Prevalence of Vaginitis at the University Hospital Center of Yaounde (CHUY) and Effect of Plant Extracts Combinations and Conventional Antifungals on the Growth of Multidrug-Resistant Candida albicans
Background: The spread of vaginal infections in Cameroon and the resistance of the causative pathogens to antimicrobials require regular monitoring to establish new therapies. The objective of this study was to determine the prevalence of vaginitis among pregnant women at the University Hospital Center of Yaoundé (CHUY) and to evaluate the effects of combinations of plant extracts and conventional antifungals on the growth of Candidaalbicans isolates. Methods: Cervicovaginal samples collected from women were used to identify the involved pathogens and determination of infection prevalence. The effects of aqueous extracts of Alchorneacordifolia, Antrocaryonklaineanum, and Cylicodiscusgabunensis were then evaluated on the growth of five Candidaalbicans isolates, all resistant to at least three antifungals. This involved determining their sensitivity to the plant extracts and identifying inhibition parameters (MIC and MFC). Subsequently, combinations of plant extracts and plant extracts/conventional antifungals were prepared and tested on the isolates’ growth. The determination of the FICI (Fractional Inhibitory Concentration Index) highlighted the effects of the combinations on C.albicans. Results: The prevalence of genital infections at CHUY was 70% during the study period, comprising 30% for vulvovaginal candidiasis (VVC) and 40% for bacterial vaginosis. From the samples collected, nine C.albicans isolates were obtained, five of which were multi-resistant to at least three antifungals. A high resistance rate was recorded with azoles, notably Fluconazole at 88.88%, compared to 77.77% for Miconazole and Econazole. The plant extracts showed inhibitory properties on the growth of C.albicans, with inhibition diameters ranging from 6 to 15 mm. Both the plant extracts and the conventional antifungal (Amphotericin B) inhibited C.albicans growth with MIC values ranging from 0.097 to 6.25 mg/mL. The combination of A.cordifolia and A.klaineanum extracts exhibited a synergistic effect, especially on isolates Cab2, Cab3, and SR ATTCP 37037 (FICI = 0.498; 0.372; and 0.186). The combination of A.cordifolia and Amphotericin B also demonstrated a synergistic effect on C.albicans isolates Cab3 and Cab8 (FICI = 0.380; 0.505). These results indicate that combinations of A.cordifolia and A.klaineanum, as well as A.
References
[1]
Rigouzzo, A., Jonard, M. and Lepercq, J. (2024) Mortalité maternelle par infection à porte d’entrée génitale en France 2016-2018. Gynécologie Obstétrique Fertilité & Sénologie, 52, 252-258. https://doi.org/10.1016/j.gofs.2024.02.014
[2]
Wiliiam, T.A. and Robert, L.J.I. (2022) Prevalence, Associated Risk Factors and Maternal Outcomes of Lower Genital Tract Injuries in the Bamenda Regional Hospital. Open Journal of Obstetrics and Gynecology, 12, 417-433. https://doi.org/10.4236/ojog.2022.125038
[3]
(2016) OMS Stratégie Mondiale Du Secteur De La Santé Contre Les Infections Sexuel-lement Transmissibles, 2016-2021. https://www.afro.who.int/sites/default/files/2019-03/STI.FR_.BATcdr.pdf
[4]
Mosca, V., Arita, G.S., Sakita, K.M., Rodrigues-Vendramini, F.A.V., Faria, D.R., Conrado, P.C.V., et al. (2025) Candida albicans Migrates Itself from the Vagina to the Uterus and Ovaries in Estrogenized Mice. Brazilian Journal of Microbiology, 56, 415-423. https://doi.org/10.1007/s42770-024-01602-9
[5]
Yang, Y., Qu, Y., Yan, B., Wang, C. and Liu, S. (2025) The Prevalence Trends of Trichomonas vaginalis Infection among Women in Jingzhou, Central of China, 2019-2023. BMC Infectious Diseases, 25, Article No. 435. https://doi.org/10.1186/s12879-025-10815-8
[6]
Aklilu, A., Woldemariam, M., Manilal, A., Koira, G., Alahmadi, R.M., Raman, G., et al. (2024) Aerobic Vaginitis, Bacterial Vaginosis, and Vaginal Candidiasis among Women of Reproductive Age in Arba Minch, Southern Ethiopia. Scientific Reports, 14, Article No. 9813. https://doi.org/10.1038/s41598-024-58654-y
[7]
Okalla, C., Elkye, Y., Mbango, E., Nda, M., Etoga, E. and Mengue, A.D. (2018) Bacterial and Fungal Uropathogens in Diabetic Patients and Their Susceptibility Patterns: Case Study of Two Hospitals in Douala. Asian Journal of Microbiology and Biotechnology, 3, 79-89.
