复发性外阴阴道念珠菌病的致病菌种鉴定及药敏分析

目的:探究复发性外阴阴道念珠菌病致病菌的菌种分布及耐药情况,指导临床治疗。方法:收集210例念珠菌性外阴阴道炎患者阴道分泌物标本,其中复发性外阴阴道念珠菌病(RVVC)组76例,外阴阴道念珠菌病(VVC)组134例。运用科玛嘉显色培养基法进行菌种鉴定和药物敏感试验。结果:在210例病例中,RVVC组中白色念珠菌54株(71.05%),光滑念珠菌15株(19.74%),热带念珠菌4株(5.26%),克柔念珠菌2株(2.63%),近平滑念珠菌1株(1.32%)。非白色念珠菌中以光滑念珠菌为主,在RVVC组中的比例明显高于VVC组,有显著性差异(P<0.05)。药敏试验显示,RVVC的念珠菌株中仅8株对7种药物全部敏感,23株敏感药物<5种,其中1株仅对制霉菌素敏感;对药物的敏感率为制霉菌素(97.37%)>克霉唑(60.52%)>酮康唑(51.32%)>伊曲康唑(36.84%)>咪康唑(35.53%)>氟康唑(23.68%)>特比奈芬(10.53%)。结论:白色念珠菌仍是RVVC的主要致病菌,非白色念珠菌比例在RVVC组中显著高于VVC组,其中以光滑念珠菌为主。念珠菌对制霉菌素敏感率最高,对唑类药物耐药性有增加趋势。     

复发性外阴阴道念珠菌病的致病菌种鉴定及药敏试验分析

目的 了解STD门诊复发性外阴道念珠菌病(RVVC)和外阴阴道念珠菌病(VVC)的致病菌种分布及对常用抗真菌药物的敏感状况,为临床治疗提供参考.方法 用沙氏琼脂培养基分离纯化菌株,然后用ATB ID 32C酵母菌鉴定系统和ATB Fungus3药敏系统进行菌种鉴定与药物敏感试验.结果 280份标本中检出白色念珠菌201株,占71.79％;非白色念珠菌79株,占28.21％,其中光滑念珠菌42株,占15％.VVC组与RVVC组抗真菌药物比较,VVC组对氟康唑的敏感率高于RVVC组,差异有统计学意义(P＜0.05).结论 STD门诊患者阴道念珠菌病检出菌种仍以白色念珠菌为主,但RVVC组非白色念珠菌比例高于VVC组.非白色念珠菌中光滑念珠菌占比例最高.VVC组氟康唑的敏感率高于RVVC组.     

外阴阴道念珠菌病的病原检测及体外药敏试验

目的了解STD门诊患者外阴阴道念珠菌病的菌种分布及对常用抗真菌药物的敏感状况,为临床治疗提供参考。方法取STD门诊疑似念珠菌感染患者的阴道分泌物标本,用沙氏琼脂培养基分离纯化菌株,然后用ATB ID 32C酵母菌鉴定系统和ATB Fungus3药敏系统进行菌种鉴定与药物敏感试验。结果950份标本中检出306株念珠菌,占32.21%,其中白色念珠菌226株,阳性率为73.86%;光滑念珠菌37株,阳性率为12.09%;热带念珠菌24株,阳性率为7.84%;近平滑念珠菌13株,占4.25%。药敏结果显示：念珠菌对5-氟胞嘧啶（5-FC）;两性霉素B（AMB）,伏立康唑（VRC）耐药率〈6%;近平滑念珠菌对5种抗真菌药物均敏感;白色念珠菌对氟康唑（FCZ）、伊曲康唑（ICZ）耐药率依次：9.29%、11.06%,光滑念珠菌药耐药率依次为37.84%,67.57%,热带念珠菌药耐药率依次为8.33%、12.5%。结论STD门诊患者阴道念珠菌检出率明显高于普通妇科门诊患者,检出菌种仍以白色念珠菌为主,但光滑念珠菌和热带念珠菌生殖道感染有明显上升趋势;念珠菌对两性霉素B、5-氟胞嘧啶敏感性较高,对唑类药物有耐药菌株。因此,念珠菌鉴定和药敏监测是非常必要的,临床医生应根据药敏结果合理使用抗真菌药物。     

