皮肤固定型孢子丝菌病1例及其相关实验检查

患者男,50岁。左上臂皮肤溃疡2年。皮损组织病理示:炎性肉芽肿改变,PAS染色可见圆形孢子和星状体。皮损真菌培养阳性,菌种鉴定为球形孢子丝菌。确诊为皮肤固定型孢子丝菌病,给予患者口服伊曲康唑和特比萘芬联合治疗3个月,皮损部分改善。之后患者间断口服特比萘芬联合碘化钾治疗,一年半后复诊仍有局灶性皮损未愈。     

特比萘芬治疗皮肤浅部真菌病179例

用特比萘芬治疗１７９例皮肤浅部真菌病（２５０ｍｇ／ｄ，手足癣３周，体股癣２周，甲癣至少６周），结果痊愈１４９例，显效２０例，进步６例，无效４例。治愈率为８３．２％，有效率为９４．４％，真菌清除率为９５．０％。     

黑龙江省502例孢子丝菌病患者临床分析

目的对黑龙江地区502例孢子丝菌病患者临床资料进行回顾性分析,探讨近年孢子丝菌病的发病特点,为今后防治孢子丝菌病提供有力依据。方法对2014年4月—2017年4月至哈尔滨医科大学第二附属医院就诊,经过临床表现、组织病理检查及真菌培养确诊为孢子丝菌病的502例患者进行回顾性分析。结果患者男女比例1:2,平均年龄49.7岁,以41～65岁人群最为多见。66.5%的患者在冬春两季发病,76.2%的患者为农民,37.8%的患者有明确外伤史。皮肤固定型占74.9%、皮肤淋巴管型24.9%、皮肤播散型0.2%。患者对碘化钾、特比萘芬治疗反应良好。结论孢子丝菌病在黑龙江地区发病率高,其流行病学特点与吉林省、辽宁省相似,但不同于其他国家。碘化钾、特比萘芬、伊曲康唑是其有效的治疗药物。     

特比萘芬成功地治疗皮肤孢子丝菌病

孢子丝菌病是由申克氏孢子丝菌引起的。口服碘化钾和局部加热常被用于治疗固定型及皮肤淋巴管型孢子丝菌病而获得成功。最近报道一种新的口服抗真菌药特比萘芬治疗皮肤孢子丝菌病有效。该药属丙烯胺类,为高效、广谱的抗真菌制剂,抗菌谱包括皮肤癣菌、酵母菌和霉菌。作者用该药125mg每日1次治疗3例皮肤淋巴管型孢子丝菌病 获得成功。     

特比萘芬治疗皮肤孢子丝菌病的研究

特比萘芬治疗皮肤孢子丝菌病的研究吴绍熙，郭宁如，吕桂霞皮肤型孢子丝菌病在江苏省一带比较多见，我们在１９７４年至１９８１年７月间在江苏泰州地区即先后见到１５０例［１］，对本病的治疗目前首选药物还是内服１０％碘化钾溶液，但在对碘化钾过敏或因一些原因不能应...     

皮肤型孢子丝菌病585例临床分析

目的 对近3年吉林地区585例皮肤型孢子丝菌病病例进行总结,分析其临床和流行病学特征。方法 对2007-2009年我院皮肤科确诊的孢子丝菌病病例进行回顾性分析。结果 585例患者中男女比1 ∶ 1.35,平均年龄40.5岁,发病年龄以51 ～ 60岁最多见（22.05%）;平均病程6.78个月;冬春季节发病者所占百分比最高;居住于农村者551例（94.19%）,有外伤史者占25.47%。临床表现以固定型最常见（56.58%）,其次为淋巴管型（39.66%）,皮肤播散型和不确定型各占1.88%。受累部位以四肢（50.94%）及面部（43.76%）最多。治疗采用10%碘化钾溶液、伊曲康唑、特比萘芬或联合治疗。失访250例,余335例已治愈289例,平均疗程2.09个月,其余46例仍在治疗随访中。结论 孢子丝菌病近年来仍然是吉林地区的多发病,其临床及流行病学特点与以往报道相似,但中老年患者所占比例及皮损不典型病例增加,碘化钾、伊曲康唑和特比萘芬是治疗孢子丝菌病安全有效的药物。     

特比萘芬治疗孢子丝菌病的疗效观察

为探讨特比萘芬（商品名：兰美抒）治疗孢子丝菌病的疗效,笔者于1997-2003年应用特比萘芬治疗孢子丝菌病15例,取得满意疗效,现报告如下。     

特比萘芬连续和间歇疗法治疗孢子丝菌病临床疗效观察

孢子丝菌病为申克孢子丝菌所致的一种深部真菌病,在吉林省为常见、多发的深部真菌病,患者多为体力劳动者.笔者2000年7月-2008年2月应用特比萘芬治疗160例皮肤型孢子丝菌病,获得满意疗效,现报告如下.     

