红色毛癣菌引起的Majocchi肉芽肿1例

皮肤癣菌可以引起毛发、表皮和甲板感染,一般不侵犯皮下或深部组织,但在一定情况下可侵犯不含角蛋白的皮下组织,由于比较少见,常被忽视。可引起深在型感染的皮肤癣菌以红色毛癣菌最常见,深在型皮肤癣菌病临床分为蜂窝状毛囊类型、脓癣型、Majocchi肉芽肿型、皮下组织脓肿型、淋     

红色毛癣菌变种raubitschekii变种致Majocchi肉芽肿一例

目的　报道1例Majocchi肉芽肿,对其病原菌红色毛癣菌变种raubitschekii的形态学、生理学及分子学特征进行研究,并通过基因分型的方法分析其深在感染与浅表皮肤感染的关系。方法 进行临床和病理检查,真菌镜检和培养,尿素酶试验,内转录间隔区（ITS区）序列分析。对来源于该患者病变趾甲及组织的菌株及7株红色毛癣菌的rDNA非转录间隔区（NTS）串联重复亚单位1（TRS-1区）进行PCR。 结果 48岁女性患者,背部、臀部、大腿出现红色丘疹、结节2个月。9个月前曾行肝移植术,甲癣病史3年,术后加重。经病理和真菌学检查,确诊为Majocchi肉芽肿。足趾甲和组织真菌培养菌落和显微镜下形态、尿素酶试验阳性,结合ITS区序列分析结果,证实致病菌为红色毛癣菌变种raubitschekii。TRS-1区扩增后显示,病变趾甲和组织来源的菌株基因型完全一致,与其余临床分离株有差异。结论 NTS区的TRS-1区显示基因多态性,病变趾甲和组织基因型完全一致,提示两者来源相同。     

一株耐热红色毛癣菌临床分离株的基因型鉴定

目的 探讨1株引起特殊皮肤肉芽肿损害的红色毛癣菌菌株的真菌学特点及其基因序列的变化。方法 常规真菌学鉴定法和使用PCR方法测定菌株的核糖体保守区及非转录区(NTS)内trs-1区基因序列。结果 耐热菌株经真菌学鉴定及核糖体保守区基因序列测定均证实为红色毛癣菌,但其核糖体基因非转录区(NTS)内trs-1(串联重复亚单位)区基因序列测定显示有明显的不同。结论 核糖体基因NTS区内trs-1区基因序列的改变可能的解释为此株耐热红色毛癣菌为红色毛癣菌的一个同型变种,这一变种具有较强的侵袭力,能导致特殊的皮肤损害;亦或为菌株为适应外界环境条件改变发生的基因水平的变异。     

播散性红色毛癣菌肉芽肿一例

目的报道1例播散性红色毛癣菌肉芽肿。方法对患者的临床资料、真菌学检查、组织病理及疗效进行分析。结果患者为46岁女性,手足、躯干红斑、脱屑30年,头皮、躯干、上肢结节、溃破2年。检查见头皮、颈、躯干和上肢有紫红色浸润性斑块、结节,部分皮损表面破溃、渗液、结痂。皮损内穿刺液及甲直接镜检菌丝阳性,培养为红色毛癣菌生长。皮损病理检查:真皮内可见上皮细胞样肉芽肿,其中央大片坏死,周围见结节样上皮样细胞团块,伴少许多核巨细胞、淋巴细胞及嗜酸粒细胞浸润。PAS染色真皮内见真菌菌丝。诊断为播散性红色毛癣菌肉芽肿。伊曲康唑治疗3个月后皮损消退,遗留萎缩性瘢痕。用药期间未见不良反应。结论播散性红色毛癣菌肉芽肿临床少见,伊曲康唑疗效满意。     

播散型皮肤红色毛癣菌肉芽肿一例

患者男,35岁,全身出现泛发红斑、斑块、结节伴瘙痒8年。皮肤科检查：头面部及躯干四肢大片丘疹、红斑、浸润性斑块及结节,部分皮损边界清,伴少量鳞屑、结痂、萎缩性瘢痕,双眼睑肿胀,右耳廓已破坏消失,左耳廓变形,头发、眉毛、睫毛稀疏脱落,指（趾）甲甲板均肥厚、变形、断裂。真菌学检查：取皮损处皮屑直接镜检示分枝分隔菌丝阳性,真菌培养鉴定为红色毛癣菌生长。皮损组织病理检查：表皮角化过度,棘层增生肥厚,真皮浅中层可见上皮样细胞团块,伴淋巴细胞、浆细胞为主的炎细胞浸润,散在嗜酸粒细胞及多核巨噬细胞。PAS和银染色均可见真皮浅中层散在分布分枝分隔菌丝。诊断为播散性皮肤红色毛癣菌肉芽肿。伊曲康唑治疗3个月后皮损消退,留有色素沉着及萎缩性瘢痕,真菌直接镜检及培养均示阴性,服药期间未见明显不良反应。     