复发性外阴阴道假丝酵母菌病菌种分型及药敏

目的对RVVC、VVC患者阴道分泌物进行培养、菌种分型及药物敏感试验,探讨RVVC发生的原因。方法用沙保弱琼脂培养基培养阴道分泌物,分离纯化菌株;VITEK 2全自动微生物分析仪鉴定菌种;同时进行药物敏感试验。结果共分离出101株假丝酵母菌,其中RVVC组45株,VVC组51株,健康组5株。101株中白色假丝酵母菌86株,占85.1%(86/101),RVVC组45株中35株为白色假丝酵母菌,占77.8%(35/45);VVC组51株中47株为白色假丝酵母菌,占92.2%(47/51),健康组5株中4株为白色假丝酵母菌,占80%(4/5)。RV-VC组非白色假丝酵母菌比例高,与VVC组比较差异有显著性(P<0.05)。RVVC组假丝酵母菌对唑类药物敏感性低于VVC组。结论VVC、RVVC的主要致病菌仍是白色假丝酵母菌,RVVC组非白色假丝酵母菌比例高于VVC组。RVVC组假丝酵母菌对氟康唑的敏感率明显低于VVC组。     

289株VVC致病菌的菌种分布和对9种抗真菌药物敏感性

外阴阴道念珠菌病（vulvovaginal candidiasis,VVC）是女性的常见病。本研究收集了2018年1月-12月苏州地区VVC患者分离的289株念珠菌进行了病原学鉴定和包括棘白菌素类、新三唑类药物在内的9种抗真菌药物体外敏感性分析。本文采用核糖体RNA的D1/D2基因进行念珠菌菌种鉴定。参照M27-A3方法检测其对9种抗真菌药物（包括棘白菌素类及新三唑类药物）的体外敏感性。结果表明,289株VVC念珠菌菌株中,白念珠菌259株、光滑念珠菌14株、克柔念珠菌10株、热带念珠菌4株、近平滑念珠菌2株。259株VVC白念珠菌对棘白菌素类体外敏感性好,对米卡芬净敏感性高于另外两种棘白菌素类;对两性霉素B、5-氟胞嘧啶、氟康唑敏感性好;但对伊曲康唑、伏立康唑敏感性差;对泊沙康唑敏感性好。光滑念珠菌株和克柔念珠菌分离株对卡泊芬净敏感性差,但对米卡芬净、阿尼芬净敏感性好;光滑念珠菌株对两性霉素B、5-氟胞嘧啶体外敏感性好,对伊曲康唑敏感性差,对泊沙康唑敏感性好;伏立康唑对光滑念珠菌分离株MIC₅₀/₉₀为0.5/1μg/mL;克柔念珠菌对伊曲康唑、伏立康唑50%耐药;4株热带念珠菌对伊曲康唑50%耐药,对卡泊芬净、氟康唑、伏立康唑100%耐药,对其余5种抗真菌药物敏感。近平滑念珠菌对9种抗真菌药物均敏感。白念珠菌仍为苏州地区VVC的主要病原菌,其次是光滑念珠菌和克柔念珠菌,它们对临床常用药物伊曲康唑、伏立康唑、卡泊芬净敏感性差。研究结果提示对VVC病人常规进行分泌物培养、菌种鉴定,对苏州地区临床医生制定VVC治疗方案具有重要参考价值。尽管棘白菌素类、两性霉素B、5-氟胞嘧啶、新三唑类药物尚未应用到VVC的临床治疗中,但是这些药物对VVC病原体总体敏感性较好,未来有望成为氟康唑、咪唑类药物治疗失败患者的新选择。     

外阴阴道念珠菌病、复发性外阴阴道念珠菌病及健康人群甘露糖结合凝集素水平的分析研究

目的观察健康人群、外阴阴道念珠菌病(VVC)和复发性外阴阴道念珠菌病(RVVC)的甘露糖结合凝集素水平。方法收集健康人群、VVC和RVVC病例,给予规范化治疗,观察治疗前、后各组MBL水平的变化,并进行随访。结果发现各组的MBL水平VVC组>RVVC组>健康组,但各组之间及各组本身治疗前后的MBL差异无显著性意义(P>0.05)。治疗后VVC组复发者5例,占14%,RVVC组复发者13例,达到48%,两组复发者与未复发者的MBL水平,经t检验无显著性差异(P>0.05)。结论 MBL的水平在VVC患者中的水平高于RVVC患者,两者的复发率基本与既往文献报道一致,对于VVC患者来说,MBL水平高于0.8 ng/mL似乎患RVVC的风险稍小些。     

