Self-care intervention to reduce oral candidiasis recurrences in HIV-seropositive persons: a pilot study

OBJECTIVES: This single-blind randomized controlled pilot study evaluated the efficacy of a behavioral intervention program, PRO-SELF: Candidiasis, to reduce time to recurrence of oral candidiasis over 6 months in susceptible HIV-seropositive persons. The intervention involved instruction by dentists on improving oral hygiene, minimizing sugar intake, and self-diagnosing candidiasis. METHODS: Participants were adults with oral candidiasis responsive to antifungals who presented to the UCSF Stomatology Clinic between 1997 and 2000. At 2-3 weeks of follow-up visits, a dentist "examiner", masked to group assignment, quizzed participants as to the presence of candidiasis, and assessed candidiasis status. A second, unmasked dentist "instructor" then delivered the program to intervention participants. Participants recorded dietary and oral hygiene practices in 24-h recall diaries: intervention participants at each visit and controls at initial and final visits. RESULTS: At randomization, CD4+ cell counts (cells/mm(3)) were 298 +/- 188 among 18 intervention participants and 396 +/- 228 among 17 controls. The candidiasis recurrence rates at 6 months were 78% among intervention compared with 88% among control participants (hazard ratio 0.72; 95% CI 0.35-1.50). Performing oral hygiene after meals/snacks showed the largest relative improvement: intervention-control difference in proportion of meals/snacks affected was 24% (95% CI -1 to 48%). Self-diagnoses of candidiasis were inaccurate, possibly because of mild episodes. CONCLUSIONS: The results weakly indicate that regular instruction from healthcare professionals helps patients delay candidiasis recurrence by improving oral hygiene. Among HIV-seropositive persons, those with poor oral hygiene, and high-sugar diets are most likely to benefit.     

Chronic mucocutaneous candidiasis and primary hypothyroidism in two families

We describe the clinical and immunological features of two families with chronic mucocutaneous candidiasis (CMC) and primary hypothyroidism. Family A includes three siblings with both candidiasis and hypothyroidism and four individuals with hypothyroidism only. Family B includes four members with candidiasis, of whom one (a male child) also had hypothyroidism. All individuals affected with CMC had suffered from oral candidiasis and onychomycosis since infancy. Facial seborrhoic dermatitis, general folliculitis and scaling blepharitis were main manifestations. Hypothyroidism became evident during childhood. No thyroid antibodies were present in the affected siblings in family A, while the male in family B with hypothyroidism had antibodies against thyroid peroxidase at diagnosis. Immunological evaluation revealed intra-individual variations in serum immunoglobulin levels, lymphocyte subsets and proliferative responses, but there were no consistent abnormalities. Vaccine responses were normal. AIRE gene region microsatellite markers did not segregate with disease nor were autoantibodies typical for autoimmune polyendocrine syndrome type 1 detected in the families. Conclusion: the link between hypothyroidism and chronic mucocutaneous candidiasis remains to be identified.Abbreviations AADC aromatic l -amino acid decarboxylase - APS 1 autoimmune polyendocrine syndrome type 1 - CMC chronic mucocutaneous candidiasis - GAD glutamic acid decarboxylase - MBL mannose-binding lectin - 17OH 17-hydroxylase - 21OH 21-hydroxylase - SCC side-chain cleaving enzyme - TG-Ab anti-thyroglobulin antibodies - TPO-Ab anti-thyroperoxidase antibodies     

A clinical multicenter study comparing efficacy and tolerability of topical combination therapy with clotrimazole (Canesten, two formats) with oral single dose fluconazole (Diflucan) in vulvovaginal mycoses

Two topical formats containing clotrimazole [500 mg single dose vaginal tablet (VT) or 10% single dose vaginal cream (VC) for intravaginal use] combined with additional clotrimazole cream for topical application to the vulval area (Canesten 1 Combi, Bayer AG, Leverkusen, Germany) were compared with oral fluconazole 150 mg single dose treatment of vulvovaginal mycosis (VVM) in a single-blind clinical study. The objective of the study was to demonstrate the equivalent efficacy of the clotrimazole combination therapies (VT + 1% cream and VC + 2% cream), and fluconazole 150 mg oral capsule (Diflucan 1, Pfizer Gmbh, Karlsruhe, Germany) in terms of overall response defined as clinical cure and mycological resolution. Overall, combination therapies containing either clotrimazole 500 mg VTs or clotrimazole 10% VC were as effective as a single dose fluconazole 150 mg oral tablet in treating VVM with rates for overall response being 66%, 61% and 60%, respectively, after 14 days. There were no significant differences in the time to onset of symptom relief in the clotrimazole 500 mg tablet group and clotrimazole 10% VC compared with fluconazole 150 mg oral capsules. Only 50% of 88 patients across treatment groups with mycological recurrence also experienced return of symptoms over the entire 8 week follow-up period. All treatments administered were safe and well-tolerated and the number of patients experiencing adverse events was low.     

