Kunzelmann V, Tietz H J, Rossner D, Czaika V, Hopp M, Schmalreck A, Sterry W
Dermatologische Universitätsklinik und Poliklinik, Humboldt-Universität, Berlin, BR Deutschland.
Mycoses. 1996;39 Suppl 1:65-72. doi: 10.1111/j.1439-0507.1996.tb00508.x.
67 women with chronic recurrent or persistent vaginal candidosis between 5-79 years of age were seen in our outdoor department. In 34 cases, yeasts could be isolated in a vaginal swab taken at the first consultation. On average the patients reported 5 episodes per year during the last years. Typical symptoms consisted of pruritus vulvae, local inflammation and a curdy vaginal discharge. Nearly all of the women had received local or systemic antimycotic treatment for several times. In 53% (18 patients), C. albicans had been isolated, in 29% (10 patients) C. glabrata and in 9% (3 patients) C. krusei. While candidosis due to C. albicans and C. krusei was frequently associated with distressing complaints, infections with C. glabrata caused only very few symptoms. Independent of the species, severe and persistent infections were characterized by long term persisting specific IgM-antibody-titers and remarkable lack of IgG-antibodies. The laboratory parameters of WBC, CRP and immunelectrophoresis were normal. The minimum inhibitory concentrations (MIC) of 60 Candida strains against fluconacole were determined by microdilution assay. The MIC for C. albicans (n = 35) were between 0.78 and 3.125 micrograms/ml, for C. glabrata (n = 20) between 8 and 32 micrograms/ml and for C. krusei (n = 5) between 25 and 128 micrograms/ml. In 7 cases, local antimycotic treatment was sufficient. Correlating to the sensitivity, 18 women were treated with 100-800 mg fluconacole/d for 10-20 days. In 13 of them, clearance of symptoms and yeasts was achieved. The treatment of fluconacole-resistant strains with itraconazole (100-200 ml/d for 10-20 days) together with local application of nystatin (2 x 1 Mio. IE for 10 days) was without any effect. Three women with C. albicans, C. glabrata and C. krusei infection received a candidin-vaccination (0.005 BE/ml-500 BE/ml). In all of these cases, production of IgM-antibodies was induced. However, the clinical symptoms could not be influenced. Only in two cases it was not possible to reach a clearance of symptoms and yeasts. The results show the benefit of a precise differentiation before therapy. Serologic controls of antibody titers seem to be useful tools to control the efficacy of treatment.
我院门诊接待了67例年龄在5至79岁之间的慢性复发性或持续性阴道念珠菌病女性患者。34例患者在首次就诊时采集的阴道拭子中分离出酵母。过去几年，患者平均每年报告5次发作。典型症状包括外阴瘙痒、局部炎症和凝乳状白带。几乎所有女性都曾多次接受局部或全身抗真菌治疗。53%（18例患者）分离出白色念珠菌，29%（10例患者）分离出光滑念珠菌，9%（3例患者）分离出克鲁斯念珠菌。白色念珠菌和克鲁斯念珠菌引起的念珠菌病常伴有令人痛苦的症状，而光滑念珠菌感染仅引起很少症状。无论菌种如何，严重和持续性感染的特征是特异性IgM抗体滴度长期持续存在且明显缺乏IgG抗体。白细胞、CRP和免疫电泳的实验室参数均正常。采用微量稀释法测定了60株念珠菌对氟康唑的最低抑菌浓度（MIC）。白色念珠菌（n = 35）的MIC在0.78至3.125微克/毫升之间，光滑念珠菌（n = 20）的MIC在8至32微克/毫升之间，克鲁斯念珠菌（n = 5）的MIC在25至128微克/毫升之间。7例患者局部抗真菌治疗有效。根据药敏结果，18例女性患者接受100 - 800毫克氟康唑/天治疗10 - 20天。其中13例症状和念珠菌清除。用伊曲康唑（100 - 200毫克/天治疗10 - 20天）联合局部应用制霉菌素（2×100万单位，共10天）治疗耐氟康唑菌株无效。3例分别感染白色念珠菌、光滑念珠菌和克鲁斯念珠菌的女性接受了念珠菌素疫苗接种（0.005单位/毫升 - 500单位/毫升）。所有这些病例均诱导产生了IgM抗体。然而，临床症状未受影响。仅2例患者症状和念珠菌未能清除。结果表明治疗前精确鉴别有益。抗体滴度的血清学监测似乎是控制治疗效果的有用工具。
