性病门诊病人阴道念珠菌的菌种分布和耐药性检测

目的：了解性病门诊病人阴道念珠菌病的菌种分布和耐药性情况。方法：收集性病门诊病人阴道念珠菌85株，采用常规方法及API 20C AUX试验条方法鉴定念珠菌的种类，耐药性的检测采用ATB FUNGS方法测定念珠菌对6种抗真菌药物的耐药性。结果：85株念珠菌以白念珠菌为主，检出67株，占79％，其次为光滑念珠菌，占9．4％。念珠菌对两性霉素B、制霉菌素、5-氟胞嘧啶、咪康唑、酮康唑和益康唑的敏感率分别为94．1％、94．1％、85．9％、56．7％、55．3％和50．1％。结论：性病门诊病人阴道念珠菌以白念珠菌为主，对两性霉素B、制霉菌素和5-氟胞嘧啶敏感性高，对咪康唑、酮康唑和益康唑的耐药性高。     

两种人群阴道分泌物病原体感染情况分析

目的对性病门诊就诊的女性患者和女性性工作者共1 065例进行阴道分泌物检查,分析两种人群阴道病原体感染情况。方法对2010年到2012年到本单位性病门诊就诊的女性患者和外展服务的女性性工作者共1 065例进行阴道分泌物涂片,同时检测念珠菌、滴虫、线索细胞,并对检测结果进行性统计分析。结果性病门诊就诊497例女性阴道分泌物检出念珠菌40例(8.0%),检出滴虫22例(4.4%),检出线索细胞52例(10.5%),病原体检出总数114例(22.9%);女性性工作者568例阴道分泌物检出念珠菌43例(7.6%),检出滴虫63例(11.1%),检出线索细胞102例(17.9%),病原体检出总数196例(34.5%)。两种人群之间念珠菌检出没有差异,滴虫和线索细胞的检出率有显著性差异,并且两种人群阴道感染率差异有统计学意义。结论女性性工作者阴道感染的总人数比性病门诊女性就诊者多,应特别加强对这类高危人群的健康教育,建立科学的卫生观念,减少感染的机会和性病的传播。     

阴道分离的念珠菌体外抗真菌药物敏感性分析

目的 探讨念珠菌在女性阴道黏膜所致的不同表现与其对抗真菌药物敏感性之间的关系。方法 应用NCCLSM27-A方案推荐的微量液体稀释法,测定对来自外阴阴道念珠菌健康携带者、外阴阴道念珠菌病和复发性外阴阴道念珠菌病的念珠菌对抗真菌药物的敏感性。结果 8种抗真菌药对光滑念珠菌和克柔念珠菌的MIC值几乎均比白念珠菌高。来自复发性外阴阴道念珠菌病患者的菌株MIC值较高,而健康带菌者菌株的MIC值较低。耐药菌株主要来源于复发组,健康带菌者来源的白念珠菌菌株对伊曲康唑、氟康唑、酮康唑和制霉菌素未见有耐药菌株出现。结论 外阴阴道念珠菌病治疗中应重视非白念珠菌的耐药性,长期或间断应用抗真菌药物治疗,可能诱导耐药株的产生。     

微量稀释法检测氟康唑和伊曲康唑对白念珠菌的敏感性

目的了解氟康唑和伊曲康唑对白念珠菌敏感性.方法采用NCCLS公布的M27-A方案微量稀释法,对19株白念珠菌临床分离株和3株标准株进行氟康唑和伊曲康唑药物的敏感性观测.结果19株临床分离株发现氟康唑耐药株7株,敏感株8株,剂量依赖的敏感菌株4株;伊曲康唑耐药株9株,敏感株8株,余2株为剂量依赖的敏感菌株;3株标准株结果符合.结论M27-A方案微量稀释法适合于临床检测白念珠菌的药物敏感性,氟康唑和伊曲康唑在白念珠菌中存在较高的耐药率和交叉耐药现象.     

