질염 환자에서 다중 PCR을 이용한 배양이 까다로운 미생물 검출의 임상적 유용성
Clinical Implications of Multiplex PCR Detection of Fastidious Microorganisms in Vaginitis Patients
2
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
배경: 여성에서 세균성 질염과 편모충 질염은 매우 흔하고 치료 후 재발도 많은 것으로 알려져 있어, 정확하고 치료 후 추적검사가 가능한 검사방법이 요구되고 있다. 이에 본 연구에서는 질염 환자에서 중합효소연쇄반응(polymerase chain reaction, PCR)을 이용한 배양이 까다로운 미생물 검출의 임상적 유용성을 평가하고자 하였다. 방법: 중앙대학교 용산병원을 방문하여 다중 PCR에 의해 Trichomonas vaginalis (TV), Neisseria gonorrhoeae (NG),Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Mycoplasma genitalium (MG), Mycoplasma hominis (MH) 중 1균종 이상 검출된 216명의 환자를 대상으로 하였다. PCR 검사의 임상적 중요성을 평가하기 위해서 후향적 병록지 검토를 통하여 각 환자의 증상, 검사 결과, 질염 치료 후 결과를 조사하였다. 결과: 질염 환자의 73.1%에서 비정상적인 질 분비물, 가려움증을 나타냈고, 38.4%에서는 하복부 통증, 13%에서는 요로계 불편감을, 그 외에 발열 등을 호소하였다. 다중 PCR 검사 결과, MH (116명, 53.8%), UU (86명, 39.8%), CT (62명, 28.7%)등의 순으로 검출되었다. 86명(38.9%)은 중복감염을 나타내었다. 단일 양성 결과에서, PCR 검사 결과가 보고된 후에 치료제 처방이 바뀐 경우, 치료제 처방이 바뀌지 않은 경우는 각각 전체의 65.6%, 17.7%를 차지하였다. 결론: 질염 환자에서 다중 PCR을 이용한 질염의 진단은 적절한 항생제 선택에 도움을 줄 수 있으며, 특히 원인 미생물 감별이 어려운 환자에게 임상적으로 유용할 것으로 생각되었다.
Abstract
Background: Bacterial vaginitis (BV) and Trichomonas vaginitis are the most frequently recurring infectious diseases in women. Therefore, accurate tests for post-treatment follow-up are required. A multiplex PCR assay allows for the simultaneous detection of multiple pathogens in a single specimen. In this study, we assessed the clinical implications of multiplex PCR detection of fastidious microorganisms causing vaginitis. Methods: A total of 216 vaginitis patients who presented to Chung-Ang University Yongsan Hospital with more than one positive result on multiplex PCR (Trichomonas vaginalis (TV), Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Mycoplasma genitalium (MG), Mycoplasma hominis (MH)) were retrospectively enrolled in this study. Each patient’s clinical symptoms, initial treatment and follow-up for BV, and other related test results were also retrospectively reviewed. Results: The most commonly reported symptom was abnormal discharge, followed by pruritis (73.1%), lower abdominal pain (38.4%), urination difficulties (13%), and others such as fever. According to the multiplex PCR results, there were 116 cases (35.8%) of MH, 86 cases (26.5%) of UU, 62 cases (19.1%) of CT, and 84 cases (38.9%) were mixed infections. Among those patients with single infections, treatment changed for 63 cases (65.6%) while treatment remained unchanged for 17 (17.7%) after PCR results were reported. Conclusion: The diagnosis of BV using multiplex PCR is clinically effective and the results of which can be incorporated in antibiotic selection for patients with multiple sexually transmitted diseases (STD). Multiplex PCR may be especially helpful in the diagnosis of patients in whom the differentiation of STD pathogens is difficult using traditional methods.
