Sobel J D, Vazquez J, Lynch M, Meriwether C, Zervos M J
Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan.
Clin Infect Dis. 1993 Jan;16(1):93-9. doi: 10.1093/clinids/16.1.93.
Vaginitis due to Saccharomyces species is extremely rare. Nine patients with 20 vaginal isolates of Saccharomyces cerevisiae who presented with either asymptomatic vaginal colonization or symptomatic vaginitis indistinguishable from that caused by Candida albicans are described. All patients had a history of chronic or recurrent vaginitis, and all but two had systemic or local predisposing factors. In vitro tests of antimycotic sensitivity revealed reduced susceptibility of S. cerevisiae to the majority of available azole agents, with outright resistance to fluconazole. In accordance with these findings, the clinical response to conventional topical and oral antimycotic drugs was frequently suboptimal and incomplete. Electrophoretic karyotyping of strains revealed several distinct types of S. cerevisiae; this information permitted both longitudinal follow-up and differentiation of relapse from reinfection. In three patients with recurrent vaginitis, a unique epidemiological relationship was documented between S. cerevisiae and Torulopsis glabrata, another unusual and resistant vaginal pathogen. Isolation of S. cerevisiae from the vagina of symptomatic patients should not be ignored; treatment of vaginal infection with this yeast requires selected, often prolonged therapy.
由酿酒酵母属引起的阴道炎极为罕见。本文描述了9例患者，他们有20株阴道分离的酿酒酵母，这些患者表现为无症状阴道定植或与白色念珠菌引起的症状性阴道炎难以区分的症状。所有患者都有慢性或复发性阴道炎病史，除2例患者外，其余均有全身或局部易感因素。抗真菌药敏的体外试验显示，酿酒酵母对大多数现有的唑类药物敏感性降低，对氟康唑完全耐药。根据这些发现，对传统局部和口服抗真菌药物的临床反应通常不理想且不完全。菌株的电泳核型分析揭示了几种不同类型的酿酒酵母；这些信息有助于纵向随访以及区分复发和再感染。在3例复发性阴道炎患者中，记录了酿酒酵母与光滑球拟酵母（另一种不常见且耐药的阴道病原体）之间独特的流行病学关系。从有症状患者的阴道中分离出酿酒酵母不应被忽视；用这种酵母菌治疗阴道感染需要选择针对性的、通常是延长疗程的治疗。
