新生儿红臀与局部微生物感染的关系

选择新生儿科2001年8月-2002年8月收治的日龄1-9 d的40例红臀患儿与对照组新生儿进行观察。红臀病例组检出6例白色念珠菌(15％),其中5例为男性,而对照组中仅在1例男性儿检出(2.5％),两组比较有显著性差异(P相似文献   

Elevated plasma RANTES levels in patients with atopic dermatitis

Eosinophils and T cells are involved in the pathologic process of atopic dermatitis. To further understand the role of these cells, and the possible involvement of RANTES, in the pathogenesis of atopic dermatitis, we measured the plasma level of RANTES using the sandwich ELISA. The mean plasma level of RANTES in 11 patients with atopic dermatitis was significantly higher than that of 15 normal control subjects. RANTES levels were higher in patients with severe form of atopic dermatitis than that of patients with mild disease. These findings suggest that RANTES may play a role in the recruitment and activation of eosinophils and T cells in atopic dermatitis.     

结肠黑变病伴息肉的内镜特点

目的研究结肠黑变病合并结肠息肉的内镜及病理特点。方法回顾2002年10月-2004年9月该院结肠镜检查发现的结肠息肉病例，分析黑变病合并息肉的内镜及病理特点。结果结肠黑变病伴发结肠息肉的发生率为40．95％，较非黑变病者（20．41％）明显增高（P〈0.005）。黑变病组息肉直径较非黑变病组小，但无统计学差异。结论黑变病患者易伴发息肉和癌症，故对经常服用蒽醌类泻药的患者应定期行结肠镜检查，注意发现黑变病，同时警惕是否有癌变或息肉的存在。对于已经确诊为黑变病的患者，定期的肠镜随访是非常必要的。     

Newborn skin: Part I. Common rashes

Rashes are extremely common in newborns and can be a significant source of parental concern. Although most rashes are transient and benign, some require additional work-up. Erythema toxicum neonatorum, acne neonatorum, and transient neonatal pustular melanosis are transient vesiculopustular rashes that can be diagnosed clinically based on their distinctive appearances. Infants with unusual presentations or signs of systemic illness should be evaluated for Candida, viral, and bacterial infections. Milia and miliaria result from immaturity of skin structures. Miliaria rubra (also known as heat rash) usually improves after cooling measures are taken. Seborrheic dermatitis is extremely common and should be distinguished from atopic dermatitis. Parental reassurance and observation is usually sufficient, but tar-containing shampoo, topical ketoconazole, or mild topical steroids may be needed to treat severe or persistent cases.     

E试验测定78株念珠菌属真菌对4种抗真菌药物的敏感性

目的 检测4种抗真菌药物对念珠菌属真菌的最低抑菌浓度（MIC）并分析其耐药性。方法 用E试验检测两性霉素B（AP）、酮康唑（KE）、氟康唑（FL）、伊曲康唑（IT）对78株临床分离的念珠菌属真菌的MIC值。结果 78株念珠菌属真菌对AP、KE、FL、IT的总敏感率分别是89．7％、92．3％、85．9％、85．9％；白念珠菌对AP、KE、FL和IT的敏感率分别是96．9％、96．9％、100％和87．5％。结论 4种药物对白念珠菌的体外抗菌活性均较好，但对非白念珠菌的抗菌活性则较前者为差。     

结肠黑变病30例临床病理分析

目的 研究结肠黑变病的临床病理特点和病理性色素的性质。方法 全部病例作了临床资料主组织学观察,11全了脂褐素、黑色素、含铁血黄素和胆色素特殊染色,3例作APAAP法免疫组化染色及电镜检查,结果 结肠黑变病黏膜固有层都有棕褐色色素沉着,该色素的3旨褐素、黑色素、含铁血黄素和胆色素染色均为阴性,HMB45、B－100免疫组化染色该色素颗料亦为阴性,电镜见该色素为脂褐素样物质,结论 结肠黑变病的在很大程度上与便秘服用泻药有关,色素可能系巨噬细胞吞噬蒽醌类泻剂后形成的脂褐素样物质,它能否导致结直肠肿瘤有等进一步研究。     

Use of rDNA restriction fragment length polymorphisms to differentiate strains of Candida albicans in women with vulvovaginal candidiasis.