참고문헌 (25)
- Lowe NK, "Accuracy of the clinical diagnosis of vaginitis compared with a DNA probe laboratory standard", Obstet Gynecol, 113, pp.89~95 (2009)
- Eckert LO, "Clinical practice. Acute vulvovaginitis", N Engl J Med, 355, pp.1244~1252 (2006)
- Owen MK, "Management of vaginitis", Am Fam Physician, 70, pp.2125~2132 (2004)
- Anderson MR, "Evaluation of vaginal complaints", JAMA, 291, pp.1368~1379 (2004)
- Bae HG, "Detection of Ureaplasma urealyticum and Mycoplasma hominis in pregnant Women Using MYCOFAST(R) Evolution 2 and PCR", Korean J Clin Microbiol, 6, pp.74~80 (2003)
- Atashili J, "Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies", AIDS, 22, pp.1493~1501 (2008)
- Mitchell C, "Detection of fastidious vaginal bacteria in women with HIV infection and bacterial vaginosis", Infect Dis Obstet Gynecol (2010)
- 류재숙, "Trichomonas vaginalis and trichomoniasis in the Republic of Korea", The Korean Journal of Parasitology, 44(2), pp.101~116 (2006), 대한기생충학회
- Dickey LJ, "Guidelines for the treatment of bacterial vaginosis: focus on tinidazole", Ther Clin Risk Manag, 5, pp.485~489 (2009)
- Thomason JL, "Statistical evaluation of diagnostic criteria for bacterial vaginosis", Am J Obstet Gynecol, 162, pp.155~160 (1990)
- Nugent RP, "Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation", J Clin Microbiol, 29, pp.297~301 (1991)
- Patel SR, "Systematic review of diagnostic tests for vaginal trichomoniasis", Infect Dis Obstet Gynecol, 8, pp.248~257 (2000)
- Donders G, "Diagnosis and management of bacterial vaginosis and other types of abnormal vaginal bacterial flora: a review", Obstet Gynecol Surv, 65, pp.462~473 (2010)
- Madico G, "Diagnosis of Trichomonas vaginalis infection by PCR using vaginal swab samples", J Clin Microbiol, 36, pp.3205~3210 (1998)
- 이은실, "생식기 감염 증상이 있는 폐경 전 여성에서의 Mycoplasmas 감염률", Obstetrics & Gynecology Science, 51(10), pp.1142~1147 (2008), 대한산부인과학회
- Fredricks DN, "Changes in vaginal bacterial concentrations with intravaginal metronidazole therapy for bacterial vaginosis as assessed by quantitative PCR", J Clin Microbiol, 47, pp.721~726 (2009)
- Carr PL, ""Shotgun" versus sequential testing. Cost-effectiveness of diagnostic strategies for vaginitis", J Gen Intern Med, 20, pp.793~799 (2005)
- 김미주, "조산통 혹은 조기양막파수 산모와 임신 중반기 무증상 산모에서 Ureaplasma urealyticum과 Mycoplasma hominis의 검출율", 대한주산의학회잡지, 19(4), pp.370~376 (2008), 대한주산의학회
- Lee HH, "Detection of chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum in the cervical swab and paraffin tissue with female genital tract infection", Korean J Obstet Gynecol, 42, pp.549~555 (1999)
- Livengood CH, "Bacterial vaginosis: an overview for 2009", Rev Obstet Gynecol, 2, pp.28~37 (2009)
- Yoshida T, "Rapid detection of Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum organisms in genitourinary samples by PCR-microtiter plate hybridization assay", J Clin Microbiol, 41, pp.1850~1855 (2003)
- Caliendo AM, "Real-time PCR improves detection of Trichomonas vaginalis infection compared with culture using self-collected vaginal swabs", Infect Dis Obstet Gynecol, 13, pp.145~150 (2005)
- Horii T, "Use of a dual priming oligonucleotide system to detect multiple sexually transmitted pathogens in clinical specimens", Lett Appl Microbiol, 49, pp.46~52 (2009)
- 조성남, "난치성 질염의 최신 치료법", Obstetrics & Gynecology Science, 48(2), pp.261~268 (2005), 대한산부인과학회
- Lamont RF, "The efficacy of vaginal clindamycin for the treatment of abnormal genital tract flora in pregnancy", Infect Dis Obstet Gynecol, 11, pp.181~189 (2003)