Sjogren‘s综合征并发白色念珠菌口炎的诊断和治疗

报道了２０例Ｓｊｏｇｒｅｎ’ｓ综合征（ＳＳ）并发白色念珠菌口炎患者的临床表现，以及采用制霉菌素局部涂抹、２％碳酸氢钠溶液含漱、转移因子皮下注射综合治疗的结果。作者提出了ＳＳ并发白色念珠菌感染的诊断依据：①唇部小唾液腺活检证实为ＳＳ；②口腔白色念珠菌涂片检查。同时还指出采用综合治疗方法对ＳＳ并发白色念珠菌感染是有效的。     

口腔白色念珠菌病95 例临床分析及治疗体会

目的：探讨口腔白色念珠菌病的发病原因，提出初步治疗和预防措施。方法：对95例口腔白色念珠菌患者进行分型，并采用氟康唑、多抗甲素等药物对各型口腔念珠菌病患者进行综合治疗，观察其疗效；同时进行真菌学学涂片镜检，了解所用药物对白色念珠菌的清除情况。结果：综合治疗后，白色念珠菌病患者治愈率为35．79％，好转率为57．89％；白色珠菌清除率为80．59％。结论：白色念珠菌为条件致病菌，在全身或局部因素诱导下容易发病，氟康唑等药物能有效治疗口腔白色念珠菌病。     

HIV感染患者口腔念珠菌的培养鉴定及耐药性研究

目的：研究HIV感染患者口腔念珠菌感染的菌株种类和耐药情况,比较CHROMagar显色培养基（CHROMagar）和API 20C AUX酵母菌鉴定系统（API）在HIV感染者口腔念珠菌鉴别中的应用,指导临床抗真菌药物的使用。方法：6株念珠菌标准菌株和17例HIV感染合并口腔念珠菌病患者舌背白色刮取物,分别接种于沙氏培养基和CHROMagar,37℃48h后取沙氏培养基上生长物作API 20C AUX鉴定和耐药性检测。结果：白色念珠菌8例,热带念珠菌4例,近平滑念珠菌4例,白色念珠菌和克柔念珠菌混合感染1例。念珠菌对特比萘芬耐药,对氟康唑、酮康唑、眯康唑、克霉唑中度敏感,对制霉菌素、伊曲康唑、两性霉素B、氟胞嘧啶高度敏感。API 20C AUX、CHROMagar在鉴定白色念珠菌上无显著性差异,API20CAUX鉴定非白色念珠菌准确率高于CHROMagar,但CHROMagar可鉴别混合菌种感染。结论：HIV感染患者口腔念珠菌以非白色念珠菌居多（52．9％）,分型初筛可用CHROMagar,准确分型需用API20CAUX鉴定,两种方法互有裨益。临床用药建议选择制霉菌素、伊曲康唑、两性霉素B、氟胞嘧啶中的两种任意综合治疗。     

西吡氯铵含漱液辅助治疗口腔念珠菌感染临床观察

目的通过临床试验评价西吡氯铵含漱液对口腔白色念珠菌感染的治疗作用. 方法选择在粘膜科就诊的白色念珠菌感染患者60例,分为试验组、复方氯已定对照组和制霉菌素甘油对照组,经治疗后观察其临床表现和涂片检查结果的变化,从而分析其疗效. 结果西吡氯铵含漱液对白色念珠菌感染患者的临床表现有改善作用,对白色念珠菌有一定的抑制作用,未发现明显的副作用. 结论西吡氯铵含漱液对白色念珠菌感染有一定的治疗作用,由于其口感较好且无口腔粘膜及牙齿着色,是临床治疗和预防口腔念珠菌感染的一种安全有效的辅助药物.     

口腔念珠菌感染与带菌者白色念珠菌生物型的研究

口腔念珠菌感染与带菌者白色念珠菌生物型的研究徐岩英，胡碧琼，刘立新，林琴Ｌ．Ｐ．Ｓａｍａｒａｎａｙａｋｅ白色念株菌（下简称白念）是口腔念珠菌感染最主要的病原菌。白念感染的发生除与宿主全身及局部易感因素有关外，其本身因素，即是否白念本身生物型、遗传型的...     