Epidemiologic studies in women with recurrent Candida vaginitis have been hampered in the past by the lack of a reproducible typing system. Several molecular probes have now been developed that have the ability to differentiate strains of Candida albicans and give reproducible results. In this investigation, 24 women with Candida vaginitis were studied in a longitudinal fashion for 30 days following short-course antifungal therapy. Seven women with either recurrent vaginitis or with multiple culture-positive sites with C. albicans were included in an epidemiological study. A total of 18 isolates of C. albicans (12 vaginal and six rectal) were typed utilizing restriction fragment length polymorphisms of rDNA. This technique was able to differentiate five different strains of C. albicans. Our epidemiologic study revealed that vaginal and rectal strains recovered from the same women were usually different. None of our patients had a similar vaginal and rectal strain prior to treatment, and only one patient had the same strain isolated from both the rectum and the vagina at the time of recurrence. On the other hand, we found that the same strain of C. albicans was initially and later recovered from the vagina in four of five women who failed treatment or developed recurrent vaginitis. These results suggest that recurrent episodes of C. albicans vaginitis, following short-course antifungal therapy, are often due to relapse of the original infecting strain and not due to autoinoculation from the rectum.(ABSTRACT TRUNCATED AT 250 WORDS)     

Trends in species distribution and susceptibility to fluconazole among blood stream isolates of Candida species in the United States

National surveillance of blood stream infections (BSI) attributable to Candida spp. has been limited to date. Recent studies have suggested in increase in the proportion of BSI attributable to non-Candida albicans species and have also raised concerns regarding the emergence of antifungal resistance among Candida spp. The increased utilization of broad-spectrum antifungal agents and the recognition of Candida spp. as prominent pathogens with the potential for developing antifungal resistance, emphasize the need for ongoing surveillance of antifungal susceptibility patterns. In this investigation trends in species distribution and susceptibility to fluconazole among BSI isolates of Candida spp. referred to our laboratory by United States hospitals were evaluated over the 7-year period from 1992 to 1998. A total of 1579 BSI isolates from more than 50 medical centers were processed. Overall, C. albicans accounted for 52% of isolates followed by C. glabrata (18%), C. parapsilosis (15%), C. tropicalis (11%), and C. krusei (2%). The proportion of BSI isolates that were C. albicans ranged from 45% in 1992 to 60% in 1998. Among the non-C. albicans isolates, C. glabrata succeeded C. parapsilosis as the most common species beginning in 1995. Overall, the susceptibility of all Candida species (C. albicans plus all other species) to fluconazole remained stable (MIC90, 16 micrograms/mL). The fluconazole MIC90 for C. albicans was 0.5-2.0 micrograms/ml for all years studied except 1995 (8.0 micrograms/mL) and was 1.0 microgram/mL overall. The present study suggests a continued prominent role of C. albicans as a cause of BSI, and a constant level of susceptibility of Candida BSI isolates to fluconazole over 7 years. These data should serve as a baseline for future surveillance efforts for anti-fungal agents tested against yeast BSI isolates.     

Serum IgE in atopic dermatitis: relationship to severity of cutaneous involvement and course of disease as well as coexistence of atopic respiratory diseases

Serum IgE concentrations were determined according to the radioimmunosorbent technique (RIST, Phadebas) on 116 adult patients with atopic dermatitis of varying severity and activity. Geometric mean IgE levels of patients with atopic dermatitis were significantly higher compared with the mean level of ninety-three non-atopic adult subjects without parasitic infestation. Severity of the atopic dermatitis was highly correlated to the levels of serum IgE. Severe chronic cases with ever-recurrent exacerbations show the most extreme values. In the moderate forms of atopic dermatitis, coexistent bronchial asthma causes a greater increase in the IgE values. Among the mild or abortive forms higher IgE levels were found in cases with allergic rhinitis than in the cases with 'pure' atopic dermatitis. Other findings in connection with IgE in atopic dermatitis are summarized. The pathogenetic significance of IgE in the cutaneous changes is briefly discussed.     

