Search tips
Search criteria 


Logo of cmrPermissionsJournals.ASM.orgJournalCMR ArticleJournal InfoAuthorsReviewers
Clin Microbiol Rev. 1996 July; 9(3): 335–348.
PMCID: PMC172897

Immunopathogenesis of recurrent vulvovaginal candidiasis.


Recurrent vulvovaginal candidiasis (RVVC) is a prevalent opportunistic mucosal infection, caused predominantly by Candida albicans, which affects a significant number of otherwise healthy women of childbearing age. Since there are no known exogenous predisposing factors to explain the incidence of symptomatic vaginitis in most women with idiopathic RVVC, it has been postulated that these particular women suffer from an immunological abnormality that prediposes them to RVVC. Because of the increased incidence of mucosal candidiasis in individuals with depressed cell-mediated immunity (CMI), defects in CMI are viewed as a possible explanation for RVVC. In this review, we attempt to place into perspective the accumulated information regarding the immunopathogenesis of RVVC, as well as to provide new immunological perspectives and hypotheses regarding potential immunological deficiencies that may predispose to RVVC and potentially other mucosal infections by the same organism. The results of both clinical studies and studies in an animal model of experimental vaginitis suggest that systemic CMI may not be the predominant host defense mechanism against C. albicans vaginal infections. Rather, locally acquired mucosal immunity, distinct from that in the peripheral circulation, is now under consideration as an important host defense at the vaginal mucosa, as well as the notion that changes in local CMI mechanism(s) may predispose to RVVC.

Full Text

The Full Text of this article is available as a PDF (353K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Balish E, Filutowicz H, Oberley TD. Correlates of cell-mediated immunity in Candida albicans-colonized gnotobiotic mice. Infect Immun. 1990 Jan;58(1):107–113. [PMC free article] [PubMed]
  • Brenner MB, Strominger JL, Krangel MS. The gamma delta T cell receptor. Adv Immunol. 1988;43:133–192. [PubMed]
  • Cain TK, Rank RG. Local Th1-like responses are induced by intravaginal infection of mice with the mouse pneumonitis biovar of Chlamydia trachomatis. Infect Immun. 1995 May;63(5):1784–1789. [PMC free article] [PubMed]
  • Cantorna MT, Balish E. Mucosal and systemic candidiasis in congenitally immunodeficient mice. Infect Immun. 1990 Apr;58(4):1093–1100. [PMC free article] [PubMed]
  • Cantorna M, Mook D, Balish E. Resistance of congenitally immunodeficient gnotobiotic mice to vaginal candidiasis. Infect Immun. 1990 Nov;58(11):3813–3815. [PMC free article] [PubMed]
  • Carlsten H, Holmdahl R, Tarkowski A. Analysis of the genetic encoding of oestradiol suppression of delayed-type hypersensitivity in (NZB x NZW) F1 mice. Immunology. 1991 Jun;73(2):186–190. [PubMed]
  • Cassone A, De Bernardis F, Mondello F, Ceddia T, Agatensi L. Evidence for a correlation between proteinase secretion and vulvovaginal candidosis. J Infect Dis. 1987 Nov;156(5):777–783. [PubMed]
  • Clerici M, Shearer GM. A TH1-->TH2 switch is a critical step in the etiology of HIV infection. Immunol Today. 1993 Mar;14(3):107–111. [PubMed]
  • Clift RA. Candidiasis in the transplant patient. Am J Med. 1984 Oct 30;77(4D):34–38. [PubMed]
  • Dabrowa N, Howard DH. Heat shock and heat stroke proteins observed during germination of the blastoconidia of Candida albicans. Infect Immun. 1984 May;44(2):537–539. [PMC free article] [PubMed]