误诊为坏疽性脓皮病的皮肤播散型孢子丝菌病1例

患者女,63岁,农民。胸腹部结节、斑块、溃疡2年半。曾被误诊为"坏疽性脓皮病",并予糖皮质激素、米诺环素等反复治疗1年余,用药时皮疹有所好转,停药后皮疹加重。皮损组织病理示:呈炎性肉芽肿改变,脓液真菌培养鉴定为孢子丝菌。诊断:皮肤播散型孢子丝菌病。予特比萘芬口服,治疗3个月后皮损明显好转,目前仍在随访治疗中。     

特比萘芬治疗儿童孢子丝菌病的临床疗效及抗真菌药敏试验研究

<正>孢子丝菌病是由申克孢子丝菌复合体引起的一种常见的深部真菌病。在吉林省为常见、多发的深部真菌病,且患者多为劳动人群,目前儿童孢子丝菌病患者发病率增多~([1])。国内外文献报道,伊曲康唑、特比萘芬及碘化钾溶液均可用于治疗儿童和婴幼儿孢子丝菌病,疗效和安全性与成人相当~([2])。特比萘芬是一种丙烯胺类的新型广谱抗真菌药物,治疗孢子丝菌病患者皮肤及淋     

Cutaneous sporotrichosis. Intermittent treatment (pulses) with itraconazole

Sporotrichosis is a subcutaneous and exceptionally deep mycosis caused by a dimorphic fungus, Sporothrix schenckii. Itraconazole is a triazole derivative leading to good results in the treatment of sporotrichosis. Patients with cutaneous sporotrichosis proven with mycological tests (direct examination and culture) were enrolled. All patients underwent laboratory tests (at baseline and on a monthly basis) and received oral itraconazole 400 mg/day for one week with a 3-week break (pulses); thereafter the drug was administered as pulses until clinical and mycological cure was achieved. Five patients with sporotrichosis were enrolled, 4 with cutaneous lymphangitic form and one with fixed cutaneous form. Clinical and mycological cure was achieved in 4/5 cases (80%), with a mean number of pulses of 3.5. No patient had side effects and no laboratory test abnormalities occurred. Intermittent or pulsed itraconazole was effective in treating cutaneous sporotrichosis. It may be considered as a new treatment choice that entails an important reduction in total medication use.     

面部皮肤型孢子丝菌病72例临床分析

目的 报道面部皮肤型孢子丝菌病72例。方法 详细观察72例患者的皮损表现,逐一做真菌学检查,部分做病理检查。采用碘化钾、伊曲康唑、特比萘芬等联合疗法治疗。结果 颜面孢子丝菌病的皮损形态复杂,其中淋巴管型占9.72%,局限型占90.28%,有明确外伤史的26.4%。以碘化钾为基础的联合治疗,6~8周全部治愈。结论 皮损表现和真菌学检查是诊断孢子丝菌病的重要依据。颜面孢子丝菌病形态分布以局限型为主。基层误诊率高达16%。碘化钾为首选基础用药。     

Long-term effectiveness of treatment with terbinafine vs itraconazole in onychomycosis: a 5-year blinded prospective follow-up study

OBJECTIVE: To examine long-term cure and relapse rates after treatment with continuous terbinafine and intermittent itraconazole in onychomycosis. DESIGN: Long-term prospective follow-up study. SETTING: Three centers in Iceland. SUBJECTS: The study population comprised 151 patients aged 18 to 75 years with a clinical and mycological diagnosis of dermatophyte toenail onychomycosis. INTERVENTIONS: In a double-blind, double-dummy study, patients were randomized to receive either terbinafine (250 mg/d) for 12 or 16 weeks or itraconazole (400 mg/d) for 1 week in every 4 for 12 or 16 weeks (first intervention). Patients who did not achieve clinical cure at month 18 or experienced relapse or reinfection were offered an additional course of terbinafine (second intervention). MAIN OUTCOME MEASURES: The primary efficacy criterion was mycological cure, defined as negative results on microscopy and culture at the end of follow-up and no requirement of second intervention treatment. Secondary efficacy criteria included clinical cure without second intervention treatment and mycological and clinical relapse rates. RESULTS: Median duration of follow-up was 54 months. At the end of the study, mycological cure without second intervention treatment was found in 34 (46%) of the 74 terbinafine-treated subjects and 10 (13%) of the 77 itraconazole-treated subjects (P<.001). Mycological and clinical relapse rates were significantly higher in itraconazole vs terbinafine-treated patients (53% vs 23% and 48% vs 21%, respectively). Of the 72 patients who received subsequent terbinafine treatment, 63 (88%) achieved mycological cure and 55 (76%) achieved clinical cure. CONCLUSION: In the treatment of onychomycosis, continuous terbinafine provided superior long-term mycological and clinical efficacy and lower rates of mycological and clinical relapse compared with intermittent itraconazole.     

