In vitro photodynamic therapy of Candida albicans, the cause of vulvovaginal candidiasis, is enhanced by Bacillus and Enterococcus probiotics.

BACKGROUND

Candida albicans is the primary cause of vulvovaginal candidiasis, a worldwide health concern for women. The use of supplemental methods, such as antimicrobial photodynamic therapy (aPDT) and probiotics, was promoted by the ineffectiveness of the existing antifungal drugs.

METHODS

This study examines the combined effects of probiotics (Bacillus and Enterococcus isolated from the fermented pickles) and PDT (using red laser (655 nm, 18 J/cm2) as a light source and methylene blue dye (30 mg/mL) as a photosensitizer) on the in vitro virulence activity of C. albicans including growth, biofilm formation, antifungal resistance, biofilm elimination, and biofilm dispersion.

RESULTS

The probiotic strains demonstrated a higher resistance to PDT compared to the fungal cell. Bacillus and Enterococcus enhanced the antifungal effects of PDT on planktonic Candida cells in both pre-PDT and post-PDT interactions. The inhibition of biofilm formation by PDT was improved upon interaction with Bacillus (70 %) and Enterococcus (58 %). The eradication of Candida biofilm using PDT was increased after a combination with Bacillus (67 %) and Enterococcus (46 %). The nystatin resistance of the fungal biofilm following PDT treatment was decreased from (µg/ml) 25 to 6.25 due to the interaction with both probiotic strains. Fungal cell dispersion from the biofilm after PDT treatment diminished by 18 % and 25 % in the presence of Bacillus and Enterococcus strains. Galleria mellonella mortality was significantly changed following the PDT of the fungi/probiotic-injected larvae.

CONCLUSIONS

This synergistic activity suggests the use of probiotics/PDT as a supplemental treatment for vulvovaginal candidiasis.