Pathogeny And Epidemiology Research Of Candidal Vaginitis

Candidal vaginitis is a ubiquitous genital system infection in almost all caste's reproductive life women. With the 20-25% possession of vulvovaginitis, it is the second one only to bacterial vaginitis.Candida sp. is a kind of normal presence microbial population in vagina. When the endovaginal microenvironment changed, it caused vulvovaginitis. C. albicans is the most frequent pathogen of candidal vaginitis, with possess 85~90%. Non-C.albicans infections mainly occurred in immunity impaired women. Recently, for the widespread use of antibiotics, candidal vaginitis caused by C.glabrata, C. krusei, C. tropicalis, C. parapsilosis and C. guilliermondii increase gradually.About 50%~75% women have infected candidal vaginitis at least one time in the whole life, half of whom had recurrent infection. Female patients have different remote causes in different periods, remove or avoid these remote causes have significance to reduce infections. Candidal vaginitis often occurred in the women between puberty and menopause, mainly in reproductive life. Long term and bulk use of antibiotic, use of oral contraceptive and spermicide, hormone replacement therapy, diabetes, wear Chemical fiber underpants, flushes the vagina frequently or pay no attention to cleanly, tiredness, pregnancy and frequent vita sexualis would increase disease incidence.With the increasing of vagina candidal infections and widespread use of antifungal drugs, pathogens of candidal vaginitis changed, drug resistant strains appeared more and more, non-C.albicans strains infection and drug resistance increase uninterrupted, combined infection also occured. Candida showed different resistance to azoles and polyene antifungal drugs, especially non-C.albicans strains appeared more evidently, which cause candidal vaginitis hard to cure.At present, the methods of fungal indentification and classification commonly used in clinically had some disadvantages. And with the developing of molecular genetics, classifical methods with DNA targat already used in the molecular epidemiology research of fungal infectioon. Because of designing primer without knowing genome sequences, small quantity of DNA, easy to set up standard between labs, better distinguish capability and convenient operation, RAPD has generally be used in research of fungal indentification, classification and genetic polymorphism among Candida, Penicilium and other fungi. It is a good method with rapid, ecomomy and repeatability.In this research, we will use the methods of morphology, biochemics and RAPD studing indentification and classification of Candida sp., by which we will understand the species and distribution of pathogen in candidal vaginitis. Drug sensitivity test can make us know the drug resistance of these strains. The molecular epidemiologic feature we gained in this study will provide useful reference to rapid diagnosis, prevention and cure of this disease.First, we collected the information and samples of the patients who are suspected as vaginal fungal infection, then isolated strains. According to the morphologic characteristics, and the characteristics with CHROMagar Candida medium, we make an initial identification. We gain 65 strains and the positive rate is 67.71%, of which 11 samples are combined fungal infections; 4 are infected by bacterias and 27 are negative infection. 81.54% (53) of the 65 strains was C. albicans, while 18.46% is non-C. albicans, including 4 C. glabrata, 2 C. tropicalis, 1 C. krusei and 5 other Candida sp.. 87.69% of the 65 patients who are candidal vaginitis are from city. Mainly infection is 26-35 years old, that is 58.47%, and above 46 years old are obviously less, which is only 6.14%. The result is that C. albicans is still the main pathogens to cause female vaginal candidiasis infection, but the infection with non-C.albicans is increasing, which is basically the same with the reports resently. The reason why non-C.albicans infected are increasing gradually maybe the use of antibiotics largely and long-term, leading the change of micro-environment, dysbacteriosis and the increase of candidal infection.In order to clarify the Candida's resistance to antifungal drugs, drug sensitive experiments were carried out by using M27-A microdilution method of NCCLs. We tested 65 strains with FCZ,ICZ,5-FC and AmB. The result shows that difference of Candida strains'sensitivity and resistance to different drugs appears obviously. It shows high sensitivity to 5-FU and AmB, which is low to FCZ and ICZ with multidrug resistant. And non-C.albicans strains'drug resistance is much higher than C.albicans, which is the same as report domestic and abroad.In order to diagnose candidal vaginitis more quikly and accuraty, we studied the classification of Candida sp. by using RAPD. We amplificated DNA with 10 random primers, RAPD2 and RAPD5 can get clear, stable and repeatable special banding pattern, it possess evident interspecies genetic variability and intraspecies genetic resemblance. According to the special banding pattern, we can divided C. albicans and C. tropicalis from others. This two primers are good at the identification, dignosis and polymorphism of C. albicans and C. tropicalis. Therefore, RAPD is a convenient and rapid method to classify Candida sp., which could be an addition to clinical candidal vaginitis examination method.Therefore, the increase of candidal infection and the drug tolerance of Candida sp. couldn't be neglected, develop laboratory routine examination combined with DNA typing identification method to classify the species of Candida sp., and therapy with the results of drug sensitive experiment, which can reduce the appearance of drug resistant strain and have important significance to treatment of candidal vaginitis.