  • Daynes RA, Araneo BA. Contrasting effects of glucocorticoids on the capacity of T cells to produce the growth factors interleukin 2 and interleukin 4. Eur J Immunol. 1989 Dec;19(12):2319–2325. [PubMed]
  • Daynes RA, Dudley DJ, Araneo BA. Regulation of murine lymphokine production in vivo. II. Dehydroepiandrosterone is a natural enhancer of interleukin 2 synthesis by helper T cells. Eur J Immunol. 1990 Apr;20(4):793–802. [PubMed]
  • De Bernardis F, Agatensi L, Ross IK, Emerson GW, Lorenzini R, Sullivan PA, Cassone A. Evidence for a role for secreted aspartate proteinase of Candida albicans in vulvovaginal candidiasis. J Infect Dis. 1990 Jun;161(6):1276–1283. [PubMed]
  • De Bernardis F, Cassone A, Sturtevant J, Calderone R. Expression of Candida albicans SAP1 and SAP2 in experimental vaginitis. Infect Immun. 1995 May;63(5):1887–1892. [PMC free article] [PubMed]
  • De Bernardis F, Molinari A, Boccanera M, Stringaro A, Robert R, Senet JM, Arancia G, Cassone A. Modulation of cell surface-associated mannoprotein antigen expression in experimental candidal vaginitis. Infect Immun. 1994 Feb;62(2):509–519. [PMC free article] [PubMed]
  • Ehrensaft DV, Epstein RB, Sarpel S, Andersen BR. Disseminated candidiasis in leukopenic dogs. Proc Soc Exp Biol Med. 1979 Jan;160(1):6–10. [PubMed]
  • Elin RJ, Edelin JB, Wolff SM. Infection and immunoglobulin concentrations in Chediak-Higashi mice. Infect Immun. 1974 Jul;10(1):88–91. [PMC free article] [PubMed]
  • Ferrante A, Thong YH. Requirement of heat-labile opsonins for maximal phagocytosis of Candida albicans. Sabouraudia. 1979 Sep;17(3):293–297. [PubMed]
  • Fidel PL, Jr, Lynch ME, Conaway DH, Tait L, Sobel JD. Mice immunized by primary vaginal Candida albicans infection develop acquired vaginal mucosal immunity. Infect Immun. 1995 Feb;63(2):547–553. [PMC free article] [PubMed]
  • Fidel PL, Jr, Lynch ME, Redondo-Lopez V, Sobel JD, Robinson R. Systemic cell-mediated immune reactivity in women with recurrent vulvovaginal candidiasis. J Infect Dis. 1993 Dec;168(6):1458–1465. [PubMed]
  • Fidel PL, Jr, Lynch ME, Sobel JD. Candida-specific Th1-type responsiveness in mice with experimental vaginal candidiasis. Infect Immun. 1993 Oct;61(10):4202–4207. [PMC free article] [PubMed]
  • Fidel PL, Jr, Lynch ME, Sobel JD. Candida-specific cell-mediated immunity is demonstrable in mice with experimental vaginal candidiasis. Infect Immun. 1993 May;61(5):1990–1995. [PMC free article] [PubMed]
  • Fidel PL, Jr, Lynch ME, Sobel JD. Effects of preinduced Candida-specific systemic cell-mediated immunity on experimental vaginal candidiasis. Infect Immun. 1994 Mar;62(3):1032–1038. [PMC free article] [PubMed]
  • Fidel PL, Jr, Lynch ME, Sobel JD. Circulating CD4 and CD8 T cells have little impact on host defense against experimental vaginal candidiasis. Infect Immun. 1995 Jul;63(7):2403–2408. [PMC free article] [PubMed]
  • Fiorentino DF, Zlotnik A, Vieira P, Mosmann TR, Howard M, Moore KW, O'Garra A. IL-10 acts on the antigen-presenting cell to inhibit cytokine production by Th1 cells. J Immunol. 1991 May 15;146(10):3444–3451. [PubMed]
  • Fischer A, Ballet JJ, Griscelli C. Specific inhibition of in vitro Candida-induced lymphocyte proliferation by polysaccharidic antigens present in the serum of patients with chronic mucocutaneous candidiasis. J Clin Invest. 1978 Nov;62(5):1005–1013. [PMC free article] [PubMed]
  • Fleury FJ. Adult vaginitis. Clin Obstet Gynecol. 1981 Jun;24(2):407–438. [PubMed]