女性性传播疾病中阴道念珠菌带菌情况分析

目的：了解女性性病患者阴道念珠菌的带菌情况。方法：对422例女性性病患者作阴道分泌物革兰氏染色检查念珠菌，并同时检测淋球菌（NG）、解脲支原体（UU）、人型支原体（MH）、沙眼衣原体（CT）。结果：女性性病患者的阴道念珠菌带菌率为35．1％。在混合感染中，念珠菌合并UU感染率为13．7％，合并NG、MH、CT的总感染率为7．8％。结论：女性性病患者的阴道念珠菌带菌率高于健康育龄妇女，并以合并UU感染最常见。     

复发性阴道念珠菌病念珠菌的菌种及药敏分析

目的：了解复发性外阴阴道念珠菌病(RVVC)临床分离菌株及其对几种常见抗真菌药物的敏感性：方法：分别采用念珠菌显色培养基和ROSCO纸片扩散法进行RVVC念珠菌菌种鉴定和药敏试验。结果：62株阳性标本中,分离出白念珠菌47株(75．81％),热带念珠菌4株(6．45％),光滑念珠菌2株(3．23％),克柔念珠菌5株(8．06％),其他念珠菌4株(6．45％)．62株念珠菌对4种常用的抗真菌药物,即两性霉素B、酮康唑、氟康唑和伊曲康唑的敏感率分别为：100．00％(62／62)、88．71％(55／62)、96．77％(60／62)、95．16％(59／62)。结论：RVVC的主要致病菌仍是白念珠菌,但非白念珠菌所占比例呈上升趋势：RVVC分离菌株对咪唑类抗真菌药物仍有较高的敏感率。     

外阴阴道念珠菌病患者阴道念珠菌对抗真菌药物的敏感性测量

了解外阴阴道念珠菌病病原菌对抗真菌药物的敏感性,采用API法对分离自临床外阴阴道念珠菌病患者的120株念珠菌进行菌种鉴定;参照美国国家实验室标准委员会(NCCLS)M-27A方案(1997),采用微量法检测120株临床试验菌株、5株参考株及1株质量控制株对6种常用抗真菌药物的敏感性。结果显示:120株分离自外阴阴道念珠菌病患者的念珠菌中,白念珠菌105株(87.5%),非白念珠菌15株(12.5%);氟康唑、伊曲康唑、两性霉素B、酮康唑、特比萘芬及5-氟胞嘧啶对120株临床菌株的最小抑菌浓度(MIC)均数(μg/mL)分别为:9.474±2.329,0.305±0.062,0.599±0.062,0.855±0.377,9.970±3.324和14.819±5.180。提示氟康唑、伊曲康唑、两性霉素B和酮康唑对念珠菌显示一定的敏感性。外阴阴道念珠菌的主要菌种为白念珠菌。     

婴幼儿皮肤念珠菌病的致病菌株及药敏试验分析

目的 分析婴幼儿皮肤念珠菌病的致病菌种类及对抗真菌药物的敏感性。方法 收集皮肤念珠菌病患儿病例，对临床分离的致病菌进行常规菌种鉴定，采用琼脂稀释法（药基法）对临床分离的念珠菌进行6种药物（氟康唑、咪康唑、联苯苄唑、益康唑、克霉唑、制霉菌素）敏感性试验，选取9株白念珠菌临床菌株和1株白念珠菌标准菌株，参考NCCLS M27-A推荐的微量液体稀释法界定琼脂稀释法的药敏分界点，分析耐药性。结果 共收集75例皮肤念珠菌病病例，分离到的88株念珠菌均为白念珠菌，用琼脂稀释法所测的MIC范围是：氟康唑1 ～ 256 mg/L，咪康唑0.25 ～ 64 mg/L，联苯苄唑0.5 ～ 64 mg/L，益康唑0.25 ～ 32 mg/L，克霉唑1 ～ 64 mg/L，制霉菌素0.5 ～ 32 mg/L。临床株对唑类药物均有耐药株出现，氟康唑1株，克霉唑4株，益康唑3株，咪康唑5株，联苯苄唑9株。结论 婴幼儿皮肤念珠菌病主要由白念珠菌引起；白念珠菌对5种唑类药物均有耐药株出现，且有交叉耐药现象，对制霉菌素敏感。     

