima, J. Burgess, K. Danvers, 2001.Evaluation of two self-care treatments for prevention of vaginal candidiasis in women with HIV. J Assoc Nurses AIDS Care., 12: [11] Boris, S., J.E. Suarez, F. Vazquez, C. Barbes Adherence of human vaginal lactobacilli to vaginal epithelial cells and interaction with uropathogens. Infect Immun 66(5): [12] Strus, M., A. Kucharska, G. Kukla, M. Brzychczy-Wloch, K. Maresz, P.B. Heczko, The in vitro activity of vaginal Lactobacillus with probiotic properties against Candida. Infect Dis Obstet Gynecol., 13(2): [13] Hilton, E., H.D. Isenberg, P. Alperstein, K. France, M.T. Borenstein, Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Annals of Internal Medicine., 166: [14] Shalev, E., S. Battino, E. Weiner, R. Colodner, Y. Keness, Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent candidal vaginitis and bacterial vaginosis. Archives of Family Medicine., 5(10), [15]. Rönnqvist, D., Urogenital Probiotics. Department of Clinical Microbiology, Clinical Bacteriology Umea University, Umea, Sweden. Umea [16] Sobel, J., W. Chaim, Vaginal microbiology of women with acute recurrent vulvovaginal candidiasis. J Clin Microbiol., 34: [17] Demirezen, S., The Lactobacilli-Candida relationship in cervicovaginal smears. Cent Eur J Public Health.,10: [18] Osset, J., E. Garcia, R.M. Bartolome, Role of Lactobacillus as protector against vaginal candidiasis. Med Clin., 117: P a g e