河南不规则毛霉致原发性皮肤毛霉病一例

【摘要】 患者女,50岁。右上肢皮肤结节、斑块、红肿、溃烂6年,右臀部斑块2年,右面颊斑块1年。曾单独口服特比萘芬、伊曲康唑治疗无效。右上肢及臀部皮损组织病理及PAS染色均可见真皮内宽大呈直角分支菌丝。真菌培养及分子生物学鉴定为不规则毛霉。联合伊曲康唑和特比萘芬治疗2个月仍无效,改为静脉滴注两性霉素B（总量1 060 mg）治疗,患者右面颊、右臀部斑块肿胀逐渐消退,右上肢包括右手背斑块、红肿、坏死、黑痂消退,皮损愈合成瘢痕,取右上肢皮肤组织再次行真菌培养阴性。随访1年未复发。     

多变根毛霉引起原发皮肤毛霉病1例

报告1例由多变根毛霉引起的皮肤毛莓病。患者男．33岁。右上肢外伤后弥漫性斑块伴肿胀、化脓7年余。免疫功能检测CD4^ T细胞略低(28％)，皮损组织病理检查示真皮中下层有炎细胞及多核巨细胞浸润，并见粗大较短的无隔菌丝经真菌培养菌种鉴定为多变根毛霉患者曾接受伊曲康唑、特比荼芬和氟康唑等抗真菌药物治疗．均无满意疗效．最后经用两性霉素B治疗痊愈．随访6个月未复发。     

两性霉素B脂质体治疗毛霉病患者的护理

毛霉为条件致病菌,进入人体后易侵犯血管,导致血栓及组织坏死类疾病。毛霉病进展较快、治疗困难、预后不佳。早期诊断、及时治疗是提高生存率的关键。2011年5月,我科收治1例毛霉病患者,采用两性霉素B脂质体（AMB）进行治疗,效果显著。现将护理措施报告如下。     

皮肤毛霉病1例

患者女,14岁,学生。因鼻背部斑块伴瘙痒1年,于2001年6月18日入笔者所在医院治疗。1年前,患者右侧鼻背部出现一钱币大斑块,斑块质硬,色泽正常,表面皮肤无溃破,有瘙痒感,无疼痛及其他不适。曾在当地医院口服及外用药物(具体不详)治疗。3个月前皮损逐渐向右侧面颊部扩散,且于斑块表面出现成簇丘疱疹。既往体健。1年多前曾接受右侧泪囊冲洗,无外伤、手术史。体检:T36.6℃,P80次/min,R22次/min,BP13/8kPa(1mmHg=0.133kPa),体重33kg。一般情况可,浅表淋巴结无肿大。心肺正常。皮肤科检查:鼻部及右侧面颊部见一4cm×6cm大小不规则斑块,质韧,浸…     

总状毛霉所致原发性皮肤毛霉病一例

患者男,３１岁,农民。因右手肘部斑块伴结节且逐渐扩大７年来我院门诊就诊。患者自述１９９４年８月右手肘部有擦伤,伤口表浅,未经处理自愈。约１个月后局部出现红色小结节,此后结节逐渐扩大,但进展缓慢。自１９９６年８月开始至今红斑扩大加快。损害表面反复出现小片溃疡和结痂,周围不断出现新的结节。损害不痛,有时略有瘙痒。检查见右手以肘部为中心大片暗红色斑块,上缘累及上臂２／３,下缘累及前臂１／２,伴多数结节、小片溃疡和结痂,间以正常皮肤和轻度萎缩性瘢痕。损害边缘清楚,稍隆起,周围结节稍硬,部分结节不与皮肤粘…     

伊曲康唑治疗1例原发性皮肤毛霉病

应用伊曲康唑治疗１例罕见的由冻土毛霉黄色（或土黄）型所致的原发性皮肤毛霉病,并对其治疗前后的临床、真菌学及组织病理改变进行了观察。临床、真菌学痊愈。斯皮仁诺对毛霉目某些真菌是敏感的,对原发性皮肤毛霉病的治疗是安全有效的。     