  • Fong IW, Bannatyne RM, Wong P. Lack of in vitro resistance of Candida albicans to ketoconazole, itraconazole and clotrimazole in women treated for recurrent vaginal candidiasis. Genitourin Med. 1993 Feb;69(1):44–46. [PMC free article] [PubMed]
  • Fong IW, McCleary P, Read S. Cellular immunity of patients with recurrent or refractory vulvovaginal moniliasis. Am J Obstet Gynecol. 1992 Mar;166(3):887–890. [PubMed]
  • Frazier-Jessen MR, Kovacs EJ. Estrogen modulation of JE/monocyte chemoattractant protein-1 mRNA expression in murine macrophages. J Immunol. 1995 Feb 15;154(4):1838–1845. [PubMed]
  • Gajewski TF, Joyce J, Fitch FW. Antiproliferative effect of IFN-gamma in immune regulation. III. Differential selection of TH1 and TH2 murine helper T lymphocyte clones using recombinant IL-2 and recombinant IFN-gamma. J Immunol. 1989 Jul 1;143(1):15–22. [PubMed]
  • Hobbs JR, Brigden D, Davidson F, Kahan M, Oates JK. Immunological aspects of candidal vaginitis. Proc R Soc Med. 1977;70 (Suppl 4):11–14. [PMC free article] [PubMed]
  • Hocini H, Barra A, Bélec L, Iscaki S, Preud'homme JL, Pillot J, Bouvet JP. Systemic and secretory humoral immunity in the normal human vaginal tract. Scand J Immunol. 1995 Aug;42(2):269–274. [PubMed]
  • Holm HW, Marwin RM. Effects of surface active agents on the susceptibility of Swiss mice to Candida albicans. Mycopathol Mycol Appl. 1967 Nov 13;33(2):186–192. [PubMed]
  • Hurley R. Candidal vaginitis. Proc R Soc Med. 1977;70 (Suppl 4):1–2. [PMC free article] [PubMed]
  • Hurley R. Recurrent Candida infection. Clin Obstet Gynaecol. 1981 Apr;8(1):209–214. [PubMed]
  • Hurley R, De Louvois J. Candida vaginitis. Postgrad Med J. 1979 Sep;55(647):645–647. [PMC free article] [PubMed]
  • Igietseme JU, Rank RG. Susceptibility to reinfection after a primary chlamydial genital infection is associated with a decrease of antigen-specific T cells in the genital tract. Infect Immun. 1991 Apr;59(4):1346–1351. [PMC free article] [PubMed]
  • Itohara S, Farr AG, Lafaille JJ, Bonneville M, Takagaki Y, Haas W, Tonegawa S. Homing of a gamma delta thymocyte subset with homogeneous T-cell receptors to mucosal epithelia. Nature. 1990 Feb 22;343(6260):754–757. [PubMed]
  • Kagaya K, Fukazawa Y. Murine defense mechanism against Candida albicans infection. II. Opsonization, phagocytosis, and intracellular killing of C. albicans. Microbiol Immunol. 1981;25(8):807–818. [PubMed]
  • Kalo-Klein A, Witkin SS. Prostaglandin E2 enhances and gamma interferon inhibits germ tube formation in Candida albicans. Infect Immun. 1990 Jan;58(1):260–262. [PMC free article] [PubMed]
  • Kalo-Klein A, Witkin SS. Regulation of the immune response to Candida albicans by monocytes and progesterone. Am J Obstet Gynecol. 1991 May;164(5 Pt 1):1351–1354. [PubMed]
  • Kaufmann SH. Heat shock proteins and the immune response. Immunol Today. 1990 Apr;11(4):129–136. [PubMed]
  • Kent HL. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 2):1168–1176. [PubMed]
  • Kinsman OS, Collard AE. Hormonal factors in vaginal candidiasis in rats. Infect Immun. 1986 Sep;53(3):498–504. [PMC free article] [PubMed]
  • Kirkpatrick CH. Chronic mucocutaneous candidiasis. Eur J Clin Microbiol Infect Dis. 1989 May;8(5):448–456. [PubMed]
  • Kirkpatrick CH, Rich RR, Bennett JE. Chronic mucocutaneous candidiasis: model-building in cellular immunity. Ann Intern Med. 1971 Jun;74(6):955–978. [PubMed]
  • Klein RS, Harris CA, Small CB, Moll B, Lesser M, Friedland GH. Oral candidiasis in high-risk patients as the initial manifestation of the acquired immunodeficiency syndrome. N Engl J Med. 1984 Aug 9;311(6):354–358. [PubMed]