原位杂交、免疫组化及AgNOR染色法在口腔念珠菌性白斑诊断中的应用

目的:探讨原位杂交、免疫组化及AgNOR染色法在口腔念珠菌性白斑(OCL)诊断中的综合应用。方法:采用原位杂交、免疫组化及AgNOR染色法,并对照PAS染色法,检测154例口腔白斑及鳞癌组织中念珠菌的感染情况。结果:经统计学处理,4种检测方法之间无显著性差异;白斑真菌感染率为71.8%(89/124),白色念珠菌感染率为56.5%(70/124)。本研究中只发现1例热带念珠菌感染。真菌感染中78.7%(70/89)为白色念珠菌。鳞癌真菌感染率63.3%(19/30),均为白色念珠菌感染。结论:AgNOR染色法、原位杂交和免疫组化的综合应用,可以从组织、细胞、分子水平对OCL进行定位研究,为OCL的准确诊断提供客观的实验依据。     

萎缩糜烂型口腔扁平苔藓患者不同基因型白色念珠菌的药敏研究

目的:对萎缩糜烂型口腔扁平苔藓不同基因型白色念珠菌进行药物敏感性研究,为临床有效治疗萎缩糜烂型口腔扁平苔藓白色念珠菌感染提供依据。方法:采用聚合酶链反应(PCR)对101株萎缩糜烂型口腔扁平苔藓白色念珠菌进行基因分型,然后采用微量稀释法测定白色念珠菌不同基因型对4种临床常用抗真菌药物的敏感性。采用SPSS16.0软件包对数据进行χ2检验。结果:101株白色念珠菌中,A型39株,B型17株,C型45株。A型对5-氟胞嘧啶耐药率显著高于B、C型(P<0.05);B型对氟康唑耐药率显著高于A型(P<0.05);C型对伊曲康唑耐药率显著高于A型(P<0.05);B、C型均未出现制霉菌素耐药株,A、B、C型对制霉菌素的耐药率无显著性差异(P>0.05)。结论:萎缩糜烂型口腔扁平苔藓白色念珠菌不同基因型对抗真菌药物的耐药性有差异,治疗时应根据基因分型和药敏试验结果合理选用抗真菌药物。治疗萎缩糜烂型口腔扁平苔藓伴发白色念珠菌感染时,制霉菌素的临床价值应该引起充分重视。     

口腔白色念珠菌病的临床分析(附134例病例报告)

目的　进一步探讨口腔念珠菌病的易感因素 ,加深对念珠菌病的认识 ,为临床正确合理治疗奠定基础。方法　对 134例白色念珠菌感染的病例均进行口腔粘膜病变区及义齿承托区唾液细菌培养。结果　白色念珠菌感染的病人常与全身和局部因素有密切关系。结论　白色念珠菌感染的病人多见于老年人 ,尤其是戴义齿修复者占多数 ,其次为年老体弱、婴幼儿 ,长期应用广谱抗生素以及头颈部放疗、肿瘤化疗者     

感染根管内白色念珠菌的检测和治疗

白色念珠菌为感染根管中最常分离到的真菌,学者们对其不断进行研究。本文重点介绍了感染根管内白色念珠菌的感染率、检测方法以及根管冲洗液与根管内用药对白色念珠菌的作用。     

HIV感染者口腔白色念珠菌磷脂酶活性的体外研究

目的探讨HIV感染者口腔白色念珠菌单一感染与混合感染时分离株的磷脂酶活性,及其与宿主机体免疫力（用CD4细胞计数表示）的关系。方法40株白色念珠菌按单一感染或是否与其他念珠菌混合感染及CD4细胞计数的高低进行分组,采用卵黄培养基法检测其磷脂酶活性（Pz值）,并进行析因方差分析。结果40株白色念珠菌体外磷脂酶活性均为阳性（100%）,白色念珠菌单一和混合感染的平均Pz值分别为0.6007和0.5142（P〈0.05）,CD4细胞多于200个/mm3和CD4细胞少于200个/mm3时白色念珠菌的平均Pz值分别为0.5460和0.5688（P〉0.05）。结论作为白色念珠菌的重要毒力因子,HIV感染者口腔白色念珠菌磷脂酶活性与是否有其他念珠菌混合感染有关,而与机体免疫力无关。     

Sjgren’s综合征伴发白色念珠菌感染的临床研究

作者对38例Si(?)gren’s综合征(SS)患者合并白色念球菌感染情况进行了临床分析.结果显示:与对照组相比,SS患者口腔中白色念珠菌感染的阳性率高于对照组(P<0.05).同时发现白念感染的程度与唾流量多少关系密切,其中唾液不足6ml者,白念培养阳性率明显高于流量超过6ml者(PM相似文献   

Sjögren's syndrome sufferers have increased oral yeast levels despite regular dental care