冻土毛霉所致的原发性皮肤毛霉病

目的 报道一例罕见的由冻土毛霉黄色（或土黄）变种所致的原发性皮肤毛霉病。方法 取患者面部焦痂下脓性分泌物直接镜检及培养，取面部活检组织部分行组织病理，部分做真菌培养。结果 直接镜检可见粗的、无分隔的、成直角分支的菌丝，活检组织切片，ＨＥ染色示：肉芽肿样改变，并可见特征性的、宽的、无分隔的菌丝，ＰＡＳ（＋）；脓性分泌物及活检部分组织２５℃ＳＤＡ培养３天后，可见黄色的菌落，３７℃不生长，菌种鉴定为：冻     

不规则毛霉感染引起的皮肤毛霉病20例回顾性分析

目的通过对不规则毛霉感染病例的回顾性分析,探讨不规则毛霉感染引起皮肤毛霉病的流行病学、易感因素、临床表现、诊断方法及治疗策略,提高临床医生的警惕性及诊治经验。方法对检索到的20例不规则毛霉感染病例资料进行总结、分析。结果 20例不规则毛霉感染患者均表现为皮肤毛霉病,仅1例同时伴有肺部感染。15例来自中国,1例有糖尿病史,1例有白血病史,10例有外伤、手术或叮咬史。皮损几乎均出现在暴露部位,其中鼻面部13例,四肢7例,病程多呈慢性。早期表现为红斑、丘疹、结节,后期可发展成溃疡、坏死、黑痂及骨质破坏。经真菌镜检、培养、组织病理、ITS区测序等检查证实为不规则毛霉。两性霉素B及其脂质体单独或联合伊曲康唑治疗预后好。结论不规则毛霉感染多发生于免疫正常者,外伤、烧伤、手术及叮咬是最主要诱发因素。感染主要累及鼻面部及四肢皮肤暴露部位,以红斑、坏死为主要表现,极少累及内脏。真菌培养及组织病理检查可以诊断该病,ITS区测序可明确鉴定到种。及早诊断并给予清创及两性霉素B是治疗成功的关键。     

肝移植术后根霉病1例

报告1例皮肤根霉病。患者男，50岁。因丙型肝炎、肝硬化接受原位肝移植术。术后第12天，右上肢前臂出现红斑、肿胀并渐扩大，皮肤呈黑色坏疽样外观。右上肢、肩部、腋下、胸背疼痛。皮损组织病理检查示血管周围有粗大、无分隔直角菌丝，血管内真菌栓塞。真菌学检查证实为接合菌病根霉属。后经聚合酶链反应(PCR)鉴定为小孢根霉。对上肢感染组织行清创术、截肢，并予以两性霉素B脂质体治疗3周。经治疗肿胀减轻，疼痛消失，目前仍在治疗中。     

原发性皮肤毛霉病一例

患者男,52岁。鼻背部红斑并皮下结节,软腭溃烂,偶有疼痛并伴鼻出血3年余,左眼眶下出现0.8 cm × 0.4 cm大小结节1月余。患者曾接受伊曲康唑、氟康唑等抗真菌药物治疗,无满意疗效。患者一般情况好,既往有肺结核病史,Ｔ淋巴细胞亚群示CD3减少。皮损组织病理检查示真皮中下层有炎细胞及多核巨细胞浸润,HE和PAS染色见粗大较短的无隔菌丝。经真菌培养及分子生物学鉴定为多变根毛霉。该临床分离株在体外对两性霉素B敏感,对伊曲康唑、酮康唑、氟康唑均耐药。经两性霉素B治疗6周后,患者皮损明显消退,两性霉素B总用量为821 mg。治疗结束后,手术活检取鼻背部及软腭组织做真菌培养和组织病理检查。组织病理中炎性细胞明显减少,未发现菌丝。26 ℃、32 ℃（± 3 ℃）中恒温培养3周均未见真菌生长。据此,该患者已达到临床、组织病理学和真菌学治愈。治疗期间自觉食欲差,有药物性肾功能异常、一过性低血钾。     

Primary cutaneous mucormycosis in a trauma patient

We report a rare case of primary cutaneous mucormycosis caused by Rhizopus oryzae that occurred in an immunocompetent trauma patient. The patient had encrusted erythematous plaques with pustules on the left shin, which had been abraded in a traffic accident. Histologic examination revealed widespread granulomatous inflammation and characteristic broad, non-septate hyphae with right-angle branching in the dermis. The infection was cured with intravenous amphotericin B therapy.     

