外阴阴道假丝酵母菌病致病菌株分布和抗真菌药敏分析

目的 探讨外阴阴道假丝酵母菌病(VVC)致病菌株分布和药敏情况.方法 对2011年1月至2012年6月,本院门诊阴道分泌物真菌培养阳性的患者进行菌株调查及药敏分析.结果 VVC致病菌株白假丝酵母菌占85.0％(311/366),非白假丝酵母菌占15.0％(55/366);氟康唑和克霉唑敏感率较高.结论 VVC致病菌株仍以白假丝酵母菌占优势.氟康唑和克霉唑两种药物联合使用可在局部和全身具有强力抗真菌活性能力,通过药物协同作用提高疗效.VCC治疗过程中应根据抗真菌药物敏感性试验结果指导临床合理用药,避免药物滥用.     

克霉唑对妊娠期外阴阴道假丝酵母菌病的疗效观察

目的探究克霉唑对妊娠期外阴阴道假丝酵母菌病(VVC)的临床疗效和不良反应发生率。方法按照随机数字表法将472例VVC妊娠期女性患者分为对照组和观察组。对照组患者按常规方法治疗,观察组患者则给予克霉唑栓治疗。治疗后分别于第2天和第7天观察两组患者的治疗情况及不良反应。结果观察组在治疗后第2天、第7天的总有效率均高于对照组,差异有统计学意义(P0.05)。观察组不良反应发生率为4.24%;对照组为17.8%,差异有统计学意义(P0.05)。结论使用克霉唑治疗妊娠期VVC效果显著,不良反应发生率低。     

外阴阴道假丝酵母菌感染分布及抗真菌药物敏感性分析

本文对我院2008年1月-2009年12月间妇科门诊就诊患者宫颈分泌物做真菌培养及药敏试验，以便为临床医生提供合理的用药方法。     

妊娠期外阴阴道假丝酵母菌病护理体会

目的:探讨妊娠期外阴阴道假丝酵母菌病的常规护理和综合护理对其治疗效果的影响.方法:将研究对象120例随机分为对照组(n=60)和观察组(n=60),对照组应用常规护理方法,观察组应用综合护理方法.结果:通过实验,对照组治疗有效率为88.33％,观察组的治疗有效率为98.33％,观察组的治疗有效率高于对照组(P＜0.05),具有统计学意义.将对照组和观察组患者护理后的满意率进行比较,发现观察组患者护理后的满意率为100％,对照组患者护理后的满意率为88.33％,具有统计学意义.结论:综合护理对妊娠期外阴阴道假丝酵母菌病的治疗有效率高,复发低,患者对综合护理满意度高,值的临床推广.     

复发性外阴阴道假丝酵母菌病的治疗分析

外阴阴道假丝酵母菌病（VVC）是常见外阴、阴道炎症，也称外阴阴道念珠菌病。约75％的妇女，一生中至少患过一次外阴阴道假丝酵母菌病，并经治疗后约有5％患者复发，若1年内发作4次或4次以上，称为复发性外阴阴道假丝酵母菌病（RVVC），或发生与抗生素治疗无关的外阴阴道假丝酵母菌病3次以上亦称为RVVC。     

复发性外阴阴道假丝酵母菌病46例治疗体会

目的 观察定君生辅助氟康唑、达克宁栓，治疗复发性外阴阴道假丝酵母菌病（RWC）的效果；方法 将86例RVVC患者随机分为2组，采用强化和巩固治疗，观察组46例采用氟康唑口服，达克宁栓、定君生阴道上药，对照组仅用氟康唑口服，达克宁栓阴道上药，治疗3个月，治疗后1个月、3个月复查；结果 治疗后1个月观察总有效率，观察组95．6％，对照组90．O％（P〉0．05），治疗后3个月，观察复发率，观察组7．3％，对照组19．4％（P〈0．05）；结论 在使用抗真菌药物杀灭假丝酵母菌后，使用乳杆菌制剂定君生调整菌群，改善阴道微环境可提高RVVC治愈率，减少复发。     

月经周期不同时间给药对外阴阴道假丝酵母菌病疗效的影响

目的 :探讨性激素水平对外阴阴道假丝酵母菌 (念珠菌 )病 (vulvovaginalcandidiasis,VVC)复发的影响及最佳治疗时机 ,为有效防治提供依据。方法 :76例VVC患者 ,随机分为观察组和对照组各 38例 ,两组均在确诊时予首次治疗 :伊曲康唑 2 0 0mg ,每日 1次 ,连用 3日 ,与餐同服 ;第 1日经擦净外阴、阴道分泌物后 ,将克霉唑泡腾片 (每片含克霉唑 5 0 0mg ,德国产 ) 1片置入阴道后穹窿。治疗后 1周临床症状改善和镜检假丝酵母菌阴性则进入巩固治疗阶段。观察组于月经前 7日睡前将克霉唑泡腾片 1片置入阴道后穹窿 ;对照组于月经干净后 3日采用同样药物局部治疗。连续 3个月经周期。比较两组的疗效。结果 :① 76例中 ,6 2例 (82 % )出现不适症状或症状加重发生在月经周期黄体期 ;②两组治愈率与总有效率相当 (均为P >0 0 5 ) ;③疗程结束后第 3个月复查 ,观察组复发率低于对照组 (8%比4 2 % ,P <0 0 5 )。结论 :于月经黄体期采用抗真菌药物巩固预防治疗可减少VVC复发 ,提高临床疗效和妇女生活质量。     

