Research On The Etiology And Epidemiology Of Fungal Vaginitis In Jiading Area

Object To investigate the etiology and epidemiology of fungal vaginitis in Jiading area,and provide more effective guidance for clinical diagnosis and treatment of the disease.Methods 1.To collect 1219 leucorrhea specimens of patients diagnosed as fungal vaginitis in obstetrics and gynecology department from5 hospitals(Jiading District Central Hospital,Maternal and Child Health Hospital,Jiading District Hospital of traditional Chinese Medicine,Nanxiang Hospital and Anting Hospital),from July 2015 to June 2016.To culture the specimens to detect the pathogens distribution and drug sensitivity test was performed to identify the MIC values of fluconazole,voriconazole and itraconazole in clinical strains.2.Multilocus sequence typing(MLST)was conducted to investigate the molecular epidemiology of azole-resistant and azole-sensitive Candida albicans from the patients with Candida albicans vaginitis in Shanghai Jiading District Central Hospital and the genotype distribution,characteristics and the genetic diversity and population relationship of the resistant strains were analyzed.3.To explore whether high gene expression of efflux pump protein coding gene CDR1 and CDR2 is one of the main mechanism of the resistant strains collected,the real-time reverse transcription polymerase chain reaction(PCR)was used to detect the gene expression of CDR1 and CDR2 in azole drugsensitive strains and drug resistant strains respectively.Results 1.There was no significant difference in the distribution of pathogens among hospitals,and Candida albicans was the most(81.4%)pathogen.The highest proportion(14.8%)of non-Candida albicans was found as Candida glabrata.The proportion of Candida albicans in recurrent patients was 66.7%.Total sensitive rates of all strains to fluconazole,voriconazole and itraconazole were 91.3%,93.2% and 70.1%,respectively.The sensitivity of Candida albicans and non-Candida albicans to three azoles were 92.6%,93.5%,72.4% and 85.5%,91.6%,59.9%,respectively.Five hospitals showed significant differences in the sensitivity of fluconazole and itraconazole.2.After MLST analysis in the selected study subjects,there were 14 types of ST(sequence types,ST)in the drug resistant group,9 of which had been reported,and the main types were ST310,ST1364,ST2551 and ST135.There were 19 ST types in the sensitive group,12 of which had been reported,and the main types were ST2048 and DST1471.The ratio of ST type of drug resistant group to the number of isolates was lower than that of the sensitive group,and the number of ST type in the two groups showed a linear positive correlation with the number of the strains.3.By real-time reverse transcription polymerase chain reaction(PCR)in the selected objects,it had been found that the expression levels of CDR1 and CDR2 in drug resistant groups were higher than the sensitivity group(P < 0.05).The rate of high expression of CDR1 and CDR2 had reached 28.6% and 67.9% in the resistant group.However,the MIC value of drug-resistant strains showed no significant correlation with CDR1 and CDR2 gene expression(P > 0.05).Conclusion 1.The pathogen of fungal vaginitis in Jiading district ofShanghai is mainly Candida albicans,but the distribution of pathogen of recurrent patients shows a trend of diversity.Some pathogens are obvious resistance to itraconazole.There are also some differences in drug susceptibility from the various species and the research hospitals.It is helpful to promote clinical therapy through strengthening the pathologic examination of fungal vaginitis and drug sensitive test.2.The pathogen of Candida albicans vaginitis found in the Central Hospital of Jiading District in Shanghai was multiple cloning,but the genotype distribution of azole-resistance strain was more concentrated than that of sensitive strains.The affinity of each genotype of resistant strain was closer than of the sensitive strain and the genotypes of their populations were significantly clustered.3.The azole-resistant strains of Candida albicans vaginitis found in the Central Hospital of Jiading District in Shanghai showed the high expression of ABC transporters gene CDR1 and CDR2,which caused the increasing efflux to fluconazole,voriconazole and itraconazole.It is one of the main mechanisms for the appearance of drug resistance phenomenon in such drugs.But the other drug resistant mechanisms cannot be ruled out.