Επιδράσεις συνθηκών του μικροπεριβάλλοντος του βλεννογόνου του κόλπου στην επιβίωση και σε άλλους βιολογικούς χαρακτήρες στελεχών Candida albicans

Abstract

Female patients often visit physicians reporting symptoms of acute vulvovaginitis. They complain of pain and irritation and they seek immediate relief and no symptom recurrence. In the past few years, an increase in both the number of first-time incidents of vulvovaginal candidiasis (VVC) and the number of recurrent vulvovaginal candidiasis (RVVC) was noted in women of reproductive age. In recent studies infection by Candida species has been the most common reason of vulvovaginitis in Europe, and the second leading cause in the USA. Furthermore, an increased tolerance of the candida species to the broadly administered antifungal drugs has been observed. Therefore, investigation of the effectiveness of some new antifungal agents would be highly beneficial. AIMS This dissertation aimed in: A. The research of distribution of the Candida species in four groups of patients who present disturbance of the mucosa of vaginal microflora according to their medical history and to clinical and laboratory results: i) patients with Vulvovaginal Candidiasis (VVC), ii) patients with Recurent Vulvovaginal Candidiasis (RVVC), iii) women in pregnancy, iv) patients with type I and II diabetes. B. An in-vitro evaluation of the susceptibility of the isolated Candida species to two antifungal agents and their clinical efficacy was performed using a broth microdilution method. Two antifungal agents have been tested: i) a triazole, the itraconazole, a broadly per os administered antifungal drug, ii) an imidazole, the fenticonazole a novel topical agent, which was at phase III of clinical trials, in the drug approval procedure, when this project started. C. The retrospective project of in-vitro susceptibility of itraconazole and fenticonazole, that was tested for the very first time in Greek patients with: i) Vulvovaginal Candidiasis (VVC), ii) Recurent Vulvovaginal Candidiasis (RVVC), iii) pregnancy, iv) type 1 and 2 diabetes. D. The identification of pathogens such as Mycoplasma hominis, Ureoplasma urealyticum, Chlamydia trachomatis, Human Papilloma Virus, E. coli, Streptococcus agalactiae, Enterococcus faecalis that were probably responsible for the disturbance of the mucosa of vaginal microflora in the patient groups. E. The study of exogenous predisposing factors, such as antibiotics, oral contraceptives and highestrogen contraceptives for therapy, that according to international evidence provide the disturbance of the mucosa of vaginal microflora, having as result the presence of vulvovaginal candidosis. METHODS The guidelines M27-A2 of CLSI (Clinical and Laboratory Standards Institute, USA) and those of Subcommittee on Antifungal Susceptibility Testing (AFST) of the ESCMID European Committee for Antimicrobial Susceptibility Testing (EUCAST), were followed while performing the broth microdilution methods to test the susceptibility of the Candida species. These guidelines did not include a method and specific break points for fenticonazole. Consequently, we performed a new, pilot, experimental procedure to test fenticonazole using the break points of itraconazole because they both have similar chemical characteristics (water-insoluble substances). The results of the two broth microdilution reference methods had been compared and no difference of statististical significance was found. The use of these two reference methods validates the credibility of results*. We also examined the clinical efficacy of the antifungal drugs according to the percentages of cure or recurrence. .....................................