行为干预对降低外阴阴道假丝酵母菌病复发率的影响

目的探讨行为干预对降低外阴阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)复发率的影响。方法将在本院门诊确诊为VVC的890例患者随机分为实验组450例和对照组440例,实验组患者在进行规范治疗的同时,建立个人资料档案,通过电话或复诊时针对患者VVC复发原因给予行为干预,对照组患者只在治疗时给予常规健康教育。比较两组患者治疗后治愈率与复发率。结果实验组治愈率95.6%,复发率3.3%,对照组治愈率63.6%,复发率31.8%,两组比较,均P<0.01,差异具有统计学意义。结论在规范治疗的同时,通过电话回访及复诊时针对性给予患者行为干预,可提高VVC患者的治愈率,降低复发率。     

双唑泰栓联合转移因子治疗复发性外阴阴道假丝酵母菌病

目的：探讨双唑泰栓联合转移因子治疗复发性外阴阴道假丝酵母菌病（RVVC）的疗效及安全性。方法将240例RVVC患者按随机数字表法分为治疗组（予双唑泰栓＋转移因子胶囊治疗）和对照组（予双唑泰栓治疗），7 d为一疗程，共两疗程，随访3个月。观察2组的临床疗效、不良反应及复发率。结果治疗组总有效率为92.7%，明显高于对照组的81.0%（P〈0.05）。治疗组Sobel 评分、复发率均低于对照组（P〈0.01）。2组不良反应轻微且差异无统计学意义（P〉0.05）。结论双唑泰栓联合转移因子治疗RVVC安全有效，能明显降低复发率。     

复发性外阴阴道假丝酵母菌病（RVVC）30例诊治体会

外阴阴道假丝酵母菌病（VVC）是常见外阴、阴道炎症，也称外阴阴道念珠菌病。国外资料显示，约75％妇女一生中至少患过1次外阴阴道假丝酵母菌病。由于外阴阴道假丝酵母菌病容易在月经前复发，若患者经治疗临床症状及体征消失，真菌学检查阴性后又出现真菌学证实的症状称为复发，若1年内发作4次或以上称RVVC。外阴阴道假丝酵母菌病经治疗后约有5％患者复发，部分复发病例有诱发因素，但大部分患者复发机制不明。本文就2003-2007年因复发性外阴阴道假丝酵母菌病（RVVC）30例患者进行诊治分析。     

Inhibition of adherence of Candida albicans by conventional and experimental antifungal drugs

We tested the effects of antifungal drugs on adherence of Candida albicans in vitro. Significant reduction of adherence occurred after 2 h incubation with amphotericin B, nystatin, miconazole, econazole, ketoconazole, chlorohexidine and ICI 195,739. Significant inhibition of candida adherence by 5-fluorocytosine and amorolfin required 18 h incubation. Combinations of amphotericin B with 5-fluorocytosine, miconazole, ICI 195,739 and amorolfin resulted in synergistic inhibition of adherence. Adherence is an important pathogenic mechanism in candida infections and interference with this process may represent a major component of the mode of action of antifungal drugs.     

Defined anaerobic growth medium for studying Candida albicans basic biology and resistance to eight antifungal drugs

The polymorphic fungus Candida albicans is one of the most versatile opportunistic pathogens in humans. Many organs of the human body are potential targets for infection by this pathogen, but infection is commonly localized in the gastrointestinal tract, an environment providing anaerobic growth conditions. We describe a chemically defined anaerobic growth medium for four strains of Candida albicans (A72, SC5314, MEN, and 10261). It is a defined liquid glucose-phosphate-proline growth medium supplemented with oleic acid, nicotinic acid, and ammonium chloride. The cells did not require or respond to added ergosterol. Oleic acid and nicotinic acid are growth factors which are required only for the anaerobic growth of C. albicans. An important technical feature of this study was the use of anaerobically grown inocula to study anaerobic growth. Anaerobically, the cells grew exclusively as mycelia at 25, 30, and 37 degrees C. The doubling time at 30 degrees C was ca. 20 h. The cells did not produce farnesol and did not respond to exogenous farnesol, and they were resistant to the highest tested levels of amphotericin B and four of the azole antifungals. We suggest that the anaerobic growth of C. albicans may contribute to the trailing end point phenomenon and the resistance of C. albicans biofilms to antifungal drugs.     