Aim:  To investigate the prevalence and quantity of oral yeasts and their association with oral candidiasis in Sjögren's syndrome (SS) patients receiving regular dental care.
Materials and methods:  Yeasts in oral rinse and full-mouth supra-gingival plaque samples from 25 primary SS, 27 secondary SS and 29 control subjects were selectively cultured. All yeasts except single-species isolates were genotyped using pulsed field gel electrophoresis (PFGE).
Results:  Ten (19%) SS sufferers had symptomless candidiasis. SS subjects had a higher prevalence (73% vs 7%) and quantity of yeasts than controls in both oral rinse and plaque samples ( P  < 0.05). The prevalence of yeasts in plaque was associated with candidiasis regardless of denture wearing ( P  ≤ 0.04). Candida albicans was the predominant yeast isolated. PFGE showed 20 (66% of total) C. albicans isolate pairs, i.e. C. albicans species isolated from plaque and oral rinse samples of the same individual, were of closely related genetic clonal types ( P  < 0.01).
Conclusions:  Despite effective oral hygiene, more SS subjects than controls had detectable levels of oral yeasts and their presence in supra-gingival plaque was associated with candidiasis. Candida albicans colonized supra-gingival biofilm even in well-maintained SS individuals, posing a challenge to the control of oral candidiasis.     

Sj?gren's syndrome sufferers have increased oral yeast levels despite regular dental care.

AIM: To investigate the prevalence and quantity of oral yeasts and their association with oral candidiasis in Sj?gren's syndrome (SS) patients receiving regular dental care. MATERIALS AND METHODS: Yeasts in oral rinse and full-mouth supra-gingival plaque samples from 25 primary SS, 27 secondary SS and 29 control subjects were selectively cultured. All yeasts except single-species isolates were genotyped using pulsed field gel electrophoresis (PFGE). RESULTS: Ten (19%) SS sufferers had symptomless candidiasis. SS subjects had a higher prevalence (73%vs 7%) and quantity of yeasts than controls in both oral rinse and plaque samples (P < 0.05). The prevalence of yeasts in plaque was associated with candidiasis regardless of denture wearing (P < or = 0.04). Candida albicans was the predominant yeast isolated. PFGE showed 20 (66% of total) C. albicans isolate pairs, i.e. C. albicans species isolated from plaque and oral rinse samples of the same individual, were of closely related genetic clonal types (P < 0.01). CONCLUSIONS: Despite effective oral hygiene, more SS subjects than controls had detectable levels of oral yeasts and their presence in supra-gingival plaque was associated with candidiasis. Candida albicans colonized supra-gingival biofilm even in well-maintained SS individuals, posing a challenge to the control of oral candidiasis.     

Oral candidiasis in Sj?gren's syndrome: prevalence, clinical correlations, and treatment

Red, nonulcerated, uncomfortable oral mucosal lesions that are often thought to be caused by chronic xerostomia develop in some patients with Sj?gren's syndrome (SS). However, we find that these lesions (1) clinically resemble chronic atrophic candidiasis (CAC), (2) usually yield Candida species from their surface, and (3) can be eliminated by topical antifungal drugs in spite of continuing xerostomia. In 246 patients who had primary or secondary SS, we correlated the presence or absence of atrophic oral mucosal lesions with the patient's salivary function and other clinical features. The 91 patients (37%) who had these lesions were older, had a greater frequency of primary SS and of oral symptoms, had had oral symptoms for a longer period, had more salivary gland inflammation, and had lower stimulated parotid flow rates than the 155 patients without CAC (p less than 0.05). However, unstimulated whole salivary flow rates and denture status were not significantly different. Topical antifungal treatment, begun on 47 patients, eliminated lesions in some. The methods of treating CAC are discussed. Candida-associated oral mucosal lesions do not develop in all patients with SS, but in susceptible patients, SS leads to a reversible form of CAC that is not associated with dentures.     

口腔念珠菌病8例临床病理分析

目的:探讨口腔念珠菌病的临床诊断与病理诊断,以减少误诊.方法:对8例病理诊断为口腔念珠菌病的患者的临床资料进行回顾性分析,并对其标本进行组织病理学HE和PAS染色研究.结果:8例患者病理诊断为口腔念珠菌病,而临床上均未考虑为本病.常规组织病理切片均见上皮内微小脓肿,PAS染色可见真菌菌丝侵入上皮表层.结论:临床上遇到长期不愈的增生或溃疡型病变时,应考虑是否有念珠菌感染;组织病理学检查发现病变上皮内出现微小脓肿时,应高度怀疑本病,PAS染色有助于确诊.     

The management of Sj?gren's syndrome in dental practice.

