下生殖道感染与子宫颈细胞学异常的相关性研究

Objective?To study the association between abnormal cervical cytology and bacterial vaginosis (BV), vulvovaginal candidiasis(VVC), trichomonas vaginitis(TV), high-risk human papillomavirus(HR-HPV) infection in women attending cervical cancer screening. Methods?The study recruited 3 300 women aged 21 to 64 years of age who participated in cervical cancer screening. Demographic information was collected. Cervical exfoliated cell specimens were collected for liquid-based cytological diagnosis and HR-HPV detection. Reproductive tract secretions specimens were collected for molecular vaginitis diagnostics from women who were diagnosed with negative for intraepithelial lesion or malignancy(NILM) and all HR-HPV positive or ≥atypical squamous cells of undetermined significance(ASC-US). The Logistic multivariate model was used to analyze the risk factors of abnormal cervical cytology. Results?645 women were included in the study, including 408 NILM, 182 ASC-US, 23 low-grade squamous intraepithelial lesion (LSIL), and 32 high-grade squamous intraepithelial lesions (HSIL). The positive rate of HR-HPV (14.7%, 39.0%, 78.3% and 87.5%) increased with the severity of cytology (P<0.001). The prevalence of BV in different cytological diagnosis (34.1%, 49.5%, 60.9% and 43.8%) were significantly different (P<0.001), and the prevalence of BV in ASC-US were significantly higher than that in women with NILM (P<0.05). The prevalence of VVC in different cytological diagnosis (14.2%, 4.9%, 8.7% and 3.1%) was significantly different (P<0.01), and the ASC-US group was significantly lower than the NILM group (P<0.001). There was also a significant difference in the distribution of the prevalence of TV (2.5%, 9.3%, 4.3%, and 6.3%, P<0.01). The prevalence of TV in women with abnormal cytology was higher than that in women with normal cytology(P<0.05). The Logistic analysis showed that HR-HPV infection, BV, TV, VVC, lower level of education, and postmenopause were related to abnormal cervical cytology. Conclusion?HR-HPV infection is the determinant of abnormal cervical cytology. BV, TV, VVC, lower level of education, postmenopause, etc. may associate with abnormal cervical cytology.     

Oral Candida isolates in patients undergoing radiotherapy for head and neck cancer: prevalence, azole susceptibility profiles and response to antifungal treatment

Oral pseudomembranous candidiasis and mucositis were assessed in 39 patients receiving a total dose of 39-70 Gy radiotherapy for head and neck cancer. Mucositis was scored using the Radiation Therapy Oncology Group criteria, and oral candidiasis was diagnosed on the basis of clinical evaluation and quantitative laboratory findings. Radiation-induced mucositis was observed in 9/39 patients. Only 3/39 patients discontinued radiotherapy due to acute severe mucosal effects. Candidiasis (colony-forming units 35 to > or = 60/lesion) associated with mucositis was diagnosed in 30/39 patients: the most frequent aetiology of the infection was Candida albicans (n = 23), followed by Candida glabrata (n = 3), Candida krusei (n = 2), Candida tropicalis (n = 1) and Candida kefyr (n = 1). Patients with confirmed oral pseudomembranous candidiasis were treated with either fluconazole 200 mg/day or itraconazole 200 mg/day for 2 weeks. Clinical improvement and concomitant negative Candida cultures (mycologic cure) were the criteria determining a response to antifungal treatment. Etest revealed very low voriconazole MICs (0.004-0.125 microg/ml) for all isolates, and fluconazole resistance for eight C. albicans strains (MIC > 64 microg/ml) and for the C. krusei isolates (MIC > 32 microg/ml). The same strains showed itraconazole susceptibility dose dependence (MIC 0.5 microg/ml). Despite the itraconazole susceptible dose dependent MIC readings, all patients with oral pseudomembranous candidiasis caused by these strains responded to antifungal treatment with 200 mg/day itraconazole. Oral mycologic surveillance of patients undergoing radiotherapy for head and neck malignancies and susceptibility testing of isolates may be indicated in cases with mucositis-associated confirmed oral pseudomembranous candidiasis to ensure prompt administration of targeted antifungal treatment. On the basis of the low MIC values found, clinical evaluation of voriconazole is indicated for management of oral pseudomembranous candidiasis refractory to other azoles.     

Clonal identity of Candida albicans in the oral cavity and the gastrointestinal tract of pre‐school children

The clonal relationship between oral and fecal Candida albicans isolated from children of pre‐school age was examined using RAPD analysis. Significantly higher levels of C. albicans were found in saliva, dental plaque, carious specimens and stools of 56 patients with severe caries as compared to 52 healthy control subjects. The highest prevalence was found in carious specimens and a strong correlation was observed between its presence in saliva, dental plaque, carious specimen and feces. RAPD analysis of isolates from 23 patients with simultaneous oral and fecal C. albicans revealed clonal counterparts present in both oral and stool samples in 15 cases; five patients harbored closely related strains; and three patients harbored unrelated strains. Our results demonstrate a strong correlation between oral and gastrointestinal C. albicans colonization. We assume that carious teeth may constitute an ecologic niche for C. albicans potentially responsible for recurrent oral and non‐oral candidiasis.