3580例阴道炎患者阴道分泌物病原学检测及耐药性研究

目的 了解广州地区成年女性阴道炎患者阴道分泌物病原体感染状况及耐药情况,为该病的临床诊治提供依据.方法 对2010年1～12月在该院妇科就诊的阴道炎患者阴道分泌物常规及病原体检测结果进行统计分析.结果 3 580例患者阴道分泌物常规检查,检出真菌1 376例(占38.4%)、细菌性阴道炎1 256例(35.1%)、滴虫55例(1.5%)、革兰阴性双球菌11例(0.3%),清洁度以Ⅲ、Ⅳ度为主,分别占48.9%、27.5%.2 126例患者病原学检测,共检出2 248株病原体,其中假丝酵母菌1 028株、支原体728株、细菌457株、沙眼衣原体35株、485例患者同时检出两种或两种以上病原体,混合感染率为22.8%(485/2 126).检出率前三位的病原体依次为:白色假丝酵母菌、解脲支原体、大肠埃希菌.白色假丝酵母菌对抗真菌药物普遍敏感,耐药率均在10%以下;解脲支原体对多数抗生素的耐药率均较低,对交沙霉素、强力霉素等敏感率在95%以上;大肠埃希菌对氨苄西林及第三代头孢菌素耐药率较高,但对亚胺培南及阿米卡星仍高度敏感.结论 白色假丝酵母菌和解脲支原体是广州地区成年女性阴道炎患者感染的主要病原体.临床应重视病原菌的分离培养及药敏试验,并根据培养及药敏结果合理选用敏感抗菌药物的治疗.     

HWY-289, a novel semi-synthetic protoberberine derivative with multiple target sites in Candida albicans

The antifungal properties of 515 synthetic and semi-synthetic protoberberines were investigated. HWY-289 was chosen for further study because it exhibited the most significant anti-Candida activity (MICs were 1.56 mg/L for Candida albicans and Candida krusei; 6.25 mg/L for Candida guilliermondii) but did not demonstrate toxicity in rats. HWY-289 inhibited the incorporation of L-[methyl-(14)C]methionine into the C-24 of ergosterol in whole cells of C. albicans (IC(50) 20 microM). However, HWY-289 (100 microM) had no effect on mammalian cholesterol biosynthesis in rat microsomes while miconazole (100 microM) was a potent inhibitor of cholesterol biosynthesis under identical assay conditions. A second major target site for HWY-289 was identified that involves cell wall biosynthesis in C. albicans. HWY-289 was a potent inhibitor of the chitin synthase isozymes CaCHS1 and CaCHS2, with IC(50) values of 22 microM for each enzyme. The effect was highly specific in that HWY-289 had no significant effect on C. albicans CaCHS3 (IC(50) > 200 microM). Thus, HWY-289 compared favourably with well-established antifungal agents as an inhibitor of the growth of Candida species in vitro, and may have considerable potential as a new class of antifungal agent that lacks toxic side effects in the human host.     

Candida krusei fungaemia: antifungal susceptibility and clinical presentation of an uncommon entity during 15 years in a single general hospital

BACKGROUND: Candida krusei fungaemia is an uncommon entity described in immunocompromised patients previously exposed to azole agents. METHODS: From 1988 to 2003, 13 episodes of C. krusei fungaemia (2.3% of all fungaemias) were detected in our institution and compared with 39 Candida albicans controls. Susceptibility testing was carried out with the modified microdilution method according to NCCLS recommendations. RESULTS: Underlying conditions were: HIV infection (4), haematological malignancies (4), organ transplantation (2), abdominal surgery (2) and lactose intolerance (1). Nine patients (69%) were not neutropenic. In comparison with C. albicans, patients with C. krusei infection had more commonly received antifungal agents (54% versus 15%, P = 0.006), had a haematological disease (31% versus 3%, P = 0.03), or a transplant (15% versus 3%, P = 0.08), were on corticosteroids (47% versus 13%, P = 0.01) and were neutropenic (31% versus 0%, P < 0.001). Patients with C. albicans had more surgical interventions (41% versus 15%, P = 0.09) and bladder catheters (61% versus 31%, P = 0.05). The most common origin for C. albicans was a catheter (41% versus 0%; P = 0.006) whereas for C. krusei the most common origin was unknown (69% versus 20%; P = 0.001). C. krusei presented more commonly with skin lesions in neutropenic patients (23% versus 5%; P = 0.05). Multivariate analysis of these differential characteristics showed that the only factor that independently predicted the presence of C. krusei fungaemia was the administration of antifungal agents before the fungaemia (RR: 6.4; P=0.009; 95%CI 1.6-25.99). Overall mortality of C. krusei fungaemia was 38% (C. albicans 49%). Except for voriconazole (MIC90 0.125 mg/L), azoles and 5-flucytosine had poor activity against C. krusei, whereas amphotericin (MIC90 1 mg/L) and LY-303366 (MIC90 0.06 mg/L) showed good activity. CONCLUSION: C. krusei fungaemia incidence remains low despite widespread use of azoles. It may occur outside the setting of cancer patients with previous antifungal use. The presence of skin lesions should be a warning sign.     