红色毛癣菌基因型与表型的研究

目的 探讨红色毛癣菌基因型与表型、侵犯部位及其来源地区的相关性.方法 基因分型采用ITS区域探针与DNA印迹杂交法,表型分型采用传统方法.结果 所试49株红色毛癣菌(南京21株、大连26株、北京2株)分为20型(A-T型),其中A型9株均为大连株;B型9株中7株为南京株;C型6株均为南京株.5种表型除颗粒型外其他4型均有A型,17株绒毛型和7株沟纹型B型占居首位,6株羊毛型和17株粉末型A型占居首位.分离自甲癣的21株以C型为主;股癣10株和体癣6株以A型为主;足癣8株,B型占居首位;头癣4株G型占居首位.结论 红色毛癣菌基因型与表型、侵犯部位及其来源地区可能具有一定的相关性.     

石膏样毛癣菌致皮肤癣菌肉芽肿一例

患者,男,47岁。右手浸润性鳞屑性斑块2年,上覆脓疱、血痂。皮肤病理示感染性肉芽肿,真菌培养见石膏样毛癣菌。诊断为皮肤癣菌肉芽肿。口服伊曲康唑200 mg,每日2次,3周后明显好转。     

须癣毛癣菌肉芽肿一例

患者女,３８岁。左眼外眦旁起红疹、痒１０d,皮疹初起为黄豆大红疹,因瘙痒抓后出现破溃、结痂,且范围扩大、隆起。于２０００年１１月１６日到本院就诊。发疹前否认局部有外伤史和使用皮质类固醇史,发疹后未接受治疗。既往健康,无糖尿病史和浅部真菌病史,家属中无类似病史。体检：一般情况好,各系统检查无异常发现。皮肤科情况：左眼外眦旁见一直径２cm斑块,高于皮面约２mm,表面高低不平,间以粟粒大丘疹,丘疹表面覆以黄白色痂。皮损呈圆形,境界清楚,颜色较红,周围皮肤不红肿。实验室检查：血尿常规、肝肾功能、免疫学检查Ig…     

播散型红色毛癣菌肉芽肿5例

通过对1998～2004年我院5例播散型红色毛癣菌肉芽肿患者的临床资料回顾性分析,探讨播散型红色毛癣菌肉芽肿的临床特征、病理表现及治疗方案。5例均口服伊曲康唑治疗,4例随诊未见复发,1例经常复发,与其疗程不足有关。     

Majocchi肉芽肿1例临床分析及其病原菌分子鉴定

分析我科收治的1例Majocchi肉芽肿的临床、病理特点、真菌学及分子生物学鉴定结果，并对文献进行复习。该患者以右侧面颊部红色斑块状损害10余年为主要症状，病理检查示上皮样细胞肉芽肿，PAS染色见分枝分隔菌丝。活检组织培养出丝状真菌，37℃生长良好。分子生物学ITS1、ITS2和D1/D2区测序结果示：病原菌与红色毛癣菌标准株ATCC28188的相似性为100%。本病例为耐热型红色毛癣菌引起的Majocchi肉芽肿。     

Majocchi's肉芽肿一例

患者,女,68岁。右侧腕部红斑、丘疹、结节伴疼痛1年半,加重2个月。组织病理学示肉芽肿性改变,HE荧光染色及真菌培养显示红色毛癣菌。诊断:Majocchi's肉芽肿。患者给予抗真菌治疗,皮疹痊愈,随访一年无复发。     

Epidemiological aspects of Trichophyton rubrum var. raubitschekii in Japan

Trichophyton rubrum var. raubitschekii is a rare anthropophilic dermatophyte isolated around the world from tinea corporis, tinea cruris, tinea pedis and tinea unguium. In this study, the isolation rate of T. rubrum var. raubitschekii was studied in 200 cases of tinea pedis and tinea unguium in Japan. The 200 clinical isolates were shown to be of downy type as their colonies on Sabouraud's dextrose agar were white to cream, suede‐like to downy, with a yellow‐brown to wine‐red reverse, and they produced few macroconidia. The type strain of T. rubrum var. raubitschekii (CBS 100084) and one clinical isolate (KMU 8337; isolated at Kanazawa) of downy type tested positive for urease, but the reference strain of T. rubrum (CBS 392.58) and the remaining 199 clinical isolates tested negative. Further epidemiological investigations are required to study human cases of infection with the granular type of T. rubrum and T. rubrum var. raubitschekii in Japan.     