Atypical presentation of cutaneous sporotrichosis in an alcoholic patient

Sporotrichosis is a subcutaneous mycosis with a high prevalence in Brasil. It is caused by the dimorphic fungus Sporothrix schenckii, and may lead to different clinical presentations. The disseminated cutaneous form is uncommon and corresponds to 4 percent of the total number of cases. We report a case of atypical disseminated sporotrichosis in an alcoholic patient, whose culture for fungi revealed the presence of Sporothrix schenckii. The patient was treated with itraconazole 200 mg/day for 6 months with clinical clearing.     

伊曲康唑、氟康唑与特比萘芬联合治疗肺隐球菌病1例

采用伊曲康唑、氟康唑与特比萘芬联合治疗1例肺隐球菌病。患者男,48岁。发热、咳嗽、右肺部出现大片阴影27d。经皮肺穿刺活检,确诊为肺隐球菌病。给予氟康唑150mg／a、特比萘芬250mg／a口服治疗,1个月后复查胸部X线片及CT,肺部病变明显好转,但随后恢复较慢,改用伊曲康唑200mg／a联合特比萘芬250mg／d口服治疗3个月后,肺部阴影完全消失。     

Terbinafine in the treatment of dermatophyte toenail onychomycosis: a meta‐analysis of efficacy for continuous and intermittent regimens

Objective To compare mycological and complete cures of terbinafine continuous and intermittent regimens in the treatment of toenail onychomycosis. Methods The PubMed database was searched using the terms “terbinafine”, “onychomycosis”, “continuous” and “pulse(d)” or “intermittent”. The inclusion criteria were head‐to‐head comparison of terbinafine pulse and continuous regimens for dermatophyte toenail infections. Risk ratios were calculated for intention‐to‐treat and evaluable patient analyses, when possible. Pooled estimates for total and subgroup analyses were calculated using a random effect model, Mantel‐Haenszel method and their probabilities were calculated with z‐statistics. Results Nine studies from eight publications were included. Two continuous regimens and four intermittent regimens were investigated. A pooled risk ratio of 0.87 was obtained for intention‐to‐treat (95% CI: 0.79–0.96, P = 0.004, n = 6) and evaluable patient (95% CI: 0.80–0.96, P = 0.003, n = 8) analyses of mycological cure, favouring continuous terbinafine. For complete cure, pooled risk ratios of 0.97 (95% CI: 0.77–1.23, P = 0.82, n = 7) for intention‐to‐treat and 0.93 (95% CI: 0.76–1.13, P = 0.44, n = 9) for evaluable patient analyses showed equality of the two regimens. The pulse regimen that demonstrated consistently comparable results to the continuous terbinafine regimen was two pulses of terbinafine 250 mg/day for 4 weeks on/4 weeks off. Conclusions Meta‐analysis of published studies of toenail onychomycosis showed that a continuous terbinafine regimen is generally significantly superior to a pulsed terbinafine regimen for mycological cure. In contrast, some pulse terbinafine regimens were as effective as continuous terbinafine regimens for complete cure.     

Long-term results in patients with onychomycosis treated with terbinafine or itraconazole

BACKGROUND: Previously, a double-blind, randomized, multicentre study (LION study) compared the efficacy of continuous terbinafine 250 mg daily for 3 or 4 months with itraconazole pulse therapy 400 mg daily for 3 or 4 months. At the end of the study at week 72 terbinafine proved to be more effective. OBJECTIVES: To perform a 4-year follow-up of the Finnish participants in this study. METHODS: Patients were re-examined clinically and mycologically. RESULTS: Complete clinical and mycological cure with terbinafine for 4 months was 78% compared with 35% with terbinafine for 3 months, 24% with itraconazole for 4 months and 28% with itraconazole for 3 months. CONCLUSIONS: These results suggest that the initial treatment for onychomycosis should be a 4-month continuous course of terbinafine.