外阴阴道念珠菌病相关危险因素研究

目的探讨外阴阴道念珠菌病（Vulvovaginal candidiasis，VVC）相关危险因素。方法采用前瞻l生研究方法，对230例阴道内念珠菌培养阳性者及200例培养阴性者进行病例对照研究。结果VVC主要发生于性活跃期育龄妇女，平均年龄为（31．01±8．43）岁。VVC的相关危险因素有口交、非月经期护垫的应用、口服避孕药、既往有VVC病史、抗生素应用（OR分别为5．85，12．05，6．46，1．41，4．07；95％C1分别为2．82—12．13，5．38—26．97，3．51—11．98，0．71—2．78，1．35—12．26）；避孕套的应用是保护性因素（OR=0．67，95％CI0．57—0．78）。结论VVC主要发生于性活跃期育龄妇女，口交、非月经期护垫的应用、避孕药的应用、既往有VVC病史、抗生素的应用是VVC发生的高危因素。避孕套的应用是VVC的保护性因素。     

消糜颗粒治疗HIV/AIDS口腔念珠菌病对念珠菌的抑制作用

目的观察消糜颗粒治疗HIV/AIDS口腔念珠菌病对念殊菌的抑制作用。方法治疗组40例艾滋病病人使用消糜颗粒治疗并与制霉菌素片作对照,检测念珠菌的镜检、培养情况。结果消糜颗粒治疗该地HIV/AIDS口腔念珠菌病,对念珠菌的抑制效果优于制霉菌素片。结论消糜颗粒治疗HIV/AIDS口腔念珠菌病对念珠菌的抑制效率高。     

抗白色假丝酵母菌IgY的应用研究

目的探讨抗白色假丝酵母菌IgY对小鼠阴道白色假丝酵母菌感染的治疗作用,及抗白色假丝酵母菌IgY泡腾片的安全性和对外阴阴道假丝酵母菌病的治疗效果。方法2001年5月至2003年5月于南昌大学医学院免疫学教研室应用抗白色假丝酵母菌IgY对小鼠阴道白色假丝酵母菌感染进行保护性研究;观察抗白色假丝酵母菌IgY泡腾片对新西兰兔的急性皮肤刺激试验、阴道局部黏膜刺激试验的结果及对外阴阴道假丝酵母菌病患者的临床效果。结果(1)小鼠阴道冲洗液白色假丝酵母菌培养结果(菌落数)抗白色假丝酵母菌IgY中剂量组与制霉菌素阳性对照组之间差异无显著性意义(0.3947±0.3265对0.3336±0.4634)。(2)新西兰兔试验部位皮肤、阴道黏膜及周围皮肤无红斑、水肿等,全身情况未见异常;阴道黏膜亦未见病理改变。(3)抗白色假丝酵母菌IgY泡腾片对外阴阴道假丝酵母菌病有效率88.9%,与硝酸咪康唑栓对照组(82.5%)比较差异无显著性意义。结论抗白色假丝酵母菌IgY对小鼠阴道白色假丝酵母菌感染有明显的保护作用;抗白色假丝酵母菌IgY泡腾片对皮肤、阴道黏膜无刺激作用;对外阴阴道假丝酵母菌病有很好的治疗效果。     

达克宁栓并碘附治疗念珠菌性阴道炎临床观察

目的探讨治疗念珠菌性阴道炎并减少其复发的有效途径。方法念珠菌性阴道炎病人140例，随机分为研究组80例，对照组60例。研究组采用碘附棉球擦拭阴道配合达克宁栓阴道放置治疗，对照组采用单纯达克宁栓阴道放置治疗，两组连续3d为一疗程。结果治疗组疗效及远期随访的复发率与对照组比较差异有显著性（uc=5．53、5．45，Χ^2=4．04，P〈0．05、0．01）。结论碘附擦拭阴道配合达克宁栓阴道放置治疗念珠菌性阴道炎疗效较好，值得临床上推广应用。     

Impact of vulvovaginal atrophy of menopause: prevalence and symptoms in Italian women according to the EVES study

Abstract

This cross-sectional study included postmenopausal women, aged 45–75?years, with the aim to assess the presence of vulvovaginal atrophy (VVA) confirmed by a clinical assessment in the Italian population attending menopausal/gynecological centers. Apart from baseline variables, women scored vaginal, vulvar and urinary VVA symptoms. Impact of VVA on sexual function and quality of life (QoL) was assessed thorough EuroQoL questionnaire (EQ5D3L), Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-revised (FSDS-R). A physical examination was carried out in accordance with routine gynecological practice. VVA was confirmed in 90% of the 1226 evaluable patients (aged 59.0?±?7.3?years). The prevalence of postmenopausal women with VVA confirmed by gynecological clinical assessment was 75.3%. The patients with VVA confirmed (n?=?926) had more severe symptoms (p?<?.0005), lower QoL (EQ-visual analog scale, p?=?.008 and DIVA, p?<?.0005) and worsened sexual function (FSFI and FSDS-R, p?<?.0005 for both) when compared with the patients having nonconfirmed VVA (n?=?140). VVA is highly prevalent among postmenopausal Italian women. The objective of VVA confirmation is associated with severe symptoms and impaired QoL and sexual function. A proactive approach of Italian clinicians to promote regular and early gynecological evaluation should be performed in order to delay the advancing of the disorder.