250例头部皮肤癣菌病误诊情况分析

２５０例头部皮肤癣菌病误诊情况分析陈建德（江苏省溧阳市肤病防治站，２１３００１）皮肤癣菌病位于手、足或躯干者易于诊断，然位于头面者往往被误诊。本文就１９９０年５月～１９９３年５月门诊所遇２５０例头面部皮肤癣菌患者误诊情况进行分析，现报告如下：１临床资...     

皮肤型孢子丝菌病3例误诊分析

皮肤型孢子丝菌病是比较少见的真菌慢性感染性疾病,临床容易误诊。本文报告3例,并对其流行病学及误诊原因作简要分析。     

细菌性皮肤病

用PCR-限制性片段长度多态性分析法检测游泳池肉芽肿中海分枝杆菌；游泳池肉芽肿误诊孢子丝菌病一例；游泳池肉芽肿1例；接种非结核疫苗后发生皮肤结核2例；寻常狼疮1例；     

皮肤孢子丝菌病误诊为皮肤结核病2例

孢子丝菌病是由申克孢子丝菌污染受损伤的皮肤发病。我们在临床工作中遇到2例孢子丝菌病患者，长期被误诊、误治为皮肤结核病，现报道如下。病例1，女，62岁，农民。因左下肢结节状皮损流脓，久治不愈，于2002年3月21日来诊。患者于2001年10月29日在田间割草，左内踝处被石头碰破出血，未作适当处理，13天后皮损处出现仡生米大紫红     

手部皮肤垢着病17例分析

目的：通过病例分析，探讨手部皮肤垢着病的临床特征以及其与马拉色菌感染的关系。方法：对门诊2001年至2004年17例手部皮肤垢着病作回顾性分析，分析其临床特征及实验室真菌学检查，并与21例无手部皮损的皮肤垢着病作比较。结果：17例手部皮肤垢着病在临床表现方面与经典的皮肤垢着病有所不同，在皮损部位检出及分离出马拉色菌方面前者明显高于后者。结论：手部皮肤垢着病在临床表现方面不同于经典的皮肤垢着病，它与马拉色菌感染有较密切的关系，可能是马拉色菌在手部感染的特殊表现形式，而找出口可疑的病因对治疗是有帮助的。     

小范围发生皮肤诺卡菌病23例

目的 报道国内首见群体发生的皮肤诺卡菌病23例。方法 详细检查了23例患者的皮疹表现，对6例患者的标本进行了病原学鉴定，同时对可能的发病原因进行了调查。结果 发现全部患者同住一个自然村，发病均与臀部肌内注射有关，每例患者均于肌内注射治疗后2-10个月内出现臀部（肌肉注射部位）结节，脓肿，部分皮损破溃成溃疡及窦道，病原学检查证实为星形奴卡菌。结论 23例皮肤奴卡菌病的发生均与肌内注射有关。     

孢子丝菌病25例临床治疗分析

目的：对近年临床积累的孢子丝菌病例进行临床治疗总结分析。探讨菌子丝菌病的临床、组织病理特点，诊断及有效的治疗方法。方法：对门诊疑为皮肤孢子丝菌病的患者进行真菌学镜检培养和组织病理检查。对确诊病例进行治疗观察。结果：经临床和真菌学检查共25例皮肤孢子丝菌病，病理上按炎性浸润类型的不同，分4型。所有患者确诊后口服10％碘化钾溶液10nd每日3次，大多病例2至2．5个月治愈。结论：本病淋巴管型临床诊断不难，固定型因皮疹形似其他皮肤病易误诊，因此对慢性顽固难治的溃疡及可疑病例应作深部真菌检查培养及时明确诊断。该病治疗首选碘化钾，如单独口服碘化钾效果不明显或皮损面积较大者可考虑联合应用其他抗真菌药物及局部治疗或手术切除。     

皮肤垢着病与糠秕孢子菌感染(附7例报告)

目的：探讨皮肤垢着病与糠秕孢子菌感染的关系。方法：回顾分析2002年1月～2004年3月我中心皮肤科门诊发现的7例皮肤垢着病患者的临床特征、实验室检查和治疗情况。结果：6例皮肤垢着病患者皮损均检测有糠秕孢子菌，1例未检测到糠秕孢子菌。通过口服和外用抗真菌治疗后，疗效显著。结论：皮肤垢着病与糠秕孢子菌有着密切的关系，糠秕孢子菌感染可能是皮肤垢着病的一种病因。     

3例白塞氏病误诊原因分析

３例白塞氏病误诊原因分析黄虹（云南中医学院附属医院６５００２１）关键词白塞氏病误诊分析白塞氏病的病变波及口腔、眼、生殖器和皮肤，临床表现多种多样，非典型病例在临床上多易误诊或漏诊。现将笔者收治的３例病人的有关资料作一分析。一、临床资料病例１：刘某某，...     