[8]
Ngaba, G.P. and Essomba, N. (2014) Profil des germes impliqués dans les infections cervi-co-vaginales chez la femme en âge de procréer à l’hôpital de district de bonas-sama [Profile of Germs Involved in Cervicovaginal Infections in Women of Childbearing Age in the Bonassama]. Revue de Médecine et de Pharmacie, 4, 400-408.
[9]
Nsagha, D.S., Zofou, D., Assob, J.C.N., Njunda, A.L., Nchang, C.D., MvoNgum, N., Patrick, W.E. and Marcelin, N.N. (2015) The Epidemiology of Trichomonas vaginalis, Gardnerella Vaginalis and Candida albicans Co-Infections in Women Attending the Yaounde University Teaching Hospital. American Journal of Epidemiology and Infectious Disease, 3, 28-31.
[10]
Jensen, J.S. and Unemo, M. (2024) Antimicrobial Treatment and Resistance in Sexually Transmitted Bacterial Infections. Nature Reviews Microbiology, 22, 435-450. https://doi.org/10.1038/s41579-024-01023-3
[11]
Meccatti, V.M., Santos, L.F., de Carvalho, L.S., Souza, C.B., Carvalho, C.A.T., Marcucci, M.C., AbuHasna, A. and de Oliveira, L. (2023) Antifungal Action of Herbal Plants’ Glycolic Extracts against Candida Species. Molecules, 28, Article 2857.
[12]
Tsakni, A., Kyriakopoulou, E., Letsiou, S., Halvatsiotis, P., Rigopoulos, H., Vassilaki, N., et al. (2025) In Vitro Determination of Antimicrobial, Antioxidant and Antiviral Properties of Greek Plant Extracts. Microorganisms, 13, Article 177. https://doi.org/10.3390/microorganisms13010177
[13]
Adico, M.D.W., Bayala, B., Bunay, J., Baron, S., Simpore, J. and Lobaccaro, J.A. (2024) Contribution of Sub-Saharan African Medicinal Plants to Cancer Research: Scientific Basis 2013-2023. Pharmacological Research, 202, Article ID: 107138. https://doi.org/10.1016/j.phrs.2024.107138
[14]
Moiketsi, B.N., Makale, K.P.P., Rantong, G., Rahube, T.O. and Makhzoum, A. (2023) Potential of Selected African Medicinal Plants as Alternative Therapeutics against Multi-Drug-Resistant Bacteria. Biomedicines, 11, Article 2605. https://doi.org/10.3390/biomedicines11102605
[15]
Jiofack, T., Fokunang, C., Guedje, N., Kemeuze, V., Fongnzossie, E., Nkongmeneck, B.A., Mapongmetsem, P.M. and Tsabang, N. (2010) Ethnobotanical Uses of Medicinal Plants of Two Ethnoecological Regions of Cameroon. International Journal of Medical Sciences, 2, 60-79. http://www.academicjournals.org/ijmms
[16]
Christelle, N.R., Didier, D.S., et al. (2017) Ethnobotanical Study of Medical Plant Used in the Treatment of Vaginal Infections in Four Towns in Cameroon. Saudi Journal of Biological Sciences, 2, 366-373.
