Analysis Of Prevalence Of Vaginal Candida Colonization In Patients With Diabetes(Treatment Of Vulvovaginal Candidiasis In 20 Patients With Diabetes With Itraconazole)

Vulvovaginal candidiasis is a clinical disease, which has plagued thousands of women in the world for a long time. Typical clinical manifestations are vaginal irritation, discharge, dyspareunia and vaginal congestion. Gynecological examination shows a thick and curdy discharge adherent to the vaginal epithelium in a non-contiguous pattern.Presently, common pathogenic strains of Candida include Candida albicans , Candida tropicalis, Candida parapsilosis, Candida hemulonii,Candida krus, Candida guilliermondii, Candida kefyr, Candida glabrata. Candida is round or oval and it reproduces spore and hypha. It is growing well on Sabouraud's dextrose agar medium and Gram-positive. Candida is biphase. In the external environment or messmateism its major existing pattern is spore. Pathogenic phase is hypha. Candida is of strong vitality.In recent years,due to large-scale application of antibiotics,long-term use of immunosuppressive drugs, diabetes and other risk factors, the incidence of vulvovaginal candidiasis has significantly been on the rise around the world and has become a research focal point.Patients with diabetes mellitus are at risk for vulvovaginal candidiasis. Candida albicans is the commonest species isolated in such infection in diabetics as well as in non-diabetics. Recently, non-C.albicans Candida species are increasingly being recognized as the cause of vulvovaginal candidiasis. These species are often less susceptible to antifungal agents. We assessed the species-specific prevalence rate and risk of candidiasis in patients with diabetes mellitus and healthy controls.The study cohort comprised of 294 subjects, including 144 consecutive patients with diabetes mellitus (mean age 44.3years) according to the diagnostic criteria of American Diabetes Association,and 150 healthy subjects . Of the 144 subjects with diabetes mellitus, 24 patients were insulin-requiring type 1 diabetics and 120 were type 2 diabetes mellitus. Of the 144 subjects with diabetes mellitus, 56 patients were asymptomatic vulvovaginal candidiasis and 88 were symptomatic vulvovaginal candidiasis . The study period spanned 10 months during 2006-2007. Subjects of which with pregnancy, on oral contraceptives, with history of treatment with antifungal agents during the previous 1 months, and who did not give consent for pelvic exam-ination were excluded. Two sterile, cotton-tipped swabs were used to collect discharge from high vagina. One of the two swabs was used to determine the presence of yeast by direct microscopy, while the other was used for fungal culture. Identification of the Candida species was made as per standard mycological protocols. Briefly, the criteria for laboratory diagnosis were: (a) direct demonstration of the yeast by KOH (10%) mount and Gram's staining; (b) culture on Sabouraud's dextrose agar supplemented with 2μg/ml gentamicin, suspected mixed samples, as determined by colony type and microscopic characteristics,were placed on plates with media showing species-specific colony color change (Chromagar,CHRO-Magar,Paris,France).We actively control blood glucose in vulvovaginal candidiasis patients with diabetes who were given a short course of oral itraconazole for a week. Candida species were isolated in 64 of 144(44.4%) subjects with diabetes mellitus and in 27of 150 (23%) healthy subjects (Chi-squared 24.040 , P < 0.05). Prevalence of vulvovaginal candidiasis in subjects with diabetes mellitus were 36 of 144 (28%),the predominant Candida species isolated in diabetics with vulvovaginal candidiasis were C. albicans(88.9%) Candida glabrata(2.8%) C. glabrata(2.8%).Candida species were isolated in 16 of 24(66.7%) subjects with type 1 diabetes mellitus and in 48 of 120 (40%) (Chi-squared 22.165,P<0.05). After the withdrawal of the first week, 4 weeks review, the total efficiency of the treatment group were 100.0% and 91.7% respectively,better than that of the controls.In short, diabetes can increase the incidence of vulvovaginal candidiasis and the asymptomatic vaginal carriage rates of Candida species. Diabetes type and Candida species were of important relevance. After short-term clinical observation, we found that itraconazole which has fewer adverse reactions and lower recurrence rate can be widely used in the treatment of vulvovaginal candidiasis in patients with diabetes mellitus. The medication has important clinical significance.