  • Klink M, Rózalska B, Rudnicka W. Osłabienie odpowiedzi komŕkowej na antygeny Listeria u myszy ciezarnych. Med Dosw Mikrobiol. 1993;45(1):51–54. [PubMed]
  • Knight L, Fletcher J. Growth of Candida albicans in saliva: stimulation by glucose associated with antibiotics, corticosteroids, and diabetes mellitus. J Infect Dis. 1971 Apr;123(4):371–377. [PubMed]
  • Liljemark WF, Gibbons RJ. Suppression of Candida albicans by human oral streptococci in gnotobiotic mice. Infect Immun. 1973 Nov;8(5):846–849. [PMC free article] [PubMed]
  • Macher AM. The pathology of AIDS. Public Health Rep. 1988 May-Jun;103(3):246–254. [PMC free article] [PubMed]
  • Maggi E, Mazzetti M, Ravina A, Annunziato F, de Carli M, Piccinni MP, Manetti R, Carbonari M, Pesce AM, del Prete G, et al. Ability of HIV to promote a TH1 to TH0 shift and to replicate preferentially in TH2 and TH0 cells. Science. 1994 Jul 8;265(5169):244–248. [PubMed]
  • Mathur S, Koistinen GV, Horger EO, 3rd, Mahvi TA, Fudenberg HH. Humoral immunity in vaginal candidiasis. Infect Immun. 1977 Jan;15(1):287–294. [PMC free article] [PubMed]
  • Matthews R, Burnie J. The role of hsp90 in fungal infection. Immunol Today. 1992 Sep;13(9):345–348. [PubMed]
  • Matthews RC, Burnie JP, Howat D, Rowland T, Walton F. Autoantibody to heat-shock protein 90 can mediate protection against systemic candidosis. Immunology. 1991 Sep;74(1):20–24. [PubMed]
  • Matthews RC, Burnie JP, Tabaqchali S. Immunoblot analysis of the serological response in systemic candidosis. Lancet. 1984 Dec 22;2(8417-8418):1415–1418. [PubMed]
  • Matthews RC, Burnie JP, Tabaqchali S. Isolation of immunodominant antigens from sera of patients with systemic candidiasis and characterization of serological response to Candida albicans. J Clin Microbiol. 1987 Feb;25(2):230–237. [PMC free article] [PubMed]
  • Mazumder DN, Ghose N, Mitra J, Dutta G, Santra A. Immunological status of women with prolonged oral contraceptives and occurrence of giardiasis. J Indian Med Assoc. 1990 May;88(5):129–131. [PubMed]
  • Morris H, Emms M, Visser T, Timme A. Lymphoid tissue of the normal fallopian tube--a form of mucosal-associated lymphoid tissue (MALT)? Int J Gynecol Pathol. 1986;5(1):11–22. [PubMed]
  • Morton RS, Rashid S. Candidal vaginitis: natural history, predisposing factors and prevention. Proc R Soc Med. 1977;70 (Suppl 4):3–6. [PMC free article] [PubMed]
  • Mosmann TR, Coffman RL. TH1 and TH2 cells: different patterns of lymphokine secretion lead to different functional properties. Annu Rev Immunol. 1989;7:145–173. [PubMed]
  • Nandi D, Allison JP. Phenotypic analysis and gamma delta-T cell receptor repertoire of murine T cells associated with the vaginal epithelium. J Immunol. 1991 Sep 15;147(6):1773–1778. [PubMed]
  • Nohmi T, Abe S, Dobashi K, Tansho S, Yamaguchi H. Suppression of anti-Candida activity of murine neutrophils by progesterone in vitro: a possible mechanism in pregnant women's vulnerability to vaginal candidiasis. Microbiol Immunol. 1995;39(6):405–409. [PubMed]
  • Parr MB, Kepple L, Parr EL. Antigen recognition in the female reproductive tract. II. Endocytosis of horseradish peroxidase by Langerhans cells in murine vaginal epithelium. Biol Reprod. 1991 Aug;45(2):261–265. [PubMed]
  • Parr MB, Kepple L, Parr EL. Langerhans cells phagocytose vaginal epithelial cells undergoing apoptosis during the murine estrous cycle. Biol Reprod. 1991 Aug;45(2):252–260. [PubMed]
  • Parr MB, Parr EL. Antigen recognition in the female reproductive tract: I. Uptake of intraluminal protein tracers in the mouse vagina. J Reprod Immunol. 1990 Apr;17(2):101–114. [PubMed]