Majocchi's granuloma of the face in an immunocompetent patient

Majocchi's granuloma is a condition with chronic erythematous and indurated plaques that is a result of the rupture of a dermatophyte-infected infundibulum as a result of trauma. It is frequently seen on the anterior aspect of the legs of women. Herein, we present a case of Majocchi's granuloma of face, a site rarely involved, in an immunocompetent patient. Diagnosis was confirmed by histological and mycological examination. Histological examination revealed hyphae and arthrospores in the hair follicles and in the dermis with a diffuse dermal infiltrate consisting of lymphoplasmacytic cells, and focal collections of epithelioid cells, neutrophils and mild interstitial edema. Mycological examination confirmed the presence of fungus, Trichophyton rubrum, and the diagnosis of Majocchi's granuloma of the face was made. No concrete predisposing factor was found to be associated with the occurrence of the lesions on the face. However, the history of prolonged veiling of the face by a cloth by the patient, perhaps contributing to the occurrence of lesions on face, is a point of dubious significance.     

First report on autochthonous urease-positive Trichophyton rubrum (T. raubitschekii) from South-east Europe

BACKGROUND: Trichophyton raubitschekii is a dermatophyte belonging to the T. rubrum complex and is differentiated principally by its positive urease activity and production of profuse macroconidia and microconidia in culture. It is classically isolated from African, South-east Asian and Australian aboriginal patients with tinea corporis or tinea cruris. OBJECTIVES: This study was undertaken to screen Greek and Bulgarian clinical isolates identified as T. rubrum for T. raubitschekii and to delineate these strains by two molecular methods used for the first time in T. rubrum epidemiological studies. METHODS: Ninety-five Greek and 10 Bulgarian strains, originating from various body sites, initially identified as T. rubrum, were screened for urease activity. The biochemical properties and morphology of the urease-positive strains were determined. Strains were delineated with polymerase chain reaction (PCR)-ribotyping amplifying repeat elements of the intergenic spacer region and by PCR fingerprinting. RESULTS: Five Greek and one Bulgarian T. raubitschekii strains were identified comprising isolates from patients with tinea manuum (one), tinea corporis (one), tinea cruris (one) and tinea unguium (three). Only one strain had the classical T. raubitschekii microscopic morphology, whereas the remaining five presented a dominant arthroconidial phenotype. Both typing methods clustered all T. raubitschekii and T. rubrum isolates together in the same group, indicating strain homogeneity in the genetic regions examined. CONCLUSIONS: The reported isolation of T. raubitschekii in the Balkan and South-eastern Mediterranean regions extends the geographical distribution of this species. As the more primitive T. raubitschekii probably represents the parental population of T. rubrum, the Greek and Bulgarian T. raubitschekii strains could represent a remnant of the T. rubrum spread that took place after the First World War, rather than being a recent epidemiological event.     

Asthma induced by allergy to Trichophyton rubrum

The worldwide incidence of asthma and of allergic respiratory diseases is increasing (Akiyama K. 'Environmental allergens and allergic diseases.' Rinsho Byori 1997;45(1):13. D'Amato G, Liccardi G, D'Amato M. Environment and development of respiratory allergy. II. Indoors. Monaldi Arch Chest Dis 1994;49(5):412. Weeke AR. Epidemiology of allergic diseases in children. Rhinol Suppl 1992;13:5. Ulrik CS, Backer V, Hesse B, Dirksen A. Risk factors for development of asthma in children and adolescents: findings from a longitudinal population study. Respir Med 1996;90(10):623.) This has been attributed to several factors, including lifestyle changes and an expanding variety of potential causative allergens. Management of asthma entails preventive and acute medications, immunologic therapies, and removal of the identified allergen(s) from the patient's environment. Without the latter, patients may not experience full symptomatic relief. This case report describes a patient who developed bronchial asthma subsequent to an infection of tinea pedis and pedal onychomycosis; antifungal management resulted in full resolution of his tinea pedis, onychomycosis and asthma.     

红色毛癣菌肉芽肿一例

患者男,76岁.因右耳结节1年,左上肢溃疡半年于2006年1月就诊.患足癣、甲癣数十年. 体检:各系统检查未发现异常.皮肤科情况:右耳廓及周围散在大小不等暗红色结节,表面粗糙不平,少许渗出及污秽的结痂.结节质地较硬,基底有浸润,无明显压痛(图1a).右上肢可见一约10 cm×5 cm大小斑块,表面附有较厚的不易剥离的痂皮,且可见浅溃疡及出血,触之微痛(图2).