| Background and objectiveAIDS is the abbreviation of human acquired immunodeficiency syndrome. As in December2011, the global AIDS patients are a total of about34,000.000.From the regional distribution, Africa and Asia are still the most concentrated areas of the AIDS patients. HIV/AIDS infection situation is not optimistic in China.Since1985when the first example of infection has been found, by the end of2011, it was estimated that we would have780,000people infected with HIV and AIDS, Among them, AIDS patients were154,000people.The number of HIV/AIDS in China shows an ascendant trend, In recent years, as the detection of increase, the new discovered HIV-positive people in recent years are increasing by the rate of30%per year.As one of the worst of the outbreak areas of the country, Guangdong HIV infected people are more than40,000. Simultaneously the early HIV infected person,gradually is entering the morbidity peak at present. Based in Shenzhen City, for example, nearly7years (2004to2011), the number of HIV/AIDS infected people has increased16times! Medical treatment will be a very arduous task. To improve the quality of treatment, reducing AIDS mortality, early detection and early treatment are very important. And there are some typical AIDS patients of oral performance, such as oral Candida albicans infection, it is often the start symptoms of most early AIDS patients. The study of AIDS oral characterization is very meaningful. And the domestic HIV/AIDS patients for oral research are less; oral Candida spp. and resistance of the infection status are less.Candida widely exists in the oral cavity in normal healthy people. It is the condition pathogenic, in certain, will become pathogenic. Low immunity, those, like children, old people, and long-term use, radiation therapy, chemotherapy, which body dysbacteriosis are more likely to happen. In recent years, due to the wide use of broad-spectrum antibiotics cause dysbacteriosis, double infections, and the use of immunosuppressant, long-term antineoplastic chemotherapy and other factors, especially HIV/AIDS, drug addicts, the expansion of the crowd, fungal infection is greatly increasing.During the HIV infector to be AIDS patient, the oral Candidiasis spp. can easily been detected. Research has shown that AIDS patients’oral Candidiasis spp. detection rate and the poisonous force are higher than healthy people. Oral Candidiasis spp. infection has become one of the earliest AIDS oral performances. And deep fungus infection causes AIDS patients eventually one of the leading causes of death. In clinic, in patients with long-term treatment, compliance cent and antifungal drugs don’t use the standard and other factors, clinical resistance fungus strains that have been on the increase.Drug-resistant mechanism is becoming more diverse and stubborn, and repeated cases have increased. At present, the conditions of pathogenic bacteria caused yeast infection AIDS patients has become the most common, and largest number of opportunistic infection, and is also the most important cause of death. Survey shows that AIDS patients with fungal infection has not only resistance exists; part of antifungal drugs may also influence to HIV infected patients’treatment, so it became a difficult problem in treatment area.With the development of research, more and more AIDS infection of the oral Candidiasis strains was also found and paid attention, in addition to the highest rate of Candida albicans outside, AIDS in oral cavity was easy to detection Candida krusei, Candida tropicalis, Candida glabrata, and has multiple beads of the strains coexist. According to foreign material report, HIV infected patients suffering from fungal infection possibility was to90%. The fungus infections include almost all the known pathogenic fungi and some of it was normal to host the fungus. Oral Candidiasis infections and whole body infections were closely associated.So understand oral Candidiasis HIV infections of strain distribution of research and oral Candidiasis occurred and development has important meaning. With China’s HIV/AIDS prevention and control of more attention to the investment enlarged year by year, part of the AIDS patients experienced fungal infection of the higher percentage provinces (such as Guangxi), have decided to provide free antifungal therapy drugs to HIV/AIDS patients. Preliminary estimates of each of the patients were allowed to need to put one million RMB in a year. Once this policy is promoted, the involving amount will be very large.Therefore, HIV/AIDS patients’fungal infections, resistance of the baseline, and how to choose the kind of antifungal drugs, are the government health economic management decision of the major research. Understanding the HIV/AIDS patients fungal infections, resistance status, and against the virus (HIV) treatment effects, to reduce HIV/AIDS clinical missed diagnosis, improve patients’quality of life, improve the clinical rational drug use level to have important meaning.This study with the HIV/AIDS patients for research object, and the separation of the oral Candida identify of antifungal drugs and sensitivity analysis, can help to understand the current strains the proportion, and to against the sensitive degree of antifungal drugs for clinical application. It can provide more secure and reasonable medication guide, and provide