  • Parr MB, Parr EL. Langerhans cells and T lymphocyte subsets in the murine vagina and cervix. Biol Reprod. 1991 Mar;44(3):491–498. [PubMed]
  • Paterson PY, Semo R, Blumenschein G, Swelstad J. Mucocutaneous candidiasis, anergy and a plasma inhibitor of cellular immunity: reversal after amphotericin B therapy. Clin Exp Immunol. 1971 Nov;9(5):595–602. [PubMed]
  • Polonelli L, De Bernardis F, Conti S, Boccanera M, Gerloni M, Morace G, Magliani W, Chezzi C, Cassone A. Idiotypic intravaginal vaccination to protect against candidal vaginitis by secretory, yeast killer toxin-like anti-idiotypic antibodies. J Immunol. 1994 Mar 15;152(6):3175–3182. [PubMed]
  • Puccetti P, Romani L, Bistoni F. A TH1-TH2-like switch in candidiasis: new perspectives for therapy. Trends Microbiol. 1995 Jun;3(6):237–240. [PubMed]
  • Regúlez P, García Fernández JF, Moragues MD, Schneider J, Quindós G, Pontón J. Detection of anti-Candida albicans IgE antibodies in vaginal washes from patients with acute vulvovaginal candidiasis. Gynecol Obstet Invest. 1994;37(2):110–114. [PubMed]
  • Rigg D, Miller MM, Metzger WJ. Recurrent allergic vulvovaginitis: treatment with Candida albicans allergen immunotherapy. Am J Obstet Gynecol. 1990 Feb;162(2):332–336. [PubMed]
  • Rogers TJ, Balish E. Immunity to Candida albicans. Microbiol Rev. 1980 Dec;44(4):660–682. [PMC free article] [PubMed]
  • Romani L, Mencacci A, Cenci E, Spaccapelo R, Mosci P, Puccetti P, Bistoni F. CD4+ subset expression in murine candidiasis. Th responses correlate directly with genetically determined susceptibility or vaccine-induced resistance. J Immunol. 1993 Feb 1;150(3):925–931. [PubMed]
  • Romani L, Mocci S, Bietta C, Lanfaloni L, Puccetti P, Bistoni F. Th1 and Th2 cytokine secretion patterns in murine candidiasis: association of Th1 responses with acquired resistance. Infect Immun. 1991 Dec;59(12):4647–4654. [PMC free article] [PubMed]
  • Rosedale N, Browne K. Hyposensitisation in the management of recurring vaginal candidiasis. Ann Allergy. 1979 Oct;43(4):250–253. [PubMed]
  • Ross IK, De Bernardis F, Emerson GW, Cassone A, Sullivan PA. The secreted aspartate proteinase of Candida albicans: physiology of secretion and virulence of a proteinase-deficient mutant. J Gen Microbiol. 1990 Apr;136(4):687–694. [PubMed]
  • Ryley JF, McGregor S. Quantification of vaginal Candida albicans infections in rodents. J Med Vet Mycol. 1986 Dec;24(6):455–460. [PubMed]
  • Schröppel K, Rotman M, Galask R, Mac K, Soll DR. Evolution and replacement of Candida albicans strains during recurrent vaginitis demonstrated by DNA fingerprinting. J Clin Microbiol. 1994 Nov;32(11):2646–2654. [PMC free article] [PubMed]
  • Sobel JD. Pathogenesis and epidemiology of vulvovaginal candidiasis. Ann N Y Acad Sci. 1988;544:547–557. [PubMed]
  • Sobel JD. Vaginal infections in adult women. Med Clin North Am. 1990 Nov;74(6):1573–1602. [PubMed]
  • Sobel JD, Muller G, Buckley HR. Critical role of germ tube formation in the pathogenesis of candidal vaginitis. Infect Immun. 1984 Jun;44(3):576–580. [PMC free article] [PubMed]
  • Sobel JD, Muller G, McCormick JF. Experimental chronic vaginal candidosis in rats. Sabouraudia. 1985 Jun;23(3):199–206. [PubMed]
  • Sobel JD, Myers PG, Kaye D, Levison ME. Adherence of Candida albicans to human vaginal and buccal epithelial cells. J Infect Dis. 1981 Jan;143(1):76–82. [PubMed]
  • Soll DR. High-frequency switching in Candida albicans and its relations to vaginal candidiasis. Am J Obstet Gynecol. 1988 Apr;158(4):997–1001. [PubMed]