Correlation between Azole Susceptibilities,Genotypes, and ERG11 Mutations in Candida albicans Isolates Associated with Vulvovaginal Candidiasis in China

The relationship between susceptibilities to fluconazole and itraconazole and microsatellite CAI genotypes were examined from a total of 154 Candida albicans isolates (97 isolates causing vulvovaginitis in Chinese women and 6 vaginal isolates and 51 oral cavity isolates from asymptomatic carriers). The two dominant genotypes, CAI 30-45 (45 isolates) and CAI 32-46 (33 isolates), associated with vulvovaginitis showed significantly different azole susceptibility patterns with strong statistical support. CAI 32-46 isolates were usually less susceptible to both fluconazole and itraconazole than CAI 30-45 isolates and than the oral isolates with other diversified CAI genotypes. Remarkably different mutation patterns in the azole target gene ERG11 were correspondingly observed among C. albicans isolates representing different genotypes and sources. Isolates with the same or similar CAI genotypes usually possessed identical or phylogenetically closely related ERG11 sequences. Loss of heterozygosity in ERG11 was observed in all the CAI 32-46 isolates but not in the CAI 30-45 isolates and most of the oral isolates sequenced. Compared with the ERG11 sequence of strain SC5314 ({"type":"entrez-nucleotide","attrs":{"text":"X13296","term_id":"2503","term_text":"X13296"}}X13296), two homozygous missense mutations (G487T and T916C) leading to two amino acid changes (A114S and Y257H) in Erg11p were found in CAI 32-46 isolates. The correlation between azole susceptibility and C. albicans genotype may be of potential therapeutic significance.Vulvovaginal candidiasis (VVC) is a common vaginal infection, affecting up to 75% of women of child-bearing age at least once in their lifetime (7, 21, 22). The most frequent cause of VVC is Candida albicans, which is responsible for 70 to 90% of vulvovaginitis cases. Non-C. albicans species of Candida, predominantly Candida glabrata, are responsible for the remainder of cases (21). On the basis of the severity of symptoms, frequency, and causative agents, VVC is usually classified as either uncomplicated (mild and sporadic) or complicated (recurrent, severe, or caused by non-C. albicans species) (7, 21). Ten to 20% of women suffer complicated VVC in their lifetime (21). When properly diagnosed, uncomplicated VVC may be treated easily and reliably. However, complicated VVC often causes long-term physical and mental discomfort, significant economic burden from treatments, and considerable negative effect on sexual relations (21-23).At present, prolonged suppressive therapy using fluconazole is recommended as the standard management for chronic, recurrent Candida vulvovaginitis (23). Therefore, there is a great concern about the emergence and spread of azole resistance of C. albicans isolates associated with VVC. Indeed, susceptibility testing of VVC-causing isolates has been performed in different countries and regions of the world (1, 2, 4, 5, 6, 13-15, 17, 18, 20, 24). Although relatively high frequencies of fluconazole- and/or itraconazole-resistant C. albicans isolates causing VVC have been observed in a few reports (13, 20, 24), most studies failed to identify any clear correlation between azole susceptibility and VVC association among C. albicans isolates (1, 2, 4, 5, 6, 14, 15, 17, 18).Recently, we compared the genotype distribution patterns among independent C. albicans isolates associated with VVC in Chinese women and those from various extragenital sites by using the polymorphic microsatellite locus CAI (8, 11). The results showed that the CAI genotypes of C. albicans isolates from extragenital sites were highly diversified. In contrast, isolates associated with VVC from unrelated patients were more homogeneous and belonged to only a few genotypes, with two genotypes, CAI 30-45 and CAI 32-46, being the most common. These two dominant genotypes were rarely found among isolates from extragenital sites (11). In addition, the distribution of the dominant genotypes correlated positively with the severity of VVC (8, 11). These results suggested that C. albicans isolates with genotypes CAI 30-45 and CAI 32-46 might be more virulent and/or more resistant to the commonly used azole drugs than those with other genotypes as causative agents of vaginal infection.Antifungal susceptibility testing using the Etest method revealed that the C. albicans isolates causing VVC in Chinese women were generally susceptible to fluconazole, amphotericin B, ketoconazole, and flucytosine; however, 19.1% of the isolates could be interpreted as being resistant to itraconazole in vitro. Interestingly, most of the itraconazole-resistant isolates belonged to a specific genotype (13). Contrary to the report described above, recent susceptibility testing and microsatellite typing of vulvovaginitis-causing Candida isolates from Europe did not find an association between azole resistance and any particular genotype cluster among C. albicans isolates (1). In the present study, fluconazole and itraconazole susceptibilities of the C. albicans isolates with the dominant genotypes CAI 30-45 and CAI 32-46 from VVC patients were compared with those of isolates possessing other minor genotypes and of isolates from the oral cavity by using the standard broth microdilution method. Furthermore, ERG11 (encoding lanosterol-14-α-demethylase, the target of azoles) gene sequences of C. albicans isolates representing different genotypes and sources were determined. The correlation between azole susceptibilities, genotypes, and ERG11 mutations was examined.     

