Abstract
Candida is a common and harmless component of the vaginal microbiota, present in approximately 50% of women of reproductive age. In specific conditions like pregnancy, Candida may cause chronic or recurrent infections which significantly impair quality of life. Additionally, due to the possibility of vertical transmission, it may lead to life-threatening infections in newborns. Timely screening, suspicion and identification of the causative agent are critical determinants of patient outcomes. Candida albicans (CA) remains the most prevalent species, but other non-albicans Candida (NAC) species and other non-Candida yeast (NCY) also play an important role in vulvovaginal infections. Due to the lack of precise local epidemiological data, this study aimed to determine the 10-year prevalence of CA, NAC and NCY species (spp.) in symptomatic pregnant women in Serbia using identification Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) for species identification. The total of 2,142 cases were examined (2013-2023) and the laboratory positivity was 48.3% (n = 1,035). The prevalence of CA, NAC and NCY were 74%, 23% and 3%, respectively. Biochemical and proteomic identification methods showed 100% concordance for CA, C. krusei (Pichia kudriavzevii), C. kefyr (Kluyveromyces marxianus), C. lusitaniae (Clavispora lusitaniae), and C. zeylanoides (Pichia norvengensis). Biochemical misidentification was observed for C. tropicalis (Lodderomyces sp.), C. glabrata (Nakaseomyces glabrata), and Saccharomyces cerevisiae. A global trend highlights the importance of renamed and reclassified yeast species in vaginal infections, supporting the reconsideration of the current disease name VVC in favor of the term vulvovaginal yeast infection (VYI). The prevalence of emerging NAC and NCY species is increasing but remains underestimated. There is a need for new laboratory diagnostic guidelines to enable timely and accurate identification, as this is crucial for guiding appropriate treatment and improving outcomes.