复发性外阴阴道念珠菌病与女性生殖支原体感染的关系

外阴阴道念珠菌病（Vulvovaginal candidiasis,VVC）是常见妇科疾病,病原体主要为白念珠菌,易出现反复发作情况。若经过治疗,临床症状和体征消失,真菌学检查为阴性后症状重现,真菌学检查又呈阳性,则属复发。1a内4次复发则称为复发性外阴阴道念珠菌病（Recurrence vulvovaginal candidiasis,RVVC）。     

我国外阴阴道念珠菌病致病菌菌种分布及体外药敏研究现状

目的回顾性分析我国外阴阴道念珠菌病致病菌的菌种分布及体外药敏研究情况。方法检索分析万方、中国知网、维普、Pubmed等数据库15年来中国外阴阴道念珠菌病致病菌的菌种分布和体外药敏相关文献资料。结果共计检索筛选60篇文献,从现有数据来看,不同地区妇科患者中VVC的患病率为10%~40%,平均为20.3%;各地研究显示外阴阴道念珠菌病的主要病原体是白念珠菌,约占70%~90%,非白念珠菌以光滑念珠菌为主;非白念珠菌在复发性外阴阴道念珠菌病的病原体中所占比例更大。大多数研究显示氟康唑、制霉菌素、两性霉素B体外抗真菌活性较高,外阴阴道念珠菌病分离的念珠菌对氟康唑敏感率在70%~98%左右,对制霉菌素、两性霉素B的敏感率超过95%;过半的研究显示外阴阴道念珠菌病分离的念珠菌对伊曲康唑敏感性高;对5-FC、酮康唑的药敏结果各地差异较大。结论对VVC患者进行病原学鉴定和体外药敏检查十分重要,尤其是难治性VVC、复发性VVC患者,若发现病原菌为非白念珠菌,应根据体外药敏结果适当调整方案,可以选用非氟康唑类药物如AmB外用制剂、硼酸胶囊等;而对于大多数由白念珠菌引起的VVC,应用传统药物如氟康唑、制霉菌素、伊曲康唑等仍是较好的选择,酮康唑、5-FC等药物不建议作为常规选择。     

复发性外阴阴道念珠菌病的免疫学研究新进展

1复发性外阴阴道念珠菌病的概况复发性外阴阴道念珠菌病(recurrent vulvovaginal candidiasis,RVVC)是指一年内有症状并经真菌学证实的外阴阴道念珠菌病(vulvovaginal candidiasis,VVC)发作4次或以上者[1]。Blostein[2]等对7个国家RVVC新患病例数展开调查,发现RVVC的发病率居于14%~28%(平均23%)。RVVC的高发病率说明RVVC是一种常见病。有些患者无明显易感因素却反复发作,RVVC严重影响了患者的生活质量、心理健康和性生活[3],RVVC患者躯体功能、角色生理、躯体疼痛、一般健康、活力、社会功能、角色情绪、心理健康SF-36维度的平均分值显著低于对照组,RVVC患者的生理、心理综合评分均明显低于对照组(P<0.05)[4]。RVVC不仅给患者带来精神、心理压力,也给社会增加了经济负担。故我们需要重视RVVC的防治,积极寻找RVVC的危险因素。     

大鼠外阴阴道假丝酵母菌病模型中局部与全身免疫机制的研究

外阴阴道假丝酵母菌病(VVC)是妇女常见病及多发病,白假丝酵母(白色念珠菌)是其主要致病菌。我们通过在大鼠皮下注射大剂量雌激素建立大鼠的假发情模型,然后在大鼠阴道内接种白假丝酵母(白色念珠菌)SC5314悬液,建立大鼠的外阴阴道假丝酵母菌病模型。在不同时间点检测大鼠血浆中及阴道局部白细胞介素‐2(IL2)、甘露糖结合凝集素(MBL)、Toll样受体‐4(TLR4)的值,探讨VVC及复发性外阴阴道假丝酵母菌病(RVVC)的免疫发病机制。我们发现大鼠血清中只有TLR4在第2周出现显著性上升,而在阴道灌洗液中,IL2在第3周显著下降,TLR4在第2和第3周显著上升,MBL在第1至第3周均显著下降。由此我们推断在外阴阴道假丝酵母菌发病过程中,阴道局部免疫功能异常可能与VVC和RVVC的发生密切相关。     

