Epidemiological, etiological, and antifungal resistance patterns of vulvovaginal Candida spp. infections in Cameroon: a systematic review and meta-analysis

Vulvovaginal candidiasis is a common fungal infection, mainly due to Candida species, affecting two-thirds of women globally at least once in their lifetime. Here, we conducted a systematic review and meta-analysis (PROSPERO ID: CRD420261368975) of the epidemiology, aetiology, and drug resistance profiles of vulvovaginal Candida infections and VVC in Cameroon. Databases were queried to identify all eligible papers. Data were extracted, and the quality bias of studies was assessed. Random effect models were used to estimate pooled proportions of primary outcomes. Thirty-four studies were included. The pooled proportions of vulvovaginal Candida infections and VVC were 33.3% (95% CI 25.5 – 41.6%, p < 0.0001) and 31.6% (95% CI 26.9 – 36.4%, p < 0.0001), respectively. Candida albicans (23.3%, 95%CI 17.9 – 29.1%, p < 0.0001) was the most frequently isolated causative species, followed by Nakaseomyces glabratus (formerly C. glabrata) (2.3%, 95%CI 0.9 – 4.2%, p < 0.0001) and Pichia kudriavzevii (formerly C. krusei) (1.3%, 95%CI 0.5 – 2.5%, p < 0.0001). Pregnancy status, diagnostic methods, and human immunodeficiency virus infection influenced the proportions of these species. Two primary azoles were least effective against C. albicans, with the following resistance levels: fluconazole (51.1%, 95% CI 21.2 – 80.7%, p < 0.0001) and itraconazole (50.5%, 95% CI 41.3 – 100%, p < 0.0001). Evidence of drug profiles for non-albicans species is limited. The findings highlight the substantial burden of VVC, the predominance of C. albicans, and high azole resistance in Cameroon. They underscore the need for standardised diagnostic approaches, broader epidemiological surveillance, and evidence-based preventive strategies.