获得性免疫缺陷综合征患者白假丝酵母分离株基因型及耐药性分析

目的研究获得性免疫缺陷综合征(AIDS)患者白假丝酵母分离株的基因型及耐药性。方法对分离自上海市公共卫生中心AIDS住院患者的40株白假丝酵母,应用微卫星核心序列引物M13进行聚合酶链反应(PCR)指纹分型。用微量稀释法分析白假丝酵母抗真菌药物敏感性。结果PCR指纹分型将所有白假丝酵母分离株分为A、B、C、D 4种基因型,其中A型14株(35.0%),B型16株(40.0%),C型9株(22.5%),D型1株(2.5%)。白假丝酵母对抗真菌药物的耐药率为:两性霉素B 2.5%,氟康唑22.5%,伊曲康唑15.0%,氟胞嘧啶20.0%,;不同基因型白假丝酵母菌株间耐药性差异无统计学意义。结论上海市AIDS住院患者分离的白假丝酵母主要由3种克隆组成,但无明显优势流行株。     

获得性免疫缺陷综合征患者白假丝酵母分离株基因型及耐药性分析

目的研究获得性免疫缺陷综合征（AIDS）患者白假丝酵母分离株的基因型及耐药性。方法对分离自上海市公共卫生中心AIDS住院患者的40株白假丝酵母,应用微卫星核心序列引物M13进行聚合酶链反应（PCR）指纹分型。用微量稀释法分析白假丝酵母抗真菌药物敏感性。结果PCR指纹分型将所有白假丝酵母分离株分为A、B、C、D 4种基因型,其中A型14株（35.0%）,B型16株（40.0%）,C型9株（22.5%）,D型1株（2.5%）。白假丝酵母对抗真菌药物的耐药率为：两性霉素B 2.5%,氟康唑22.5%,伊曲康唑15.0%,氟胞嘧啶20.0%,;不同基因型白假丝酵母菌株间耐药性差异无统计学意义。结论上海市AIDS住院患者分离的白假丝酵母主要由3种克隆组成,但无明显优势流行株。     

Candida albicans and Candida dubliniensis respond differently to echinocandin antifungal agents in vitro

Candida dubliniensis isolates tested for susceptibility to anidulafungin, caspofungin, and micafungin commonly showed artifactual regrowth and/or trailing effects with MIC tests done under conditions involving a high initial yeast concentration. The artifacts were less common with Candida albicans and seldom seen for either species under Clinical and Laboratory Standards Institute method M27-A test conditions.     

临床分离念珠菌对5种常用抗真菌药物的体外敏感试验结果分析

目的了解临床分离的念珠菌对氟康唑、两性霉素B、氟胞嘧啶、伊曲康唑及酮康唑体外敏感性.方法采用Sensititre YeastOne试验板以微量稀释法测定上述5种抗真菌药物对临床分离的108株念珠菌最低抑菌浓度(MIC).结果 108株念珠菌中达到氟康唑、伊曲康唑、氟胞嘧啶耐药标准的分别有8株(7.4%)、15株(13.9%)、2株(1.9%),念珠菌属MIC值分布种间差异较大.白色念珠菌对5种药物的MIC90值最低,60株白色念珠菌中仅2株耐氟康唑,3株耐伊曲康唑,对氟胞嘧啶无耐药株;光滑念珠菌对氟康唑、伊曲康唑、酮康唑的MIC值分布呈高值,10株光滑念珠菌中4株耐氟康唑,3株剂量依赖性敏感,7株耐伊曲康唑,且吡咯类之间有交叉耐药.其他菌株,除季也蒙念珠菌对伊曲康唑有一定的耐药(2/6)外,对5种抗真菌药物的MIC分布均较低.结论不同念珠菌对常用抗真菌药物敏感性存在差异,准确分离鉴定和药敏试验,对于指导临床合理选药有重要意义.     

Resistance of Candida albicans biofilms to antifungal agents in vitro.

Biofilms formed by Candida albicans on small discs of catheter material were resistant to the action of five clinically important antifungal agents as determined by [3H]leucine incorporation and tetrazolium reduction assays. Fluconazole showed the greatest activity, and amphotericin B showed the least activity against biofilm cells. These findings were confirmed by scanning electron microscopy of the biofilms.