An abortion that occurs spontaneously is known as a miscarriage. Various effectors associated with abortion such as Genetic and uterine anomalies, Endocrinopathy, immunological dysfunctions, infectious agents, environmental contaminants, psychogenetic elements, and endometriosis. Maternal infections considered the main reason for pregnancy wastage in females with Bad Obstetric History (BOH). Candida albicans is a dimorphic fungus that can grow as yeast or filamentous cells and considered one of the limited species of the Candida genus that cause humans candidiasis. It is an opportunistic fungus that responsible for mucosal infections in the mouth and genital tract. Excessive growth of C. albicans will follow with Vulvovaginal candidiasis (VVC). The incidence of VVC combined with chronic recurrent candidiasis is high in pregnancies than in healthy women. Several scientific researches showed the significance of VVC as an inducer of abortion, candida chorioamnionitis, subsequent preterm delivery, and immunosuppression.
- Candida albicans
- Opportunistic fungi
- Spontaneous abortion
Mycoses considered as most ancient infections, established by Hippocrates and Galen. The fungal infection may be acute, chronic, superficial, or deep . Every year, invasive candidiasis infects about 250,000 persons around the world, which leads to more than 50,000 deaths . In the 19th century, mycoses fixed as infections of newborns and the genital tract in gestation and how affected by each other. The vaginal infections that resulted from yeast-like fungi of the
Termination of the gestation by removing fetus or embryo prior to gaining the ability to survive outside the uterus is called abortion. Nevertheless, if this process happens after the fetus acquires this ability, then it is termed a “late termination of pregnancy“. If the abortion occurs spontaneously, it is termed a miscarriage. In addition, it is titled an induced abortion or “induced miscarriage” if it resulted purposely .
Induced abortion does not raise the risk of mental or physical complications if it ensues under legal and secure conditions . Every year nearly 56 million abortion cases happen worldwide , half of these cases ended unsafely . Unsafe abortion is considered one of the main challenges of public health in Africa and Middle East areas. In 2003, 1.5 million abortions occur in these regions in unhygienic and unexperienced conditions according to World Health Organization (WHO). From those abortions, 11% of the cases were ended with maternal death. Increasing family planning and birth control make the rate of abortion decline and that what happened in the last two decades globally .
In general, the causes of miscarriage are different. Several factors that can form a high degree of risk on pregnancy have been recognized. Health and medical causes have a high rate of incidence in recurrent than in spontaneous miscarriages. Cytogenetic abnormalities are probable reasons for miscarriage particularly earlier to the 9th week of gestation. Autosomal trisomies are the most common chromosomal abnormalities then 45X and triploidy. Gene inactivation in the 4 to 8 cell stages karyotype supposed to be responsible for the non-recognized cases of abortion at an earlier period of gestation.
Miscarriage also occurs by anomalies in the uterus configuration such as the bicornuate and septate uterus, which consider as congenital defects. In addition, submucosal or intramural myomata may lead to early miscarriage . Occasionally, women with spontaneous miscarriage may have endocrine and autoimmune irregularities. The danger of miscarriage will increase in pregnancies who suffered from Hypothyroidism and Polycystic Ovarian Syndrome (PCO). In addition, those with low control on their blood glucose level especially in insulin-dependent diabetes mellitus . The incidence of miscarriage will upsurge with the progression of maternal age. The rate of recurrence increased from 12% before 25 years to 18% after 39 years. At higher ages, anembryonic pregnancies are frequently prevalent. Menarche and menopause are the main factors that influenced maternal age. Social, economic and, cultural situations also affect the preferred family size and period between gestations .
Besides smoking, exposure to environmental tobacco smoke (also called passive smoking) holds the same possibility of abortion’s occurrence . Consumption of alcohol, caffeine also described as a weak and debatable risk factor of pregnancy loss . Employments with high levels of stress are associated with spontaneous abortion . Miscarriage also resulted from genital infections.
A dimorphic fungus that can grow as yeast or filamentous cells and considered one of the limited species of the
2.1.1 Fungal genome
The genome of
The heterozygosity of the Candidal genome surpasses that persist in other genomes is common among clinical isolates. Two proteins ensued via single-base polymorphisms vary in one or more amino acids will provide the functional variances of each protein. Therefore, this condition significantly raises the number of diverse proteins encoded by the candidal genome .
2.1.3 Biology of
Candidal colonies seem large, round, white, or cream that emanates a yeasty odor on agar plates at room temperature when grown
Many regions of the human body like skin and mucosal surfaces are inhabited by numerous candidal species, this colonization carried a commensal nature with the host. The immune condition of the individual plays an effect on the severity of the Candida infections, so, any disturbance in immunity increase the percentage of the host’s illness make the host more susceptible to infection with candidiasis. In immunocompromised patients, Candidal infections create main fungal infections . Generally, oropharyngeal candidiasis is the primary illness presented in those patients, because of that malnutrition developed leading to restriction of the action of the treatment . These invasive infections have many challenges against public health lead to cumulative health and economic significances because of the great mortality proportions and amplified expenditure of medical care .
Skin, mouth, throat, genitals, and blood are the main body regions that are usually infected with candidiasis. Generally,
2.1.5 Host predisposing factors
Besides the commensalism interaction between Candida species and humans and the fundamental existence of it in healthy persons, recent two decades showed an unusual overgrowth in respiratory, gastrointestinal, and urinary tracts in comparison with earlier periods. Shortly after childbirth, species colonize the mucosa of the upper respiratory passages and gastrointestinal tract. Habitually,
Candida albicansand pregnancy
During pregnancy, females exposed to many physiological changes. Gestation is a complicated condition in fetal development that requires various essential substances such as glucose, fatty acids, amino acids, minerals, and vitamins. These nutrients must continuously apply to improve the process of fetal growth and to protect the health condition of pregnant women. Many pathogens that responsible for several sexual and non-sexual transmitted infections invade the women’s bodies through the female genital tract (FGT), leading to vaginal infections. The common clinical symptom for female genital tract infection is vaginal discharge, which considers as the second main gynecological problem after menstrual disorders . Vulvovaginal candidiasis (VVC) (also called candidal vaginitis or moniliasis) initiated by an overgrowth of candida yeast species mainly
Colonization of the vagina by Candida species may be enhanced by numerous factors such as pregnancy, weak immunity, obesity, diabetes, prolonged use of corticosteroids, HIV, malnutrition, consumption of high level of estrogens, Intrauterine Contraceptive Device (IUCDs), tight clothing, poor personal hygiene, intrauterine devices and diet with high carbohydrates contents. VVC is a significant infection that may lead to abortion, candida chorioamnionitis, subsequent preterm delivery, and suppression of the immune system. Even with the isolation of Other candida
I would like to express my sincere thanks to all researchers and scientists for their support and guidance to accomplish this work.