[17]
Mambe, F.T., Voukeng, I.K., Beng, V.P. and Kuete, V. (2016) Antibacterial Activities of Methanol Extracts from Alchornea cordifolia and Four Other Cameroonian Plants against MDR Phenotypes. Journal of Taibah University Medical Sciences, 11, 121-127. https://doi.org/10.1016/j.jtumed.2015.12.001
[18]
Adelakun, A.O., Awosika, A., Adabanya, U., Omole, A.E., Olopoda, A.I. and Bello, E.T. (2024) Antimicrobial and Synergistic Effects of Syzygium Cumini, Moringa Oleifera, and Tinospora Cordifolia against Different Candida Infections. Cureus, 16, e52857. https://doi.org/10.7759/cureus.52857
[19]
Catalán, A., Pacheco, J.G., Martínez, A. and Mondaca, M.A. (2008) In Vitro and in Vivo Activity of Melaleuca Alternifolia Mixed with Tissue Conditioner on Candida albicans. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 105, 327-332. https://doi.org/10.1016/j.tripleo.2007.08.025
[20]
Donders, G. (2002) Definition of a Type of Abnormal Vaginal Flora That Is Distinct from Bacterial Vaginosis: Aerobic Vaginitis. BJOG: An International Journal of Obstetrics and Gynaecology, 109, 34-43. https://doi.org/10.1016/s1470-0328(02)00432-9
[21]
Datcu, R. (2014) Characterization of the Vaginal Microflora in Health and Disease. Danish Medical Journal, 61, 1-24.
[22]
Barantsevich, N. and Barantsevich, E. (2022) Diagnosis and Treatment of Invasive Candidiasis. Antibiotics, 11, Article 718. https://doi.org/10.3390/antibiotics11060718
[23]
Alexyuk, P.G., Bogoyavlenskiy, A.P., Moldakhanov, Y.S., Akanova, K.S., Manakbayeva, A.N., Kerimov, T., et al. (2025) Genomic and Drug Resistance Profile of Bovine Multidrug-Resistant Escherichia coli Isolated in Kazakhstan. Pathogens, 14, Article 90. https://doi.org/10.3390/pathogens14010090
[24]
(2017) CLSI Method for Antifungal Disk Diffusion Susceptibility Testing of Yeasts, Approved Guideline. CLSI Document M44-A. https://clsi.org/shop/standards/m27/
[25]
Liu, Y., Wang, R., Zhao, L., Huo, S., Liu, S., Zhang, H., et al. (2022) The Antifungal Activity of Cinnamon-Litsea Combined Essential Oil against Dominant Fungal Strains of Moldy Peanut Kernels. Foods, 11, Article 1586. https://doi.org/10.3390/foods11111586
[26]
Zainol, S.N., Mohd Said, S., Abidin, Z.Z., Azizan, N., Majid, F.A.A. and Jantan, I. (2017) Synergistic Benefit of Eugenia Caryophyllata L. and Cinnamomum zeylanicum Blume Essential Oils against Oral Pathogenic Bacteria. Chemical Engineering Transactions, 56, 1429-1434.