裴氏瓶霉致皮肤着色芽生菌病误诊为疣状皮肤结核1例

报告裴氏瓶霉致皮肤着色真菌病误诊为疣状皮肤结核1例。患者男，52岁。右上肢红斑、结节、疣状增生5年，无明显自觉症状。组织病理及真菌学检查结果符合裴氏瓶霉，结合临床表现及外伤史确诊为裴氏瓶霉致皮肤着色真菌病。     

隆突性皮肤纤维肉瘤30例临床分析

目的探讨隆突性皮肤纤维肉瘤(DFSP)早期临床及组织病理特征,降低临床误诊率,并为其诊断和治疗提供参考,以进一步降低复发率。方法收集30例临床资料完整被诊断为DFSP的病例,并对其进行临床分析。结果 30例患者男女比例为1:1,平均年龄(40.97±18.8)岁。术前80%诊断为其他皮肤病。均有组织病理学检查,表现为典型的梭形肿瘤细胞呈席纹状、车辐状排列。免疫组化染色显示CD34、vimentin阳性率为100%,SMA、S-100蛋白阴性率为100%。16例行局部切除术,其中复发10例(62.5%);14例行扩大切除术,其中复发2例(14.3%)。结论通过组织病理学及免疫组化检查,可降低临床误诊率。同时强调规范手术治疗重要性,探索新的辅助治疗,以降低术后复发率。     

皮肤结核19例临床分析

18例皮肤结核患者的临床表现差异较大,易被误诊为孢子丝菌病、结节病、慢性湿疹等。皮损组织活检病理、TB-PCR等检查有助于确定诊断。     

性传播疾病15例的误诊因素分析与对策

目的:探讨性传播疾病(STD)的误诊因素,旨在提高临床医生的正确诊断.方法:对临床15例的STD进行回顾性分析总结.结果:STD患者易被误诊为肺结核、急慢性咽喉疾病、口腔赘生物、鼻息肉、病毒性疱疹、皮肤病等,但根据STD的自身临床特征仍可鉴别诊断.结论:干预STD的误诊措施,医师应警惕与性疾病有关的致病因素,重视病史的详细询问,对可疑患者应及时做一些特殊检查,有助于疾病诊断.     

Comparison of tuberculosis cutis luposa and cutaneous leishmaniasis

We present a comparative study concerning two cases of tuberculosis cutis luposa and cutaneous leishmaniasis, respectively. These two Turkish female patients had suffered from changes of the facial skin since 20 years (tuberculosis cutis luposa) and for 5 months (cutaneous leishmaniasis). The tuberculosis cutis luposa had been misdiagnosed as cutaneous leishmaniasis and surgically treated. Both cases showed an apple jelly-like color at the edges of the lesions with soft tissue. With tuberculosis cutis luposa, the lesions had a larger extension and a more hyperkeratotic picture. We discuss the different histopathologic changes of both cases. As bacteriologic culture revealed mycobacterium tuberculosis, on one hand, and histopathology leishmania species intrahistiocytically, on the other, we could finally make the corresponding diagnoses.     

A clinicopathological study of cutaneous tuberculosis at Dibrugarh district, Assam

Background:

Cutaneous tuberculosis forms a small subset of extra pulmonary tuberculosis and has a worldwide distribution.

Aims:

The present study is an attempt to find out the incidence, clinical spectrum, and histopathological features of cutaneous tuberculosis.

Materials and Methods:

A total of 42 cases of newly diagnosed patients of cutaneous tuberculosis attending dermatology out patient department over a period of 1 year were included in the study. A detailed clinical examination and investigations including histopathological examination were carried out.

Results:

Scrofuloderma was the most common form seen in 50% cases followed by lupus vulgaris in 42.86%, tuberculosis verrucosa cutis in 4.76%, and lichen scrofulosorum in 2.38% cases. The Mantoux test was positive in 83.33% cases. Characteristic tuberculoid granulomas were seen in 72.22% cases of lupus vulgaris, 42.86% cases of scrofuloderma and all cases of tuberculosis verrucosa cutis and lichen scrofulosorum.

Conclusion:

Cutaneous tuberculosis is still highly prevalent in upper Assam. Early diagnosis and treatment are essential to prevent its complications.     

Clinical and epidemiological observations of cutaneous tuberculosis in Larkana,Pakistan

