Fungal biofilm: a relentless barrier to the cure of vulvovaginal candidiasis in post-radiotherapy cervical cancer patients

Abstract

Persistent candidiasis is a challenge for gynecological clinics, especially when associated with non-albicans Candida, as it is resistant to routine treatments. The formation of fungal biofilms recently described for those microorganisms greatly prevents the action of antimicrobials, accentuating the maintenance of a resistant microenvironment. The radiation effect decreases local defense mechanisms in patients treated for cervical cancer with radiotherapy, which enhances the pathogenicity and infection persistence. Persistent forms of blastoconidia suggestive of non-albicans forms should be reported on the Pap test. Even though the method presents low sensitivity and specificity for confirming microorganisms, the persistent condition can be referred, as it was related in our case, warning clinicians to apply vigorous therapy, especially in hospital environments and cancer centers, preventing the formation of fungal biofilms.