性病门诊5年中可疑念珠菌性外阴阴道炎患者念珠菌流行病学调查及耐药性监测

目的：研究疑似外阴阴道炎患者念珠菌菌种的分布及对氟康唑和伊曲康唑的药物敏感性监测。方法：常规分离菌株并鉴定，药敏采用E—test方法测定念珠菌的最低抑菌浓度（MIC）。结果：阴道分泌物分离念珠菌419例，其中：自念珠闲348株（83．1％），光滑念珠菌35株（8．4％），近平滑念珠菌17株（4％），热带念珠菌8株（2％），清消念珠菌4株（1％），克柔念珠菌5株（1％）。419株中对氟康唑、伊曲康唑耐药分别有13株（3％）、66株（16％），双重耐药7株占2％。结论：在疑似念珠菌性外阴阴道炎（VVC）患者分离的念珠菌中，仍以白念珠菌为优势菌株。念珠菌对伊曲康唑和氟康唑的耐药显示逐年增高趋势，不同念珠菌对常川抗真菌药物敏感性存在差异，部分菌种存在交叉耐药，非白念珠菌交叉耐药明显高于白念珠菌。     

E-test检测念珠菌对5种抗真菌药物敏感性试验

目的：评价E-test检测念珠菌和酵母菌对5种抗真菌药物敏感性的临床应用价值。方法：以白念珠菌ATCC90028为标准质控菌株，用E-test方法与NCCLS M27-A方法同时检测137株临床分离酵母菌对5-氟胞嘧啶、氟康唑、两性霉素B、伊曲康唑、酮康唑5种药物敏感性，观察两所测得结果符合率。结果：5-氟胞嘧啶和两性霉素B敏感性较高，MIC和MIC50值小，与M27-A方法测得结果的总符合率均为94．2％；氟康唑、伊曲康唑和酮康唑的MIC和MIC50值最大，出现一定耐药性，总符合率分别为83．0％、74．5％和79．6％。结论：E-test法检测念珠菌对5种抗真菌药物敏感性与NCCLSM27-A参考方法符合率较高，操作简单，结果可靠。     

念珠菌在母婴间垂直传播的流行病学研究

目的：探讨产妇念珠菌感染与其新生儿口腔念珠菌的带菌情况,了解母婴间的垂直传播。方法：对554例某妇婴医院产科经阴道分娩的产妇分娩前的阴道后穹隆分泌物,及其刚出生断脐后新生婴儿口腔分泌物进行真菌分离培养。并采用常规科玛嘉念珠菌显色培养基、玉米粉培养基、海藻糖试验、API20C生化鉴定板等进行菌种鉴定。同时对产妇的一般情况进行调查。结果：554例产妇中132例培养出真菌,分离率最高的职业是主妇,占50．76％．而第1胎检出率最高,占92．42％：产前感染率百分比最高的是农民和干部,分别占33．33％和30．00％。分离出的132株真菌中,白念珠菌78株(占分离菌的首位),其次为光滑念珠菌21株;而554例新生儿口腔真菌培养共分离出11株真菌,白念珠菌8株,光滑念珠菌2株,克柔念珠菌1株．阳性率为1．99％。母婴间同时分离出相同念珠菌共11对,为白念珠菌8对,光滑念珠菌2对,克柔念珠菌1对。结论：妊娠末期妇女阴道念珠菌的感染可垂直传播给新生儿,其垂直传播率约为8．33％。预防母亲产前阴道念珠菌感染可降低新生儿念珠菌感染的可能性。     