[27]
Koueke, P. (1996) La Gardnerellose Bactérienne Chez L’Homme Et Chez La Femme: Traitement Par L’Association Amoxicilline-Metronidazole (Ospamox®-Supplin®)-Étude Préliminaire. Médecine d’Afrique Noire, 43, 384-387. https://www.santetropicale.com/Resume/64309.pdf
[28]
Anane, S., Kaouech, E., Zouari, B., Belhadj, S., Kallel, K. and Chaker, E. (2010) Les candidoses vulvovaginales: Facteurs de risque et particularités cliniques et mycologiques. Journal de Mycologie Médicale, 20, 36-41. https://doi.org/10.1016/j.mycmed.2010.01.001
[29]
Tibaldi, C., Cappello, N., Latino, M.A., Masuelli, G., Marini, S. and Benedetto, C. (2009) Vaginal and Endocervical Microorganisms in Symptomatic and Asymptomatic Non-Pregnant Females: Risk Factors and Rates of Occurrence. Clinical Microbiology and Infection, 15, 670-679. https://doi.org/10.1111/j.1469-0691.2009.02842.x
[30]
Huang, Y., Merkatz, R.B., Hillier, S.L., Roberts, K., Blithe, D.L., Sitruk-Ware, R., et al. (2015) Effects of a One Year Reusable Contraceptive Vaginal Ring on Vaginal Microflora and the Risk of Vaginal Infection: An Open-Label Prospective Evaluation. PLOS ONE, 10, e0134460. https://doi.org/10.1371/journal.pone.0134460
[31]
Sylla, K., Sow, D., Lakhe, N., Tine, C., Dia, M, Lelo, S., Ahamada, M., Faye, B. and Dieng, T.D.Y. (2017) Candidoses Vulvo-Vaginales Au Laboratoire de Parasitologie-Mycologie Du Centre Hospitalier Universitaire de Fann, Dakar (Sénégal). REVUE CAMES SANTE, 5, 21-27. http://publication.lecames.org/index.php/sante/article/viewFile/1253/753
[32]
Kpongbo, E.A., Vincent, D., Valérie, A.I., Henriette, A.V., Kondo, F.K., Abibatou, K., et al. (2018) Susceptibility of Candida Species Isolated from Recurrent Vulvovaginal Candidiasis to Antifungal Agents among Women at Institut Pasteur of Cate Divoire. Journal of Yeast and Fungal Research, 9, 21-26. https://doi.org/10.5897/jyfr2018.0185
[33]
Badiee, P., Alborzi, A. and Joukar, M. (2011) Molecular Assay to Detect Nosocomial Fungal Infections in Intensive Care Units. European Journal of Internal Medicine, 22, 611-615. https://doi.org/10.1016/j.ejim.2011.08.025
[34]
Kamga, G., et al. (2014) Sensibilité Aux Antifongiques Des Candida Spp Isolés Dans Les Candidoses Digestives Chez Les Sujets Séropositifs Aux VIH à Yaoundé-Caméroun. Health Sciences and Disease, 1, 1-6. https://pesquisa.bvsalud.org/portal/resource/pt/afr-197895
[35]
Fournier, P., Schwebel, C., Maubon, D., Vesin, A., Lebeau, B., Foroni, L., et al. (2011) Antifungal Use Influences Candida Species Distribution and Susceptibility in the Intensive Care Unit. Journal of Antimicrobial Chemotherapy, 66, 2880-2886. https://doi.org/10.1093/jac/dkr394
Tlhapi, D., Malebo, N., Manduna, I.T., Lautenschläger, T. and Mawunu, M. (2024) A Review of Medicinal Plants Used in the Management of Microbial Infections in Angola. Plants, 13, Article 2991. https://doi.org/10.3390/plants13212991
[38]
Sima Obiang, C., Ndong Mba, T., Ondo, J.P., Ngoua Meye Misso, R.L., Orango Bourdette, J.O., Otogo N’Nang, E., et al. (2023) Toxicity, Antibacterial, and Phytochemical Analyses of Antrocaryon klaineanum Pierre Extracts. Advances in Pharmacological and Pharmaceutical Sciences, 2023, Article ID: 9304681. https://doi.org/10.1155/2023/9304681
[39]
Aldulaimi, O., Drijfhout, F., Uche, F.I., Horrocks, P. and Li, W. (2019) Discovery, Synthesis and Antibacterial Evaluation of Phenolic Compounds from Cylicodiscus gabunensis. BMC Complementary and Alternative Medicine, 19, Article No. 183. https://doi.org/10.1186/s12906-019-2589-2
