One-hundred-and-four isolates of yeast were collected from the vaginas of !I7 outpatients. The isolates were identified by their characteristics in a carbohydrate assimilation test, a serological test and from their morphology.Cundida ufbicuns and Cmdida gfubrutu were the major isolates (75 % and 20 %, respectively). The karyotypes of the isolates were analysed by pulsed-field gel electrophoresis and almost all the karyotypes were distinguishable from one another when the band mobilities were carefully compared. Characteristics and karyotypes were not directly correlated, but seven C. ufbicms isolates (from six patients) had a common atypical karyotype and shared the same phenotype. These isolates are inferred to be generated by a wide genomic reorganization and mutation and the phenotypic changes may be advantageous for survival. The karyotypes of the isolates recovered from individual patients after intervals of 1-6 months were all identical except for one or two highly variable bands which were identified with an rDNA probe. This suggests that the variable bands are too variable to be useful for distinguishing strains, but from the patterns of the identical bands (i.e. except for the variable bands) we concluded that strains from individual patients do not change, at least over short periods. This, coupled with the extensive inter-isolate variability in karyotype, will be useful for Candida source determination and epidemiological studies.

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BackgroundWe searched for indicators to predict the prognosis of infectious peritonitis by measuring levels of complement proteins and activation products in peritoneal dialysis (PD) fluid (PDF) of patients at early stages of peritonitis. We retrospectively analyzed the relationship between the levels of sC5b-9, C3 and C4 in PDF and the subsequent clinical prognosis.MethodsWe measured levels of sC5b-9, C3 and C4 in PDF on days 1, 2 and 5 post-onset of peritonitis in 104 episodes of infectious peritonitis in PD patients from 2008 and retrospectively compared levels with clinical outcomes. Further analysis for the presence of causative microorganisms or to demonstrate bacterial culture negative peritonitis was performed and correlated with change of levels of sC5b-9 in PDF.ResultsWhen PD patients with peritonitis were divided into groups that either failed to recover from peritonitis and were finally withdrawn from PD (group 1; n = 25) or recovered (group 2; n = 79), levels of sC5b-9, C3 and C4 in PDF were significantly higher in group 1 patients compared to those in group 2 on day5. Analysis of microorganisms showed significantly higher sC5b-9 levels in PDF of peritonitis cases caused by culture negative peritonitis in group 1 compared with group 2 when we analyzed for individual microorganisms. Of note, on day5, the sC5b-9 levels in PDF were similarly high in peritonitis caused by fungi or other organisms.ConclusionOur results suggested that levels of complement markers in PDF, especially sC5b-9, have potential as surrogate markers to predict prognosis of PD-related peritonitis.

Antigenic components of Candida albicans were extracted from whole ceils with a buffer containing SDS and 2-mercaptoethanol, and separated by SDS-polyacrylamide gel electrophoresis. The components reactive with IgG, IgA, IgM and IgE antibodies in sera from patients with (14 subjects) and without (15 subjects) C. albicans in the vagina, and from healthy females (34 subjects), were investigated by immunoblotting using immunoglobulin class-specific antibodies. Many components reacted with IgG and IgA in all sera tested; the major antigens that reacted strongly with the sera were 67, 62, 29 and 25 kDa components. Several components were observed which reacted with IgM in 63% of the sera; the 67, 62 and 25 kDa components that reacted with IgG and IgA also reacted with IgM. No components reacting with IgE were detected in any of the sera. No striking differences in antibody binding profiles to whole cell antigens were detected among the C. albicans positive and negative patients or the healthy subjects. On the other hand, IgG against extracellular proteinase-was more frequently detected in the C. albicans positive patients than in the C. alb# cans negative group or the healthy subjects. This may suggest that vaginal infection with C. albicans contributes to a rise in anti-proteinase antibody levels.

Summary: Vulvovaginal mycosis is primarily caused by 2 species of fungi, Candida albicans and Torulopsis glabrata. Certain clinical characteristics of vulvovaginal mycosis caused by different fungi were studied. Of the 314 cases of vulvovaginal mycosis, 259 were caused by C. albicans, 24 by Candida species other than C. albicans, 27 by T. glabrata, one by Rhodotorula, and 3 by C. albicans and T. glabrata together. The age distribution showed significantly more patients (p <0.01) under the age of 30 in the C. albicans group in the T. glabrata group. Significantly fewer (p <0.05) non‐pregnant women belonged to the C. albicans than to the non‐albicans Candida group; the number also seemed smaller than in the T. glabrata group (p <0.10). The number of cases with leukorrhea only was significantly lower (p <0.01) in the C. albicans than in the T. glabrata group. Whether patients were single or married, nulliparous or multiparous, users of antibiotics or hormones revealed no differences. Zusammenfassung: Die Vulvovaginalmykose wird hauptsächlich von zwei Pilzarten verursacht: Candida albicans und Torulopsis glabrata. Im vorliegenden Beitrag wird die ätiologie dieser Erkrankung in einem Patientinnenkollektiv statistisch untersucht. Es zeigte sich, daß von 314 Fällen vulvovaginal Mykose 259 auf C. albicans, 24 auf andere Candida‐Species als C. albicans, 27 auf T. glabrata, einer auf Rhodotorula und 3 auf Mischinfektionen durch C. albicans und T. glabrata zurückzuführen waren. Hinsichtlich der Altersverteilung kamen jüngere als 30 Jahre alte Patientinnen statistisch signifikant häufiger (p <0.01) in der C. albicans‐Gruppe als in der T. glabrata‐Gruppe vor. Eine signifikant geringere Anzahl nicht‐schwangerer Frauen (p <0.05) ist in der C. albicans‐Gruppe, verglichen mit der nicht‐albicans Candida‐Gruppe wie auch mit der T. glabrata‐Gruppe (p <0.10), enthalten. Fälle mit Leukorrhoe allein fand sich statistisch signifikant seltener in der C. albicans‐ als in der T. glabrata‐Gruppe (p <0.01). Ob die Patientinnen ledig oder verheiratet, Nullipara oder Multipara waren oder ob sie Antibiotika oder Hormone nahmen zeigte keine statistisch signifikanten Unterschiede.

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A self-medication therapy with clotrimazole vaginal tablets, application of two tablets at bedtime on 3 consecutive days, was carried out to find out whether vulvo-vaginal mycoses can be treated more effectively and with fewer drop-outs when treatment is simpler and shorter. Our study included forty-one patients, seventeen of whom were in their second or third trimester of pregnancy. There was no significant difference between the efficacy rates in the pregnant (82.4%) and non-pregnant (83.3%) women. In 36 infections caused by various Candida species the cure rate was 91.7%; in 8 infections due to Torulopsis glabrata it was 75%. For thirty-three women with primary infections the cure rate was 84.8% and for eight women with recurrent infections it was 75%. The cure rate for the entire group of patients was 82.9% (thirty-four out of forty-one cases). Failures were seen in six out of thirty cases, i.e. in 16.7%. In one case burning was experienced after the insertion of the vaginal tablet so that treatment was discontinued.