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中国 649 例临床外阴阴道假丝酵母菌病相关白念珠菌菌株的偏倚基因型分布。

Biased Genotype Distributions of Candida albicans Strains Associated with 649 Clinical Vulvovaginal Candidiasis in China.

机构信息

Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, 610041, China.

Department of Medical Mycology, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China.

出版信息

Mycopathologia. 2022 Dec;187(5-6):427-437. doi: 10.1007/s11046-022-00671-4. Epub 2022 Oct 9.

Abstract

Vulvovaginal candidiasis (VVC), which is most frequently caused by Candida albicans, is a common problem worldwide. Despite the fact that extensive epidemiological studies have been performed, the cause of recurrent VVC (RVVC) remains uncertain. The aims of this work were to compare the genotypes of C. albicans strains causing different conditions of VVC, and explore the relationship between the drug resistance and genotype of C. albicans strains. In our study, we collected 649 independent strains from VVC patients in China. Isolates were tested for in vitro susceptibility to fluconazole, itraconazole, voriconazole, amphotericin B and caspofungin in accordance with the Clinical Laboratory Standards Institute (CLSI) document M27-A3. Genotyping was performed using PCR targeting specific CAI locus marker. C. albicans is the main pathogen of VVC, but the proportion of non-candida albicans (NAC) infection is also increasing, and we also found increased cases of mixed infection. Some C. albicans are resistant to multiple drugs. The strains with the genotypes including 16-16, 18-18 and 22-22 was likely to be the dominant genotype of uncomplicated VVC (p < 0.05). The genotypes of complicated VVC are mainly distributed in 30-45, 33-45, 32-46 and 39-45. Strains of 30-45, 32-45, 30-47 and 30-46 genotypes showed resistance to fluconazole, itraconazole, voriconazole and amphotericin B respectively. Our work suggests that the dominant genotypes with higher repeat number of C. albicans strains were more prevalent in patients with RVVC and drug-resistant strains, however, strains with uncomplicated VVC were more likely to distribute in homozygous. Identification of specific genotypes that correlate with different conditions of VVC and drug resistant is also of diagnostic and therapeutic significance.

摘要

外阴阴道假丝酵母菌病(Vulvovaginal candidiasis,VVC),最常由白假丝酵母菌引起,是一种全球范围内常见的问题。尽管已经进行了广泛的流行病学研究,但复发性 VVC(Recurrent Vulvovaginal Candidiasis,RVVC)的病因仍不确定。本研究旨在比较引起不同 VVC 状态的白假丝酵母菌菌株的基因型,并探讨白假丝酵母菌菌株的耐药性与基因型之间的关系。

在本研究中,我们从中国 VVC 患者中收集了 649 株独立菌株。根据临床实验室标准化协会(Clinical Laboratory Standards Institute,CLSI)M27-A3 文件,对分离株进行体外氟康唑、伊曲康唑、伏立康唑、两性霉素 B 和卡泊芬净药敏试验。采用针对 CAI 特异基因座标记的 PCR 进行基因分型。

白假丝酵母菌是 VVC 的主要病原体,但非白假丝酵母菌(Non-Candida albicans,NAC)感染的比例也在增加,我们还发现混合感染的病例增多。一些白假丝酵母菌对多种药物耐药。基因型包括 16-16、18-18 和 22-22 的菌株可能是单纯 VVC 的优势基因型(p<0.05)。复杂 VVC 的基因型主要分布在 30-45、33-45、32-46 和 39-45。基因型为 30-45、32-45、30-47 和 30-46 的菌株分别对白念珠菌、伊曲康唑、伏立康唑和两性霉素 B 耐药。

我们的研究表明,在 RVVC 和耐药菌株中,白假丝酵母菌菌株的高重复次数的优势基因型更为普遍,而单纯 VVC 的菌株更可能呈纯合分布。识别与不同 VVC 状态和耐药性相关的特定基因型具有诊断和治疗意义。

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