  • Soll DR. High-frequency switching in Candida albicans. Clin Microbiol Rev. 1992 Apr;5(2):183–203. [PMC free article] [PubMed]
  • Soll DR, Galask R, Isley S, Rao TV, Stone D, Hicks J, Schmid J, Mac K, Hanna C. Switching of Candida albicans during successive episodes of recurrent vaginitis. J Clin Microbiol. 1989 Apr;27(4):681–690. [PMC free article] [PubMed]
  • Styrt B, Sugarman B. Estrogens and infection. Rev Infect Dis. 1991 Nov-Dec;13(6):1139–1150. [PubMed]
  • Syverson RE, Buckley H, Gibian J, Ryan GM., Jr Cellular and humoral immune status in women with chronic Candida vaginitis. Am J Obstet Gynecol. 1979 Jul 15;134(6):624–627. [PubMed]
  • Thapar MA, Parr EL, Bozzola JJ, Parr MB. Secretory immune responses in the mouse vagina after parenteral or intravaginal immunization with an immunostimulating complex (ISCOM). Vaccine. 1991 Feb;9(2):129–133. [PubMed]
  • Thapar MA, Parr EL, Parr MB. Secretory immune responses in mouse vaginal fluid after pelvic, parenteral or vaginal immunization. Immunology. 1990 May;70(1):121–125. [PubMed]
  • Trumbore DJ, Sobel JD. Recurrent vulvovaginal candidiasis: vaginal epithelial cell susceptibility to Candida albicans adherence. Obstet Gynecol. 1986 Jun;67(6):810–812. [PubMed]
  • Uehling DT, James LJ, Hopkins WJ, Balish E. Immunization against urinary tract infection with a multi-valent vaginal vaccine. J Urol. 1991 Jul;146(1):223–226. [PubMed]
  • Vazquez JA, Sobel JD, Demitriou R, Vaishampayan J, Lynch M, Zervos MJ. Karyotyping of Candida albicans isolates obtained longitudinally in women with recurrent vulvovaginal candidiasis. J Infect Dis. 1994 Dec;170(6):1566–1569. [PubMed]
  • Wira CR, Rossoll RM. Antigen-presenting cells in the female reproductive tract: influence of sex hormones on antigen presentation in the vagina. Immunology. 1995 Apr;84(4):505–508. [PubMed]
  • Witkin SS. Immunologic factors influencing susceptibility to recurrent candidal vaginitis. Clin Obstet Gynecol. 1991 Sep;34(3):662–668. [PubMed]
  • Witkin SS, Hirsch J, Ledger WJ. A macrophage defect in women with recurrent Candida vaginitis and its reversal in vitro by prostaglandin inhibitors. Am J Obstet Gynecol. 1986 Oct;155(4):790–795. [PubMed]
  • Witkin SS, Jeremias J, Ledger WJ. A localized vaginal allergic response in women with recurrent vaginitis. J Allergy Clin Immunol. 1988 Feb;81(2):412–416. [PubMed]
  • Witkin SS, Jeremias J, Ledger WJ. Vaginal eosinophils and IgE antibodies to Candida albicans in women with recurrent vaginitis. J Med Vet Mycol. 1989;27(1):57–58. [PubMed]
  • Witkin SS, Kalo-Klein A, Galland L, Teich M, Ledger WJ. Effect of Candida albicans plus histamine on prostaglandin E2 production by peripheral blood mononuclear cells from healthy women and women with recurrent candidal vaginitis. J Infect Dis. 1991 Aug;164(2):396–399. [PubMed]
  • Witkin SS, Yu IR, Ledger WJ. Inhibition of Candida albicans--induced lymphocyte proliferation by lymphocytes and sera from women with recurrent vaginitis. Am J Obstet Gynecol. 1983 Dec 1;147(7):809–811. [PubMed]
  • Wu HY, Russell MW. Induction of mucosal immunity by intranasal application of a streptococcal surface protein antigen with the cholera toxin B subunit. Infect Immun. 1993 Jan;61(1):314–322. [PMC free article] [PubMed]
  • Yamamura M, Valdimarsson H. Participation of C3 in intracellular killing of Candida albicans. Scand J Immunol. 1977;6(6-7):591–594. [PubMed]

Articles from Clinical Microbiology Reviews are provided here courtesy of American Society for Microbiology (ASM)