Vaginal yeasts in the era of "over the counter" antifungals

OBJECTIVE: To establish whether there has been any rise in the prevalence of non-albicans Candida species isolated from vaginal swabs since the introduction of "over the counter" antifungal treatments. METHOD: A retrospective review looking at all positive vaginal yeast isolates collected from women attending one genitourinary medicine clinic during the 6 year period from 1993 to 1998 inclusive. All positive vaginal yeast isolates were included, regardless of whether or not the patients were symptomatic. Isolates from HIV positive women were excluded from the analysis. RESULTS: No increase in non-albicans vaginal yeast isolates was shown during the period studied. The proportion of non-albicans yeasts remained constant at approximately 5% of the total yeasts isolated. The most common non-albicans yeast isolated was C glabrata. CONCLUSION: There is no evidence from this study to suggest that the increasing use of "over the counter" antifungal treatment has selected for atypical, possibly inherently azole resistant, strains of vaginal yeasts in HIV seronegative women.     

Prevalence of Mobiluncus spp among women with and without bacterial vaginosis as detected by polymerase chain reaction

BACKGROUND: Mobiluncus spp are highly associated with bacterial vaginosis, but their role in its pathogenesis is unknown. The authors used polymerase chain reaction (PCR) to compare the prevalence of Mobiluncus in women with and without bacterial vaginosis. GOAL: To compare the prevalence of Mobiluncus spp among women with and without bacterial vaginosis and to compare the sensitivities of PCR and Gram stain for detection. STUDY DESIGN: Vaginal specimens from 74 women were analyzed by PCR and Gram stain for the presence of Mobiluncus spp. Comparisons were made between the prevalence of this organism between the two cohorts and between the Gram stain and PCR detection methods. RESULTS: Mobiluncus was detected by PCR in 84.5% of women with bacterial vaginosis and in 38% of women without infection. M curtisii was rarely detected in the latter group, though it was found in 65.3% of women with bacterial vaginosis. The sensitivity and specificity of Gram stain compared with PCR were 46.9% and 100%, respectively. CONCLUSIONS: Mobiluncus is more common in healthy women than previously suspected, with M mulieris as the predominant species. The significant difference in the prevalence of M curtisii between women with bacterial vaginosis and uninfected women suggests that this species could be involved in the pathogenesis of bacterial vaginosis.     

高分辨熔解曲线技术检测阴道念珠菌分型的研究

目的探讨采用高分辨熔解曲线方法鉴定常见致病性念珠菌的可行性,为外阴阴道念珠菌病的分子流行病学及病原学研究奠定基础。方法用芽管试验、厚壁孢子试验、科玛嘉(CHRO Magar)显色培养基及API20CAUX酵母菌鉴定系统对临床致病性念珠菌进行鉴定,然后对5株标准株和80株临床分离株的基因组DNA内转录间隔区进行聚合酶链反应,对扩增产物进行高分辨熔解曲线分型。结果 5株念珠菌标准株和80株临床株聚合酶链反应扩增后,通过熔解曲线技术分析产生5种不同的峰图,即得到念珠菌5种分型。结论外阴阴道念珠菌的主要致病菌是白念珠菌(77.50%),高分辨熔解曲线方法鉴定常见的致病性念珠菌特异性强、稳定性好,是传统鉴别方法的有益补充。     

儿童、青少年甲真菌病临床特点及致病菌分析

目的:确定儿童、青少年甲真菌病的主要临床特征和致病菌的种类。方法:回顾性分析220例(年龄18岁)甲真菌病患者的临床特征和致病菌种类。结果:220例患者中男110例,女100例,年龄3个月~17岁,儿童、青少年甲真菌病最常见的感染类型是远端侧缘甲下型(50.45%)和白色浅表型(42.27%)。趾甲较指甲感染常见,共分离出病原菌228株(混合感染8例),其中皮肤癣菌199株(87.28%)、念珠菌属27株(11.84%)、曲霉菌属2株(0.88%)。在199株皮肤癣菌属中红色毛癣菌192株(96.48%),趾甲真菌病多为红色毛癣菌,指甲多为念珠菌属。结论:儿童、青少年甲真菌病中最常见的病原菌为红色毛癣菌,其次为念珠菌属。     