Vulvovaginal candidiasis is associated with the production of germ tubes by <Emphasis Type="Italic">Candida albicans</Emphasis>

Twenty Candida albicans strains isolated from women attended at the Teaching and Research in the Laboratory of Teaching and Research in Clinical Analysis of the State University of Maringa, Paraná, Brazil, have been analyzed. Yeasts were identified by classical methods and patients subdivided into asymptomatic, vulvovaginal candidiasis(VVC) and recurrent vulvovaginal candidiasis (RVVC) groups. Yeasts were incubated in RPMI + fetal calf serum to analyze germ tubes every two hours, up to 10 h. In vitro sensitivity to fluconazole, itraconazole, ketoconazole, amphotericin B and nystatin was analyzed according to NCCLS-M27-A microdilution assay. Yeast isolated from symptomatic women produced significantly more germ tubes than asymptomatic women (P < 0.05). However, no significant difference between yeasts from VVC and RVVC occurred (P > 0.05). Variation between MIC₅₀ and MIC₉₀ of tested antifungal agents was slight among isolated yeasts, while no resistant yeasts were detected. Nevertheless, VVC yeasts were more DDS (reduced dose-dependent susceptibility) for nystatin and RVVC were more DDS for ketoconazole. Results suggest that colonization by yeast in the vagina and lack of symptoms may be partially explained by the yeast’s sparse capacity to form germ tubes, On the other hand, RVVC was not associated with antimicrobial resistance. DDS high frequency for nystatin and ketoconazole indicates that identification, and susceptibility of antifungals tests are important to management of VVC.     

Proteinase detection,DNA typing and antimycotic susceptibility of Candida isolates from Colombian women with vulvovaginal candidiasis

Forty non-pregnant Colombian women (ages 18-45) with vulvovaginal candidiasis diagnosis (VVC) were enrolled in a blinded study to compare the efficacy of Itraconazole (ITRA) 400 mg vs. Fluconazole (FLU) 150 mg. Sexual partners received similar therapy. Proteinase detection by the Staib method and minimal inhibitory concentration (MIC) for FLU and ITRA by Etest method were performed in all Candida isolates. Patients were followed one year to determine clinical evolution and recurrence of VVC (RVVC). The strain identity of the RVVC isolates was determined by contour-clamped homogeneous electric field (CHEF) gel electrophoresis karyotyping and restriction fragment length polymorphism (RFLP). Thirty patients (75%) had one or two episodes of VVC/year, 83% of these were due to Candida albicans, while ten patients (25%) developed RVVC (three or more episodes/year); seven of them were treated with FLU. Non-C. albicans Candida species were detected in five of 30 (17%) of the patients with VVC and in seven of ten (70%) patients with RVVC (p=0.003). Isolates from nineteen patients were proteinase positive. Proteinase production and type of treatment were not related to recurrence of VVC (p>0.05). DNA typing revealed that in this population RVVC might be due to the same strain, substrain shuffling or different strains and species.     

生殖道念珠菌病病原真菌的调查及药敏试验

目的了解本地区生殖道念珠菌病病原真菌构成及其体外药敏试验情况。方法采用科玛嘉念珠菌显色培养基和YBC鉴定卡对患者1164份生殖道标本的致病真菌进行分离和鉴定,并用ROSCO纸片扩散法检测分离菌株对制霉菌素、酮康唑、氟康唑、伊曲康唑、咪康唑和特比萘芬的药敏情况。结果共分离9种295株念珠菌,其中自念珠菌为85．76％,近平滑念珠菌为7．46％,光滑念珠菌为3．39％,其他念珠菌为3．39％。295株念珠菌对制霉菌素、酮康唑、氟康唑、伊曲康唑、咪康唑和特比萘芬的敏感性分别为99．66％、97．29％、89．83％、72．22％、46．44％和36．61％。结论本地区生殖道念珠菌病患者致病菌分布以白念珠菌为主,体外药敏显示制霉菌素、酮康唑和氟康唑有较好的敏感性。     

