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Background  Vulvovaginal candidiasis (VVC), the second leading cause of genital infection in women of reproductive age, is caused by yeasts of the genus  Candida.  Treatment is usually empirical and performed with azoles, which have shown increasing ineffectiveness due to resistance from these species. This therapeutic challenge has led to the search for new treatment strategies.  Lactobacillus  spp. produce several components with microbicidal effects, such as lactic acid. These species are the main components of a healthy vaginal microbiota and have been used as probiotics. The aim of this work was to investigate the in vitro inhibitory effects of  Lactobacillus casei  Shirota on both the  Candida  spp. that cause VVC and on  C. auris .    Methods  The microbicidal effects of  L. casei  Shirota on the main VVC-causing species,  C. albicans ,  C. tropicalis ,  C. norvegensis  and  C. parapsilosis,  in addition to  C. auris  were investigated by counting the Colony-forming Units (CFUs) after cocultivation. The antifungal activity of lactic acid against these  Candida  strains was assessed using the microtiter broth dilution method to determine the minimum inhibitory concentrations (MICs). The effects of  L. casei  Shirota on hyphal and early biofilm formation was measured by optical microscopy.    Results   L. casei  Shirota showed inhibitory action against all tested  Candida  spp., ranging from 66.9 to 95.6% inhibition depending on the species. This inhibition is possibly related to the production of lactic acid, since lactic acid has shown microbicidal action against these same  Candida  spp. at a concentration of 5 mg/mL, which corresponds to half of the normal physiological concentration. In addition,  L. casei  Shirota was able to reduce the formation of  C. albicans  hyphae and early biofilms, showing strong anti- Candida  effects.    Conclusions  These results suggest that  L. casei  Shirota has antifungal activity against the  Candida  species that cause VVC.  L. casei  also has microbicidal action against  C. auris .

bmc complementary medicine and therapies

Inhibitory effects of Lactobacillus casei Shirota against both Candida auris and Candida spp. isolates that cause vulvovaginal candidiasis and are resistant to antifungals