住院患者下呼吸道374株念珠菌鉴定及对抗真菌药物的耐药性

目的分析患者下呼吸道念珠菌属分布及药敏特点,为指导临床用药提供理论依据。方法采用科玛嘉显色培养基对分离的374株念珠菌进行菌种鉴定,并用ATBFUNGUS 2INT进行真菌药敏试验。结果念珠菌属中白色念珠菌仍是最常见的,光滑念珠菌居第2位占14．4％;白色念珠菌对氟康唑及伊曲康唑的耐药率均较前提高;光滑念珠菌对氟康唑及伊曲康唑的敏感率较低,仅为29．6％;克柔念珠菌天生对氟康唑耐药。两性霉素B及氟胞嘧啶对念珠菌的敏感率较高分别为99．6％,98．0％。结论念珠菌属对抗真菌药物的敏感性下降,应加强念珠菌的检测和敏感性分析。     

Antifungal combinations against Candida albicans biofilms in vitro

Candida biofilms display increased resistance to most antifungal agents. We have evaluated the efficacy of combinations of fluconazole (FLC), amphotericin B, and caspofungin (CSP) against Candida albicans biofilms in vitro. Indifference was observed for all the combinations of paired antifungal agents when a checkerboard titration method was used. Time-kill experiments revealed an antagonistic effect of high FLC doses with CSP.     

Prospective Study of Candida Species in Patients at a Comprehensive Cancer Center

Since most nosocomial systemic yeast infections arise from the endogenous flora of the patient, we prospectively evaluated the species stratification and antifungal susceptibility profile of Candida spp. associated with heavy colonization and systemic infection in patients at Memorial Sloan-Kettering Cancer Center in New York. A total of 349 Candida isolates were obtained from 223 patients during the later half of 1998. Cancer was the most common underlying disease, occurring in 91% of the patients, including 61.8% with organ and 23.7% with hematological malignancies; 4.4% of the patients had AIDS. Candida albicans was the predominant species (67.3%); among 114 non-albicans Candida spp., C. glabrata (45.6%) was the most frequent, followed by C. tropicalis (18.4%), C. parapsilosis (16.6%), and C. krusei (9.6%). The overall resistance to triazole-based agents among all yeast isolates was 9.4 and 10.8% for fluconazole and itraconazole, respectively. A total of 5% of C. albicans strains were resistant to triazole antifungals, whereas 30.8 and 46.2% of C. glabrata strains were resistant to fluconazole (MIC > or = 64 microg/ml) and itraconazole (MIC > or = 1 microg/ml), respectively. A significant association was observed between prior treatment with triazole and isolation of fluconazole-resistant C. albicans (P = 0.005, OR 36), although this relationship was not seen in C. glabrata isolates (P = 0.4). This study reinforces the importance of periodic, prospective surveillance of clinical fungal isolates to determine appropriate prophylactic, empiric, and preemptive antifungal therapy for the highly susceptible patient population.     

Development of an orogastrointestinal mucosal model of candidiasis with dissemination to visceral organs

Studies were done to develop a murine model that mimics the pattern of mucosal candidiasis followed by disseminated disease seen in patients given cytotoxic chemotherapy. Developmental studies showed that suppression of mice with 5-fluorouracil beginning 3 days prior to infection and given every 7 days thereafter necessitated antibacterial treatment but resulted in a reproducible model. Candida albicans given in the drinking water resulted in oral infection by day 3 that significantly increased from days 10 to 15 and mucosal infection with 4 to 7 log(10) Candida CFU in the esophagus, stomach, small intestine, and cecum. Dissemination to livers occurred and was 100% on days 5 to 15; fewer animals had kidney infection. The median kidney or liver CFU were 2 or 3 log(10) CFU, respectively, on day 15; despite this, mortality was low through 21 days of infection. As a demonstration of the utility of the model to test antifungal activity, daily treatment with 10 or 50 mg/kg itraconazole significantly reduced dissemination to the liver and kidneys and reduced tongue CFU compared to controls. Overall, these studies indicate that a nonlethal model of oral and gastrointestinal mucosal candidiasis with dissemination can be established in mice. Drug efficacy in treating localized infection and in preventing or treating disseminated infection can be studied.     

