Dromer F, Improvisi L, Dupont B, Eliaszewicz M, Pialoux G, Fournier S, Feuillie V
Unité de Mycologie, Centre National de Référence des Mycoses et des Antifongiques, Paris, France.
AIDS. 1997 Jul 15;11(9):1095-101. doi: 10.1097/00002030-199709000-00003.
Fluconazole resistance has emerged among Candida albicans isolates and has been associated with the prolonged or repeated use of the drug. This study was designed to discover whether transmission of oral isolates could occur between sexual partners and thereby explain fluconazole resistance in patients never treated with the drug.
The oral flora of 10 HIV-infected couples (five heterosexual and five homosexual) were studied. In vitro susceptibility testing and genotyping (restriction fragment length polymorphism with EcoRI and HinfI) were used to delineate strain relatedness for 230 clones (five clones per sample, one to four samples per patient).
The genetic diversity of the clones with one DNA subtype was specific to a given patient or a given couple, except in one case in which unrelated patients shared clones of the same genotype. The persistence of clones between partners was stable over time in six out of 10 couples and only transient in one couple. Fluconazole resistance in isolates from patients who had never been treated with azoles was associated in three patients with the first episode of oropharyngeal candidiasis and treatment failure.
The observation that couples tended to share genetically indistinguishable clones was highly suggestive of transmission between partners. This phenomenon may, in part, explain the pathogenesis of oropharyngeal candidiasis and the increased frequency of fluconazole resistance both in vitro and in vivo.
白色念珠菌分离株中已出现氟康唑耐药性，且与该药物的长期或反复使用有关。本研究旨在探究口腔分离株是否会在性伴侣之间传播，从而解释从未接受过该药物治疗的患者中出现氟康唑耐药性的原因。
对10对感染HIV的伴侣（5对异性恋和5对同性恋）的口腔菌群进行了研究。采用体外药敏试验和基因分型（用EcoRI和HinfI进行限制性片段长度多态性分析）来确定230个克隆（每个样本5个克隆，每位患者1至4个样本）之间的菌株相关性。
具有一种DNA亚型的克隆的遗传多样性特定于某一患者或某一伴侣，只有一例无关患者共享相同基因型的克隆。10对伴侣中有6对伴侣之间克隆的持续性随时间保持稳定，只有一对伴侣是短暂的。在从未接受过唑类药物治疗的患者分离株中，氟康唑耐药性在3例患者中与口咽念珠菌病的首发及治疗失败有关。
伴侣倾向于共享基因上无法区分的克隆这一观察结果强烈提示了伴侣之间存在传播。这种现象可能部分解释了口咽念珠菌病的发病机制以及体外和体内氟康唑耐药性频率增加的原因。