Karyotyping of Candida albicans and Candida glabrata isolates from recurrent vaginal infections by pulsed-field gel electrophoresis

In the present study, 16 women with recurrent vulvovaginal candidiasis (RVVC) due to Candida albicans and Candida (Torulopsis) glabrata were followed for a period of 4 to 12 months, and 36 vaginal isolates were evaluated by pulsed-field gel electrophoresis (PFGE). Eleven women were infected by C. albicans and 5 by C. glabrata. Three electrophoretic karyotypes of C. albicans and 3 of C. glabrata were identified throughout the follow-up. All patients but one was infected with the same karyotype of C. albicans or C. glabrata during the follow-up period. Two different karyotypes of C. glabrata were identified in one patient in the course of 12 months. The results confirmed the diversity of the karyotypes of C. albicans and C. glabrata causing vulvovaginitis, and demonstrated the persistence of colonization with the same strain over different periods of time despite therapy (15/16 women).     

RVVC患者阴道分泌物中SP-A的表达及意义

旨在探讨肺表面活性物质相关蛋白A(SP-A)在复发性外阴阴道假丝酵母菌病(RVVC)患者阴道分泌物中的表达及意义。收集RVVC患者、外阴阴道假丝酵母菌患者(VVC)及健康体检者(对照组)阴道分泌物各20例,用酶联免疫吸附测定法(ELISA)测定各组中SP-A蛋白的含量,用逆转录聚合酶链式反应(RT-PCR)方法检测各组中SP-A的基因表达情况。用ELISA方法检测各组中SP-A蛋白的含量发现,VVC组的SP-A明显高于对照组(P0.05),RVVC组的SP-A高于对照组及VVC组(P0.05)。RT-PCR检测结果发现,VVC组的SP-A mRNA的表达水平高于对照组(P0.05),RVVC组的SP-AmR-NA的表达水平明显高于对照组及VVC组(P0.05)。SP-A可能是RVVC患者抗假丝酵母菌的重要物质,其性质或数量的改变可能在RVVC的发病机制中发挥重要作用。     

Effect of pepstatin A on the virulence factors of Candida albicans strains isolated from vaginal environment of patients in three different clinical conditions

The aspartate proteinase inhibitor pepstatin A was used to study a possible correlation among proteinase activity and other virulence factors of Candida albicans strains isolated from the vaginal environment of patients in three different clinical conditions: asympthomatic, vulvovaginal candidiasis (VVC) and recurrent vulvovaginal candidiasis (RVVC). The addition of 1.0 μM pepstatin A did not have any significant effect on hyphae formation, biofilm production and in the cell surface hydrofobicity of isolates in the three different clinical conditions. However, pepstatin A reduced the adherence of C. albicans to vaginal mucosa epithelial cells (53.1, 48.7 and 59.9%, respectively to isolates from asymptomatic, VVC and RVVC patients). This result suggests that the secreted aspartate proteinases (Saps) of this fungal pathogen may have auxiliary roles in cellular adhesion.     

阴道用乳杆菌活菌在治疗重度外阴阴道假丝酵母菌病和预防其复发中的作用

目的初步探讨阴道用乳杆菌活菌联合抗真菌药物在治疗重度外阴阴道假丝酵母菌病（VVC）和预防其复发中的临床作用。方法选取2012年1月至2012年12月就诊于柳州市人民医院确诊为重度VVC的患者共118例,随机分为研究组59例,对照组59例,对照组于第1、第4天阴道放克霉唑阴道片0．5g,联合口服伊曲康唑胶囊0．2g,qd,连用7d;研究组上述治疗后阴道继续放阴道用乳杆菌活菌0．25g,qn,连用14d;分别于停药后7～14d、28～35d及2个月复查,观察近期、远期疗效及是否有复发。结果停药后7～14d,研究组有效率为91．53％,对照组效率为86．44％,两组比较差异无统计学意义（P〉0．05）;停药后28—35d,研究组有效率为98．21％,对照组效率为87．75％,两组比较差异有统计学意义（P〈0．05）;2个月后随访,研究组复发率为O％,对照组为10．53％,两组比较差异有统计学意义（P〈0．05）。结论重度VVC在抗真菌治疗后给予阴道放乳杆菌活菌可提高远期疗效,减少复发。