A clinicomycological study of fungal foot infections among Algerian military personnel

There have been few studies on fungal infection of the foot in military personnel. The aim of this study was to determine the prevalence and aetiological factors of superficial mycoses of the foot in military personnel attending the Department of Dermatology of the Army Central Hospital in Algiers, Algeria. A complete dermatological examination was performed in 650 male military personnel. Cultures of skin and nail specimens of the feet were performed for each participant. Fungal infection of the foot (including tinea pedis and Candida interdigital infection) was clinically diagnosed in 147, and confirmed in 119 by positive cultures, resulting in a total prevalence of 18.3%. When subjects were grouped according to military rank, fungal infection of the foot was prevalent in troop soldiers; when grouped according to years of service to the army, the infection was frequent in military recruits. The dermatophyte species Trichophyton rubrum (20.9%) and the yeast species Candida parapsilosis (18.7%) were shown to be the major causal agents isolated. Tinea pedis and Candida interdigital infection are the most prevalent (68%) superficial fungal infections among Algerian military personnel.     

Clinical and microbiological characteristics of symptomatic vulvovaginal candidiasis in HIV-seropositive women.

OBJECTIVES--To evaluate the clinical and microbiological characteristics of symptomatic vaginal candidiasis in Human Immunodeficiency Virus (HIV)-seropositive women attending a gynaecologic outpatient clinic for sexually transmitted diseases (STDs). DESIGN--Vaginal, rectal and oral specimens from cases and controls were cultured for Candida spp. SUBJECTS--Eighty-four consecutive HIV-seropositive and 384 HIV-seronegative women with clinical signs of vulvovaginitis. SETTING--A gynaecological out-patient clinic in Pavia, Italy. RESULTS--The overall prevalence of vaginal candidiasis was 61.9% (52/84) in the cases and 32.3% (124/384; p < .001) in the controls. After adjustment by logistic regression analysis for confounding factors (age at first intercourse, lifetime sex partners, new partner/s in the last 6 months, type of contraceptive used), HIV-seropositive patients were at higher risk for both Candida albicans (odds ratio = 2.5; 95% confidence interval 1.31-4.69; p = 0.006) and Torulopsis glabrata vaginitis (OR = 3.5; 95% CI = 1.05-11.60; p = 0.04) than controls. HIV-seropositive subjects had also increased rates of oral and rectal colonisation with Candida spp. Finally, the time to recurrence of vaginal infection was significantly shorter in HIV-seropositive patients than controls and was correlated with the severity of HIV-induced immunodepression. CONCLUSIONS--Vulvovaginal candidiasis is very common in HIV-seropositive women and its prevalence is correlated with the immunological status of the host. These patients have higher frequencies of Torulopsis glabrata vaginal infection and are more prone to recurrence than HIV-seronegative controls.     

念珠菌性包皮龟头炎的致病菌种及其药敏试验分析

目的了解念珠菌性包皮龟头炎的致病菌种及其对常见抗真菌药物的敏感性。方法分别采用科玛嘉念珠菌显色培养基、YBC鉴定卡和ROSCO纸片扩散法进行念珠菌培养、菌种鉴定及药敏试验。结果380例患者共培养出93株阳性标本(24.47%),分离出白念珠菌81株(87.10%),非白念珠菌12株(12.90%)。93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率分别为100%,95.70%,92.47%,67.74%,56.99%,45.16%。结论白念珠菌是念珠菌性龟头包皮炎的主要致病菌种,分离菌株对制霉菌素敏感性最高,其次是酮康唑和氟康唑,特比萘芬最低。