the scientific basis for government decision making. After further fungi and drug-resistant strains of genetic analysis, the molecular level research resistance mechanism has laid the foundation.This study is not only to AIDS merger opportunistic fungal infection especially stubborn cases make a diagnosis and give the treatment, prevention has strong application value, but also to other causes of the oral cavities’diagnosis and treatment of fungal infections, and has potential significance for the development of new type of antifungal drugs..Part I HIV/AIDS patients oral Candidiasis cultivation and identification Methods1HIV/AIDS patients’oral Candidiasis collection and culturingHIV/AIDS patients’oral mucous membrane swabs direct plated onto CHROMagar Candida agar medium, in2hours to send to the lab. Candidiasis observation and identification1.1Show color of the culture medium morphologyObserved CHROMagar Candida test showed growth strains, number, and color.1.2The microscopic morphological observationAfter dyeing watched the microscope form, clear was Candidiasis after purified strains, proliferation.1.3API20C AUX identify systemUsed API20C AUX identification system of the points of pure Candidiasis identification.Results 1HIV/AIDS patients’oral Candidiasis culturingMucosa swab to direct vaccination in CHROMagar Candida test medium,24to48hours after the growth, if did not see the growth of content was to be continue training to7days2Candidiasis observation and identification2.1Morphological observationIn Candidiasis showed color the culture medium, according to the growth, color is different to preliminary identification Candidiasis sort:color for the green or emerald for Candida albicans or Candida dubliniensis; Candida tropicalis colonies for blue gray color or iron blue; Candida krusei colonies for pink color, edge blur, have the hair; Smooth colonies for purple color beads; Other colonies for white. And can be observed in more mixed growth.2.2The microscopic morphological observationAfter dyeing, directly under the microscope examination, we found the spores and hyphens, all sure for Candida spp.2.3. API20C AUX systemAPI20C AUX system directly would bacteria identification to the kind of Candida albicans crowd, second were Candida krusei, nearly Candida parapsilosis, Candida famata, Candida glabrata respectively.3Oral Candidacies’detection574HIV/AIDS patients detected159people existed oral Candida, Accounted for the largest proportion were Candida albians.4The relationship between Candida detection rates and CD4+T cell numberAccording to CD4+T cell number,574patients were been divided into two groups, CD4+T<200cells/μl and CD4+T≥200cells/μl. Compare two groups of the Candid’s detection rate χ2=41.689, P=0.000, the difference was significant. CD4+T <200cells/μl patients’oral Candidiasis detection rate was higher than CD4200cells/μl.ConclusionHIV/AIDS patients’oral Candidiasis detection rates were about27.70%, most for Candida albicans. Multi-bacteria symbiosis was existence. CD4+T cells number the greater the Candida detection rate was the lower.Part Ⅱ Healthy people’s oral Candidiasis cultivation and identificationMethods1.1Oral Candidiasis collection of healthy people and culturingMethods consistent with part one1.2Oral Candidiasis observation and identificationMethods consistent with part oneResults2.1The culturing of healthy oral Candida spp.Mucosa swab to direct vaccination in CHROMagar Candida test medium.24to48hours after culturing, if did not see the growth of content is to be continue training to7days.2.2Candidiasis observation and identificationResults consistent with part one2.3Candidiasis detection rateThe detection of the oral Candidiasis healthy for12.72%, with the first part of the HIV/AIDS patients’ oral Candidiasis detection rates were27.70%,Compared with the normal culture group, there was significant difference.(x2=39.954,P=0.000)ConclusionThe healthy people’s oral Candidiasis detection rates lower than the HIV/AIDS patients.Part Ⅲ HIV/AIDS patients’oral Candidiasis in vitro sensitivity of drug resistance experiment and researchMethodsWith the experiment of the detection of Candidiasis continues to points pure, increases the bacterium, training (method with the experiment one), in ATB FUNGUS3of drug sensitive kit, training, matching, according to5kinds of antifungal drugs recommended CLSI/NCCLS Candida species cut-off of drug sensitivity judgment.Results133plants Candida albicans, to5-flucytosine and amphotericin B were sensitive, and fluconazole, itraconazole, voriconazole resistant were66.17%,81.20%,,74.44%;19cases Candida glabrata, to5-flucytosine were sensitive, to fluconazole was natural resistance, amphotericin B, itraconazole, and voriconazole, the resistant were5.26%,15.79%,,5.26%;5strains of parapsilosis were sensitive to these5kinds;5strains of Candida famata itraconazole resistant to was40%, the other four were sensitive;5strains of Candida tropicalis to5-flucytosine were sensitive,to amphotericin B, fluconazole, itraconazole, resistant rates were20%,80%,80%,80%.ConclusionSeveral Candidiasis spp. to the external medicine sensitive experiment shows that the highest rate of Candida albicans to5-flucytosine and amphotericin B were sensitive, to fluconazole, itraconazole, voriconazole the high resistant. |
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