BACKGROUND: Sj?gren's syndrome, or SS, is a multisystem inflammatory disorder of the exocrine glands with a wide range of extraglandular involvement. Symptoms of dry eyes and xerostomia, although not invariably present, are characteristic features of SS. An increased risk of oral and dental diseases is a prominent consequence of SS. TYPES OF STUDIES REVIEWED: The author reviewed recent medical and dental studies that have advanced our understanding of the causes and treatment of SS. She particularly focused on studies addressing the diagnosis and treatment of the oral component of the disease. RESULTS: Sj?gren's syndrome is a widely underdiagnosed disease. A delay in the diagnosis of SS may have a significant physical, psychological and economic impact on the affected person. The pathogenesis of SS appears to involve a number of factors: immunological, genetic, hormonal and possibly infectious. Successful management of SS requires a multidisciplinary approach, and the dentist plays an essential role in the diagnosis and treatment of the disease. ORAL IMPLICATIONS: Impairment of salivary function in SS increases the risk of developing oral diseases. Effective management of oral health comprises enhancement of salivary output (cholinergic agonist drugs such as pilocarpine or cevimeline) and prevention and treatment of dental caries, oral candidiasis and allergic mucositis. Finally, periodic evaluation of various clinical and laboratory parameters is needed to monitor disease status.     

Prevalence of oral candidiasis in chronic renal failure and renal transplant pediatric patients

The objective of this study was to evaluate the prevalence and risk factors associated with candidiasis in chronic renal failure (CRF) and renal transplant (RT) patients. A cross-sectional study was made of 66 patients who were divided into 2 groups: group A (33 patients), RT patients, and group B (33 patients), who had been diagnosed with CRF. Data with respect to demographics, treatment type and duration, clinical laboratory results for blood leucocytes, oral hygiene, and diagnosis of oral candidiasis were collected. Risk factors associated with candidiasis were evaluated. Among the 66 patients, 21 showed microbiologic evidence of oral candidiasis; 12 of these were from the RT group and 9 were from the CRF patients. Children who were renally compromised (RT and CRF) presented a frequency of oral candidiasis of 31.82%, with no difference between study groups. C. albicans was the most frequently isolated species from RT and CRF patients. Duration of therapy and oral hygiene were the variables associated with the presence of oral candidiasis.     

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.     

Cytokine profiles in parotid saliva from HIV-1-infected individuals: changes associated with opportunistic infections in the oral cavity

The purpose of this study was to quantitate levels of cytokines in parotid saliva of subjects infected with human immunodeficiency virus-1 (HIV-1) and to determine if the cytokine profiles differ in subjects with an oral opportunistic infection, i.e., candidiasis or oral hairy leukoplakia. Parotid saliva samples were obtained from HIV-infected individuals with or without candidiasis or oral hairy leukoplakia and from healthy controls and were assessed by ELISA for levels of interleukin (IL)-1, IL-2, IL-4, IL-5, IL-10, transforming growth factor-beta, tumor necrosis factor-alpha and interferon (IFN)-gamma. Saliva from HIV-infected subjects with oral candidiasis had significantly higher levels of IFN-gamma than that seen in HIV-infected individuals with no oral disease and significantly higher levels of IL-2, IL-5 and IFN-gamma than saliva of healthy controls. No significant difference was seen in cytokine levels in saliva from HIV-infected subjects with no oral infections and healthy controls. The HIV-infected subjects with oral hairy leukoplakia displayed significantly higher levels of both IL-1 alpha and IFN-gamma compared with the HIV and no oral disease group and a higher level of IFN-gamma than seen in saliva from the healthy control group. In comparing cytokine levels from both HIV and oral disease groups, significant differences were detected in levels of IL-5 and IL-10. These results indicate that the profile of salivary cytokines is altered as a result of the oral opportunistic infection candidiasis or oral hairy leukoplakia and also by concurrent HIV infection.     

Experimental chairside test for the rapid diagnosis of oropharyngeal candidiasis

Oral infection with Candida fungal species is very common. Oral candidiasis is usually diagnosed by clinical appearance because no chairside diagnostic methods are available. In contrast, a rapid latex agglutination (RLA) test has proven useful for in-office diagnosis of vulvovaginal candidiasis. This study was undertaken to determine if the RLA technique might be used to provide a quick chairside test for oral candidiasis. Twenty-five patients participated in the study, including 21 patients with clinical evidence suggestive of oral candidiasis serving as the experimental group and 4 patients with apparent good oral health serving as controls. The presence of oral candidiasis was evaluated using RLA, fungal culturing, and cytology. RLA testing was consistent with established diagnostic tests in patients with oral candidiasis. However, RLA false positive results were noted, and the test is highly technique-sensitive and subjective. The technique is worthy of further study to determine its ultimate value in the diagnosis of oral candidiasis.