RESUMO
High-risk human papillomavirus (HPV) DNA detection provides high sensitivity but low specificity for moderate-grade cervical intraepithelial neoplasia or worse histological identification. A prospective study evaluated mRNA testing efficacy for predicting this histological diagnosis in case of HPV 16 and/or 18 DNA detection. A total of 165 endocervical samples harboring HPV 16 and/or 18 DNA were tested with NucliSENS-EasyQ® HPV E6/E7-mRNA-assay (Biomerieux, Marcy l´Etoile, France). Women with cytological alterations were referred to colposcopy (n = 111). Moderate-grade cervical intraepithelial neoplasia or worse was diagnosed in 25.8% of women presenting atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions and in 89.8% of women with high-grade squamous intraepithelial lesions. mRNA sensitivity was 81.3% and 84.1%, respectively. Specificity was 52.2%, and 80.0%, respectively. Negative predictive value (NPV) was 88.9% in undetermined or low-grade squamous lesions. Positive predictive value (PPV) was 97.4% in high-grade squamous lesions. mRNA reduced colposcopies by 44.3% in undetermined or low-grade squamous lesions. Direct treatment of mRNA-positive cases reduced 77.5% of colposcopies in high-grade squamous lesions. Women without cytological alterations were followed for 18 months (n = 35), and moderate-grade cervical intraepithelial neoplasia or worse was diagnosed in 34.3%; mRNA sensitivity and specificity were 83.3% and 86.9%, respectively. PPV and NPV were 76.9% and 90.9%, respectively for predicting moderate-grade cervical intraepithelial neoplasia or worse in 18 months. mRNA reduced the number of visits for follow-up in 62.2%. In conclusion, NucliSENS-EasyQ® HPV E6/E7-mRNA-assay (Biomerieux) can serve as a triage test in case of HPV 16 and/or 18 DNA detection.
Assuntos
Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Infecções por Papillomavirus/diagnóstico , RNA Mensageiro/genética , RNA Viral/genética , Displasia do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Idoso , Colo do Útero/patologia , Colo do Útero/virologia , Colposcopia , Testes Diagnósticos de Rotina , Feminino , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/isolamento & purificação , Humanos , Pessoa de Meia-Idade , Proteínas Oncogênicas Virais/análise , Proteínas Oncogênicas Virais/genética , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Gravidez , Estudos Prospectivos , RNA Mensageiro/análise , RNA Viral/análise , Sensibilidade e Especificidade , Triagem , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/virologiaRESUMO
Antecedentes. La vulvovaginitis candidiásica es una infección frecuente en mujeres jóvenes que se acompaña de alta morbilidad y elevados gastos sanitarios. Objetivos. Las candidiasis vaginales causadas por Candida glabrata constituyen un reto terapéutico dada la resistencia adquirida por muchas cepas de esta especie a los antifúngicos azólicos. Métodos. En este trabajo presentamos 2 casos de candidiasis vaginal complicada por Candida glabrata resistentes a fluconazol y tratadas con voriconazol. Resultados. Las 2 pacientes mejoraron tras la administración de voriconazol, 400mg/12h el primer día y posteriormente 200mg/12h durante 14 días, con desaparición de la sintomatología y la negativización de los cultivos. Conclusiones. En conclusión, los resultados obtenidos nos llevan a sugerir el uso del voriconazol como alternativa terapéutica en este tipo de candidiasis que, aunque no comprometen la vida, llevan asociada una elevada morbilidad(AU)
Background. Vulvovaginal candidosis is a common infection in young women, and it is associated with high morbidity and high health costs. Aims. Vulvovaginal candidosis caused by Candida glabrata is a therapeutic challenge due to the acquired resistance of many strains of this species to azole antifungals. Methods. We present two cases of vaginal candidosis complicated by fluconazole-resistant Candida glabrata, and treated with voriconazole. Results. Both patients improved after administration of voriconazole, 400mg/12h the first day and then 200mg every 12h for 14 days. Their symptoms disappeared and cultures became negative. Conclusions. These results suggest voriconazole can be used as a therapeutic alternative for this type of candidosis which, although not life threatening, is associated with a high morbidity(AU)
Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Vulvovaginite/complicações , Vulvovaginite/diagnóstico , Vulvovaginite/terapia , Candida glabrata , Candida glabrata/isolamento & purificação , Candida glabrata/patogenicidade , Antifúngicos/administração & dosagem , Antifúngicos/economia , Antifúngicos/uso terapêutico , Fluconazol/uso terapêutico , Vulvovaginite/microbiologia , Indicadores de Morbimortalidade , Azóis/economia , Azóis/uso terapêuticoRESUMO
BACKGROUND: Vulvovaginal candidosis is a common infection in young women, and it is associated with high morbidity and high health costs. AIMS: Vulvovaginal candidosis caused by Candida glabrata is a therapeutic challenge due to the acquired resistance of many strains of this species to azole antifungals. METHODS: We present two cases of vaginal candidosis complicated by fluconazole-resistant Candida glabrata, and treated with voriconazole. RESULTS: Both patients improved after administration of voriconazole, 400 mg/12 h the first day and then 200 mg every 12 h for 14 days. Their symptoms disappeared and cultures became negative. CONCLUSIONS: These results suggest voriconazole can be used as a therapeutic alternative for this type of candidosis which, although not life threatening, is associated with a high morbidity.
