Hashemi Seyed Ebrahim, Shokohi Tahereh, Abastabar Mahdi, Aslani Narges, Ghadamzadeh Mahbobeh, Haghani Iman
Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Invasive Fungi Research Centre (IFRC), Mazandaran University of Medical Sciences, Sari, Iran.
Curr Med Mycol. 2019;5(4):26-34. doi: 10.18502/cmm.5.4.2062.
The aim of the current study was to investigate the epidemiology of vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC), as well as the antifungal susceptibility patterns of species isolates.
A cross-sectional study was carried out on 260 women suspected of VVC from February 2017 to January 2018. In order to identify species isolated from the genital tracts, the isolates were subjected to polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) using enzymes and sequencing. Moreover, antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute guidelines (M27-A3).
Out of 250 subjects, 75 (28.8%) patients were affected by VVC, out of whom 15 (20%) cases had RVVC. Among the species, was the most common species (42/95; 44.21%), followed by (18/95; 18.95%), (13/95; 13.69%), (8/95; 8.42%), (6/95; 6.31%), (5/95; 5.26%), (2/95; 2.11%), and (1/95; 1.05%), respectively. Multiple species were observed in 28% (21/75) of the patients. Nystatin showed the narrowest range of minimum inhibitory concentration (MIC) (0.25-16 μg/ml) against all strains, whereas fluconazole (0.063-64 μg/ml) demonstrated the widest MIC range. In the current study, as the second most common causative agent of VVC, was susceptible to all antifungal agents. Furthermore, 61.1% of isolates were inhibited at a concentration of ≤ 2 μg/ml while 38.9% (n=7) of them exhibited fluconazole MICs above the epidemiologic cutoff values (ECV). species showed the highest overall resistance against fluconazole (61.3%), followed by itraconazole (45.2%) and caspofungin (23.7%). All of strains were resistant to itraconazole with a MIC value of ≥ 1 μg/ml; in addition, 87.5% of them were resistant to fluconazole. Moreover, 100% and 87.5% of strains were resistant to caspofungin and fluconazole, respectively.
As the findings revealed, the majority of VVC cases were caused by non- species which were often more resistant to antifungal agents. generally had fluconazole MICs above the ECV. Given the propensity of to develop resistance under drug pressure, antifungals should be administered with caution. The emergence of these species justify the epidemiological surveillance surveys to watch out the distribution of yeast species.
本研究旨在调查外阴阴道念珠菌病（VVC）和复发性外阴阴道念珠菌病（RVVC）的流行病学情况，以及念珠菌分离株的抗真菌药敏模式。
2017年2月至2018年1月，对260名疑似VVC的女性进行了一项横断面研究。为了鉴定从生殖道分离出的念珠菌种类，使用酶和测序对分离株进行聚合酶链反应-限制性片段长度多态性分析（PCR-RFLP）。此外，根据临床和实验室标准协会指南（M27-A3）进行抗真菌药敏试验。
在250名受试者中，75名（28.8%）患者患有VVC，其中15名（20%）为RVVC。在念珠菌种类中，白色念珠菌是最常见的种类（42/95；44.21%），其次是光滑念珠菌（18/95；18.95%）、热带念珠菌（13/95；13.69%）、近平滑念珠菌（8/95；8.42%）、克柔念珠菌（6/95；6.31%）、季也蒙念珠菌（5/95；5.26%）、葡萄牙念珠菌（2/95；2.11%）和无名念珠菌（1/95；1.05%）。28%（21/75）的患者中观察到多种念珠菌种类。制霉菌素对所有念珠菌菌株显示出最窄的最低抑菌浓度（MIC）范围（0.25 - 16μg/ml），而氟康唑（0.063 - 64μg/ml）显示出最宽的MIC范围。在本研究中，作为VVC的第二常见病原体，光滑念珠菌对所有抗真菌药物敏感。此外，61.1%的光滑念珠菌分离株在浓度≤2μg/ml时受到抑制，而其中38.9%（n = 7）的分离株氟康唑MIC高于流行病学临界值（ECV）。克柔念珠菌对氟康唑的总体耐药率最高（61.3%），其次是伊曲康唑（45.2%）和卡泊芬净（23.7%）。所有克柔念珠菌菌株对伊曲康唑耐药，MIC值≥1μg/ml；此外，87.5%的菌株对氟康唑耐药。此外，100%和87.5%的季也蒙念珠菌菌株分别对卡泊芬净和氟康唑耐药。
研究结果表明，大多数VVC病例由非白色念珠菌引起，这些菌株通常对抗真菌药物更具耐药性。克柔念珠菌的氟康唑MIC通常高于ECV。鉴于克柔念珠菌在药物压力下易产生耐药性，应谨慎使用抗真菌药物。这些念珠菌种类的出现证明了进行流行病学监测调查以关注酵母种类分布的合理性。