[40]
Domfeh, S.A., Kyeremeh, G. and Belifini, M. (2023) Evaluation of Anti-Candida albicans Activities of Herbal Preparations Sold at the Kumasi Central Market in the Ashanti Region of Ghana. Evidence-Based Complementary and Alternative Medicine, 2023, Article ID: 6162532. https://doi.org/10.1155/2023/6162532
[41]
Agyare, C. (2014) Wound Healing and Anti-Infective Properties of Myrianthus arboreus and Alchornea cordifolia. Medicinal Chemistry, 4, 533-539. https://doi.org/10.4172/2161-0444.1000191
[42]
Amang à Ngnoung, G., Sidjui, L., Leutcha, P., Nganso Ditchou, Y., Tchokouaha, L., Herbette, G., et al. (2023) Antileishmanial and Antiplasmodial Activities of Secondary Metabolites from the Root of Antrocaryon klaineanum Pierre (Anacardiaceae). Molecules, 28, Article 2730. https://doi.org/10.3390/molecules28062730
[43]
Banso, A., Dachi, S., Usman, J.I., Ajewole, A.E. and Etsu-Musa, N. (2024) Assessment of Bioactive Phytochemical and Free Radical Scavenging Analysis of Leaf Extract of Alchornea cordifolia (Schumach & Thonn) Mull. Arg. The Pharma Innovation, 13, 20-25. https://doi.org/10.22271/tpi.2024.v13.i4a.25593
[44]
Sinan, K.I., Ak, G., Etienne, O.K., Jekő, J., Cziáky, Z., Gupcsó, K., et al. (2021) Deeper Insights on Alchornea cordifolia (Schumach. & Thonn.) Müll.Arg Extracts: Chemical Profiles, Biological Abilities, Network Analysis and Molecular Docking. Biomolecules, 11, Article 219. https://doi.org/10.3390/biom11020219
[45]
Fongang, A.L.M., Laure Nguemfo, E., Djouatsa Nangue, Y., Bogning Zangueu, C., Fouokeng, Y., Azebaze, A.G.B., et al. (2017) Antinociceptive and Anti-Inflammatory Effects of the Methanolic Stem Bark Extract of Antrocaryon klaineanum Pierre (Anacardiaceae) in Mice and Rat. Journal of Ethnopharmacology, 203, 11-19. https://doi.org/10.1016/j.jep.2017.03.036
[46]
Victor, D.M., Priscille, E., Steve, V., Bedine, A., Fabiola, D., Moise, N., et al. (2024) In vitro and in situ Activity of Cymbopogon citratus Essential Oil Against Alternaria alternata and Phomopsis carica-papayae, Causal Agents of Papaya Leaf Diseases. Journal of Plant Sciences, 12, 55-63. https://doi.org/10.11648/j.jps.20241202.11
[47]
Hlebova, M., Veseleniyova, D., Sramkova, Z., Vojcikova, V., Kovacik, A., Cubon, J., et al. (2023) The in Vitro Antifungal and Synergistic Activity of Selected Plant Extracts and Essential Oils against Candida spp. Journal of Microbiology, Biotechnology and Food Sciences, 12, e10167. https://doi.org/10.55251/jmbfs.10167
[48]
Ghandour, A., El-Badawy, O., Abdel-Rahim, M., Sayed, H. and Bayoumi, S. (2021) Evaluation of Antimicrobial and Synergistic Effects of Some Medicinal Plant Extracts on Antimicrobial Resistant Organisms. Microbes and Infectious Diseases, 2, 807-818. https://doi.org/10.21608/mid.2021.91702.1184
[49]
Achukwu, N.O., Enweani-Nwokelo, I.B. and Achukwu, P.U. (2024) Synergistic Invitro Antimicrobial Activity of Polyherbal Combination of Morinda lucida Fruit and Pterocarpus santalinoides Seed against Multi-Drug Resistant Clinical Bacterial Isolates. African Journal of Clinical and Experimental Microbiology, 25, 446-455. https://doi.org/10.4314/ajcem.v25i4.9
[50]
Silva, F., Ferreira, S., Duarte, A., Mendonça, D.I. and Domingues, F.C. (2011) Antifungal Activity of Coriandrum sativum Essential Oil, Its Mode of Action against Candida Species and Potential Synergism with Amphotericin B. Phytomedicine, 19, 42-47. https://doi.org/10.1016/j.phymed.2011.06.033
