Is candidiasis the true cause of vulvovaginal irritation in women with diabetes mellitus?

Article Abstract:

Candida albicans is the most frequent cause of yeast infections in humans. The organism is common in the oral, gastrointestinal and urogenital tracts and is found in both men and women, children and adults. The etiologic agents of this infection are adventitious pathogens; the condition of the host is more important to the extent and severity of the infection than the virulence of the yeast. Immunosuppression, immunodeficiency, hormonal imbalances and broad spectrum antibiotic therapy predispose patients to yeast infections, most commonly vulvovaginitis. About 75 percent of all adult females develop vulvovaginal candidiasis at some time in their lives. Women with diabetes mellitus often experience glycosuria (sugar in the urine) and increased glucose concentrations in vaginal secretions, which may precipitate vulvovaginitis. At a diabetes clinic, a survey asked 100 consecutive women with non-insulin dependent diabetes mellitus (NIDDM) to provide information about the duration, type and treatment of any vaginal infection they might have experienced in the past three years, and whether they had a gynecological examination prior to receiving treatment. The survey results revealed that 36 of the 100 diabetic women had visited their physicians for treatment of vaginitis in the previous 3 years; 26 women were treated with antifungal antibiotics without having vaginal smears or a vaginal examination. In a second study, 27 postmenopausal women with NIDDM and symptoms of vulvovaginitis were evaluated. Each woman had a vaginal exam, a high vaginal swab and a midstream urine collection at three consecutive weekly visits. Clinical signs and symptoms of vulvovaginitis were noted and clinically significant microbiological pathogens were isolated and identified. Of the second group's specimens, Candida albicans was isolated in only 6 cases. Strains of beta hemolytic streptococci, especially group B, were isolated in 50 percent of the cases. All of the pathogens responded to appropriate therapy. Inasmuch as Candida albicans was not isolated in the specimens obtained from the diabetic women as frequently as expected, clinicians should reconsider the practice of prescribing antifungal antibiotic treatment for vulvovaginitis without examining high vaginal swabs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Causes of, Risk factors, Diabetics, Drug therapy, Type 2 diabetes, Candidiasis, Vulvovaginal, Vulvovaginal candidiasis, Vulvovaginitis

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Increased albumin excretion in diabetes

Article Abstract:

This article reviews the clinical developments and implications of increased urinary albumin secretion (albuminuria) in patients with diabetes. The development of a radioimmunoassay to measure albumin concentration in the urine of diabetics has facilitated the detection of albumin secretion in specimens that would have tested negative using standard procedures. The difficulty of a confusing nomenclature for albuminuria is addressed and an acceptable alternative offered. Studies that have investigated the diagnostic and prognostic value of a raised urinary albumin excretion rate are described. The mechanisms and pathophysiology of proteinuria and albuminuria are discussed, with emphasis on diabetic patients. The transcapillary escape rate of albumin and its relationship to albuminuria is described. Analytical procedures are discussed individually, and are also compared with each other. Methods mentioned are radioimmunoassay, non-isotopic immunoassay, nephelometry and immunoturbidimetry, and radial immunodiffusion; semiquantitative procedures are also briefly considered. Specific factors impinging on analytical results of tests are described. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Measurement, Diabetes, Diabetes mellitus, Albumin

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A comparison between two screening methods for detection of microproteinuria

Article Abstract:

A urine test tablet may detect small amounts of protein in the urine better than a commonly used urine dipstick test. Researchers obtained urine samples from 401 pregnant women and compared the sensitivity of the Micro-bumintest to that of Ames Multistix 10SG in their ability to detect small amounts of urinary protein. The Micro-bumintest was much better at detecting protein in the urine without false positive or false negative results than was the Multistix 10SG test. The Micro-bumintest could detect small and large amounts of protein in the urine samples. Even small amounts of protein found in the urine of a pregnant woman may predict the development of preeclampsia, a serious complication of pregnancy involving high blood pressure and protein in the urine.

Analysis, Urine, Urinalysis, Proteinuria

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