原发于头皮的皮肤淀粉样变一例

原发性皮肤淀粉样变皮损常见于双侧胫前、背部及大腿,也可见于阴茎及面颈部,原发于头皮者少见,诊治具有一定的难度。现报道1例我科诊治原发于头皮的皮肤淀粉样变患者。给予0.1%维A酸外用头皮,治疗2个月,皮损变化不明显,瘙痒缓解,目前进一步随访中。     

Primary cutaneous mucormycosis caused by Mucor irregularis in an elderly person

Primary cutaneous mucormycosis is a rare but often lethal severe fungal infection, which usually occurs in immunocompromised patients. We report a case of primary cutaneous mucormycosis caused by Mucor irregularis in an elderly patient. Seven months after the surgical dissection of the involved skin, cutaneous mucormycosis recurred at the peripheral edge of the skin graft. Shortly subsequent to the administration of liposomal amphotericin B, the remaining skin lesion was excised again. M. irregularis is rarely but increasingly reported as a cause of mucormycosis in immunocompetent individuals, especially in Asian farmers. M. irregularis may be largely disseminated in the soils of Asia and thus the trivial trauma at the time of farm work may be a trigger for the onset. These cases tend to leave severe cosmetic damage even in healthy individuals, although the vital prognosis is not affected.     

不规则毛霉致皮肤型毛霉病一例

患者,女,65岁。反复左上肢结节、斑块、流脓伴疼痛7年,累及右上肢1年。2型糖尿病病史3年。左手背皮损组织病理示表皮棘层肥厚伴角化不全,真皮全层多灶肉芽肿形成伴淋巴细胞、浆细胞浸润,胶原纤维变性,并累及皮下脂肪;真菌培养示白色绒毛状菌落生长,镜下表现为粗大、无分隔菌丝,可见圆形孢子囊;宏基因组测序示不规则毛霉。诊断为不规则毛霉致皮肤型毛霉病。     

原发性皮肤弥漫性大B细胞淋巴瘤一例

患者,男,51岁。左小腿红斑、结节、斑块伴疼痛3个月。组织病理及免疫组化确诊为原发性皮肤弥漫性大B细胞淋巴瘤,腿型。     

The first case of cutaneous mucormycosis caused by Rhizopus azygosporus

A rapidly enlarging leg ulcer appeared in a 54-year-old woman with systemic lupus erythematosus receiving aggressive immunosuppressive therapy. Skin biopsy revealed proliferation of hyphae in the midst of a neutrophilic abscess. Culture yielded Rhizopus azygosporus. As no organ involvement was detected by thorough examination, the patient was diagnosed as having primary cutaneous mucormycosis. Although intravenous amphotericin B therapy seemed to be very effective, it had to be discontinued due to nephrotoxicity. She unfortunately died of subsequent disseminated fungal infection and cerebral infarction in which the primary cause could not be determined. Minimum inhibitory concentrations of several antifungal drugs to the isolate were examined and amphotericin B proved to be the only agent that may potentially reach the effective plasma concentration. This is the first case report of cutaneous mucormycosis caused by R. azygosporus.     

Liposomal amphotericin B treatment of cutaneous leishmaniasis due to Leishmania tropica

Background Cutaneous leishmaniasis (CL) is endemic in Israel, and in the past, has been attributed almost exclusively to Leishmania major. Over the last decade or so, an increase in Leishmania tropica (L. tropica) infections has occurred in several regions of Israel. Topical treatment of Old World CL is usually the rule, however, in some cases systemic treatment is indicated. Liposomal amphotericin B (L‐AmB) is efficacious and safe for treating visceral leishmaniasis but its role in treating various forms of CL is yet to be defined. In this study, we summarize the efficacy and safety of L‐AmB treatment in a series of Israeli patients with L. tropica infection. Methods Cases of PCR‐proven CL caused by L. tropica were treated in an outpatient setting. Treatment schedule consisted of five consecutive days of 3 mg/kg L‐AmB, followed by a sixth dose on day 10. Results Thirteen consecutive patients (11 men, two women), received L‐AmB. Mean age was 15.3 years; of the 13 patients, 85% had facial lesions. Six had previously failed intralesional sodium stibogluconate treatment and four had failed topical paromomycin treatment. Eleven of 13 patients (84%) achieved complete clinical cure within 2 months. Mean follow‐up of 11 months revealed no relapses. Side effects were mild and none terminated treatment prematurely. Limitations A non‐randomized study, with a small number of patients. Conclusion Liposomal amphotericin B treatment for L. tropica is effective, well tolerated and cost beneficial in countries where cost of hospital‐care is significant.