真菌血症31例临床分析

目的对真菌血症的临床及微生物学特征进行分析,为临床诊治提供参考。方法收集2004年8月—2005年12月期间我院31例真菌血症患者的临床资料进行回顾分析。结果超过80%的真菌血症患者患有2种或以上的基础疾病。半数以上患者均有导管留置,而且83．9%患者在血培养采样前1周内均不同程度使用抗菌药物。31例真菌血症中,24例(77．4%)与念珠菌有关,但仅3例由白念珠菌引起,念珠菌血症患者的病死率为45．8%。不同念珠菌对抗真菌药物存在不同程度的耐药率。结论真菌血症多发生于基础疾病严重者,由非白念珠菌导致的败血症在真菌血症中占很大比例;部分真菌对氟康唑、伊曲康唑耐药。     

Studies of the mechanism of human salivary histatin-5 candidacidal activity with histatin-5 variants and azole-sensitive and -resistant Candida species.

Histatins are a group of small, cationic, antifungal peptides present in human saliva. A previous molecular modeling analysis suggested structural similarity between the Phe14-His15 and His18-His19 dipeptide sequences in histatin-5 (Hsn-5; a 24-amino-acid polypeptide) and the sequence of miconazole (one of the azole-based antifungal therapeutic agents), implying that the mechanisms of killing of Candida albicans by these two molecules may be similar. To further elaborate on this observation, we have produced two variants of Hsn-5 in which Phe14-His15 or His18-His19 dipeptide sequences were replaced by Ala-Ala (F14A/H15A and H18A/H19A) to eliminate the phenyl and imidazole rings of the side chains and assessed their candidacidal activities against C. albicans. In addition, we tested azole-resistant C. albicans and Candida glabrata strains for their susceptibilities to Hsn-5. Analysis of the purified recombinant proteins for their candidacidal activities indicated that both variants were significantly less effective (the molar concentrations required to kill half of the maximum number of cells [ED50s], approximately 67 and approximately 149 microM for F14A/H15A and H18A/H19A, respectively) than the unaltered Hsn-5 (ED50, approximately 8 microM) at killing C. albicans, suggesting that the two dipeptide sequences are important for the candidacidal activity of Hsn-5. Assessment of the candidacidal activity of Hsn-5 with the well-characterized azole-resistant strains of C. albicans and C. glabrata, however, suggested that the mode of action of histatins against Candida is distinct from that of azole-based antifungal agents because Hsn-5 kills both azole-sensitive and azole-resistant strains equally well.     

Development of resistance in candida isolates from patients receiving prolonged antifungal therapy.

The impact of prolonged antifungal therapy on the development of resistance was examined in 61 patients with oropharyngeal thrush. Fifty-nine patients had symptomatic human immunodeficiency virus infection, one had lung cancer, and one had metastatic prostate cancer. Cultures of pharyngeal samples from all patients were positive for yeasts and included 57 (93.4%) Candida albicans, 3 (4.9%) Candida glabrata, and 1 (1.6%) Candida krusii. Of 61 patients, 32 (52.5%) were receiving or had recently received antifungal therapy. Clotrimazole was the most commonly prescribed azole, followed by ketoconazole and fluconazole. Two patients had received amphotericin B therapy and one had received flucytosine. The duration of therapy with clotrimazole, ketoconazole, and fluconazole ranged from 3 to 240, 14 to 44, and 7 to 138 days, respectively. There was no overall difference in the susceptibilities of the clinical isolates from treated and untreated patients to amphotericin B, nystatin, flucytosine, clotrimazole, ketoconazole, and fluconazole. A.C. albicans isolate from one patient who had clinically failed on ketoconazole, fluconazole, and amphotericin B was resistant to these drugs. The lack of difference in the susceptibility pattern indicates that clinically significant emergence of resistance does not occur in those patients who receive prolonged antifungal therapy.     

含光滑念珠菌与白色念珠菌白带的比较分析

目的分析女性含白色念珠菌和光滑念珠菌白带的性状及镜下特征,以便认识并区分这两类念珠菌所引起的妇科感染。方法连续选取2000例做白带检查的妇科门诊患者,询问患者的典型症状并观察单纯含念珠菌妇科涂片的镜下特征,用显色培养基对白带内的真菌进行鉴定,比较分析白色念珠菌组与光滑念珠菌组的差异。结果共检出476例含念珠菌标本,其中白色念珠菌393例,光滑念珠菌60例,其他念珠菌23例。白色念珠菌与光滑念珠菌阴道感染患者均表现出较高的性交痛症状。与白色念珠菌比较,光滑念珠菌组白带无豆渣样改变,患者少见外阴瘙痒;高倍视野下白细胞数量较少,上皮细胞、乳酸杆菌及真菌孢子数量较多,清洁度较好。结论含光滑念珠菌白带与白色念珠菌白带比较具有较为明显的差异,光滑念珠菌感染后患者临床症状及白带镜下特征均无白色念珠菌典型。