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Background  Study of  in vivo  antifungal activity of the hydroalcoholic extract (HE) and n-BuOH extract (BUTE) of  Sapindus saponaria  against azole-susceptible and -resistant human vaginal  Candida  spp.    Methods  The  in vitro  antifungal activity of HE, BUTE, fluconazole (FLU), and itraconazole (ITRA) was determined by the broth microdilution method. We obtained values of minimal inhibitory concentration (MIC) and minimum fungicide concentration (MFC) for 46 strains of  C. albicans  and 10 of  C. glabrata  isolated from patients with vulvovaginal candidiasis (VVC). VVC was induced in hyperestrogenic Wistar rats with azole-susceptible  C. albicans  (SCA), azole-resistant  C. albicans  (RCA), and azole-resistant  C. glabrata  (RCG). The rats were treated intravaginally with 0.1 mL of HE or BUTE at concentrations of 1%, 2.5% and 5%; 100 μg/mL of FLU (treatment positive control); or distilled water (negative control) at 1, 24, and 48 h after induction of the infection, and the progress of VVC was monitored by culturing and scanning electron microscopy (SEM). The toxicity was evaluated in cervical cells of the HeLa cell line.    Results  The extracts showed  in vitro  inhibitory and fungicidal activity against all the isolates, and the MIC and MFC values for the  C. glabrata  isolates were slightly higher.  In vivo , the SCA, RCA, and RCG infections were eliminated by 21 days post-infection, with up to 5% HE and BUTE, comparable to the activity of FLU. No cytotoxic action was observed for either extract.    Conclusions  Our results demonstrated that HE and BUTE from  S. saponaria  show inhibitory and fungicidal activity  in vitro , in addition to  in vivo  activity against azole-resistant vaginal isolates of  C. glabrata  and azole-susceptible and resistant isolates of  C. albicans . Also considering the lack of cytotoxicity and the low concentrations of the extracts necessary to eliminate the infection  in vivo , HE and BUTE show promise for continued studies with purified antifungal substances in VVC yeast isolates.

In vivo activity of Sapindus saponaria against azole-susceptible and -resistant human vaginal Candida species