BACKGROUND: Cutaneous tuberculosis is widespread in Pakistan but has not been fully documented. This study was conducted to determine the clinical pattern, nature and existence of the disease in Larkana, Sindh province, Pakistan. METHODS: We are reporting 153 cases of patients with cutaneous tuberculosis who visited our department from 1996 to 1999. All cases were diagnosed at the clinic, and the biopsies were examined for histopathological evidence. The patients received three antituberculous treatments during a 9 month course. RESULTS: Clinically, 63 (41.2%) cases of lupus vulgaris, 54 (35.3%) of scrofuloderma, 29 (19.59%) of lupus verrucosa cutis, six (3.92%) of tuberculosis cutis orificialis and one (0.64%) case of disseminated cutaneous tuberculosis were observed in our department from 1996 to 1999. All patients were aged between 3 and 50 years and had experienced the present complaints for 1 to 12 years. Sixty-nine (45.1%) cases were children aged under 10 years, 50 cases (37.25%) were aged between 10 and 20 years, and 27 cases (17.65%) were aged over 20 years. There was no considerable ratio difference of the disease between male and female patients. Histopathologically, all the specimens showed chronic granulomatous changes; the majority was infiltrated with epitheloid cells, langhans giant cells, plasma cells and other inflammatory cells, such as lymphocytes, eosinophils and neutrophils in ulcerated lesions. Increased numbers of mast cells were seen in upper and lower dermis in two-thirds of the specimens. Caseating necrosis was visible in half of the specimens while Ziehl-Neelsen stain was negative in all the sections. CONCLUSIONS: The observed number of patients was moderately large, thus indicating a high incidence of cutaneous tuberculosis in Larkana. Lupus vulgaris, a form of cutaneous tuberculosis, was widespread in this area and prevalent in adults, while scrofuloderma was prevalent in children. Moreover, the existing rate of the disease was higher in children aged under 10 years and lower in adults. This indicates that children are more prone to this disease than adults.     

老年及儿童孢子丝菌病131例分析报告

本文报告1975~1983年间我所在苏北地区发现孢子丝菌病234例,其中儿童及老年孢子丝菌病共131例,与15~59岁的中年组相比,患者占55.93%.在老年组73例中,女多于男(1.92:1),儿童组58例中男多于女(1.32:1).临床上老年组中皮肤固定型占52.05%,儿童组中达86.21%.131例中有33例曾误诊为肿瘤、疖肿、化脓性溃疡、酒渣鼻、结核等.尤其是儿童患者误诊更多,应引起重视.     

A clinicoepidemiological study of 50 cases of cutaneous tuberculosis in a tertiary care teaching hospital in pokhara, Nepal

Background:

Cutaneous tuberculosis (TB) is essentially an invasion of the skin by Mycobacterium tuberculosis, the same bacteria that causes pulmonary tuberculosis.

Aim:

This study was conducted to study the common types of cutaneous TB and to find the management pattern in a tertiary teaching hospital in Pokhara, Nepal.

Materials and Methods:

All the cases of cutaneous TB were biopsied and furthermore investigated by performing Mantoux test, sputum examination, fine needle aspiration cytology, chest X-ray and ELISA.

Results:

In this study, we found that tuberculosis verrucous cutis (48%) had a higher incidence than other types of cutaneous TB. More males were affected than were females (1.2:1). Commonly affected sites were the limb and the buttock (48%). The most commonly affected age group was 16–25 years (40%). All cases (except two) were more than 15 mm in size in the Mantoux test. The histopathological picture was typical in all except three cases. All patients were treated with antitubercular treatment as per the national guidelines.

Conclusion:

The most common type of cutaneous TB was tuberculosis verrucous cutis and the most commonly affected sites were the limb and the buttock. As cutaneous TB sometimes reflects the presence of pulmonary tuberculosis, its incidence should not be ignored.     

Cutaneous tuberculosis in Indian children: the importance of screening for involvement of internal organs

AIMS AND OBJECTIVES: Resurgence of skin tuberculosis especially with drug-resistant strains has been well documented in recent years, but this problem has not received much attention in the paediatric age group. Hence, we carried out the present study to analyse the clinical and therapeutic aspects of cutaneous tuberculosis in children. MATERIALS AND METHODS: A detailed clinical examination, investigations, such as haemogram, serology for HIV, Mantoux test, chest X-ray, cytology, culture and histopathology were carried out in all children. They were treated with antitubercular therapy (WHO regimen), and the clinical response was followed up. RESULTS: Of 142 patients with cutaneous tuberculosis, 68 were children (40 females, 28 males). These children were aged from 9 months to 14 years. The duration of the disease varied from 1 month to 6 years. Family history of tuberculosis was present in 28 (41.2%) of the patients. Scrofuloderma was the most common presentation encountered in 30 (44.1%) patients with preferential involvement of the cervical (56.2%) and inguinal (20%) regions. Fifteen (22.1%) patients had lupus vulgaris, of which the keratotic type was the most common (46.7%), 16 had lichen scrofulosorum, three had tuberculosis verrucosa cutis, and four had more than one type of tuberculosis. Involvement of the lung in 14 (20.6%), bone in seven (10.2%), and both in four (5.9%) was found. Histopathology corroborated the clinical diagnosis in 54 (80.6%), culture was positive in six (8.8%). Fifty (73.5%) patients completed the treatment with an excellent response, no multidrug resistant cases were seen. CONCLUSIONS: Cutaneous tuberculosis in children continues to be an important cause of morbidity, there is a high likelihood of internal involvement, especially in patients with scrofuloderma. A search is required for more sensitive, economic diagnostic tools. Response to treatment at 4 weeks often helps in substantiating the diagnosis of tuberculosis in doubtful cases.