霉克（霜剂）治疗皮肤真菌病疗效观察

霉克（霜剂）治疗皮肤真菌病疗效观察吴建华，廖万清，李守峰最近我们应用拜耳（Ｂａｙｅｒ）有限公司提供的霉克霜剂治疗３０例皮肤浅部真菌病，取得显著效果，现报告如下。１临床资料与方法１．１病例：所有观察病例均为门诊病人，有典型的临床表现且刮取皮损部位的皮屑...     

阿萨希丝孢酵母引起播散性毛孢子菌病国内首例报告

目的报道国内首见阿萨希丝孢酵母（T.Asahii）所致播散性毛孢子菌病1例。方法全面临床检查排除其他疾病;多部位皮损组织及肝穿组织活检,组织病理检查;皮损组织、口腔假膜、阴道及鼻腔分泌物、尿、粪、肝穿组织及皮损表面痂皮多次真菌培养、直接镜检证实为系统性真菌病;菌种与标准菌株对照进行培养、生化试验、菌种鉴定及DNA序列分析;临床系统抗真菌治疗观察。结果发现皮肤、肝、肾、肠道、口腔、阴道粘膜等广泛受累,组织病理发现在感染性肉芽肿损害中有大量真菌孢子。真菌学培养均为同一菌落生长。菌落呈乳白色至淡黄色,表面褶皱,暗淡,边缘有菌丝长出。镜下见大小不一的矩形关节孢子及大量圆形或卵圆形孢子,出芽或不出芽,并见分支分隔菌丝。菌种经生化试验、糖发酵试验、同化硝酸盐试验、温度试验及碳源同化试验等最终鉴定为阿萨希丝孢酵母(No.AS2.2174),DNA序列分析证实该菌与阿萨希丝孢酵母的模式菌株在核糖体D1/D2区域碱基序列完全相同。经脂质体两性霉素B联合氟康唑治疗5个月后病情显著好转,各种真菌学检查阴性。结论阿萨希丝孢酵母所致播散性毛孢子菌病为国内首见;阿萨希丝孢酵母所致皮肤、粘膜、肝、脾、肾、肠道等系统损害,范围广、病程长,且基础病变不明,实为罕见。脂质体两性霉素B联合氟康唑治疗本病疗效显著。     

面部皮肤中型无绿藻病国内首例报告

我们于１９９２年从安徽淮北农村一１３岁女孩面部皮损处分离到一株无绿藻菌。根据其菌落形态、显微镜下结构、放线菌酮试验、耐热试验及碳水化合物利用试验，结合皮屑直接镜检及组织病理切片特征，最后确定为中型无绿藻。     

裴氏着色霉所致着色芽生菌病深圳首例报告及分析

目的　报告深圳首例裴氏着色霉 (Fonsecaeapedrosoi)所致着色芽生菌病 1例。方法　全面临床检查排除其他疾病 ;皮肤组织病理检查及皮损表面痂皮多次真菌培养、直接镜检证实为着色芽生菌病 ;菌种与标准菌株对照进行培养、鉴定确定为裴氏着色霉 ;临床系统抗真菌治疗观察。结果　组织病理HE染色于表皮角栓内和真皮浅层脓肿内见棕黄色厚壁孢子 (硬壳细胞 )。真菌学培养均为同一菌落生长 (3次 ) ,菌落呈暗棕色 ,绒毛状 ,紧凑感 ,镜下见喙枝孢型分生孢子梗和棕色分枝分隔菌丝。经伊曲康唑和特比萘芬联合治疗辅以高温灯照射 ,5个月后病情明显好转 ,各种真菌学检查阴性。结论　此例着色芽生菌病为深圳特区成立 2 0年来首次发现的病例 ,经联合治疗获成功     

Hendersonula toruloidea Infection in Thailand

Hendersonula toruloidea infection is present in Thailand, where the clinical picture of tinea pedis is scales 61%, erythema 22%, maceration 10.8%, and hyperkeratosis 9%. The diagnosis was confirmed by repeated isolation of H. toruloidea. The slow-growing type was found more often than the fast-growing in the ratio of 2.8:1. In patients with H. toruloidea infection, skin test with Hs antigen of 1:10 was positive. Griseofulvin sensitivity test revealed that the MIC of 20 cultures was more than 100 micrograms/ml. Only 2 out of 93 cases (0.02%) were cured with half-strength Whitfield ointment for 4 months. Pathomechanism of the infection is being studied.     

Fungal infection of skin and nails by Hendersonula toruloidea

Ten cases of skin and nail infection by Hendersonula toruloidea are described. All the patients were from tropical countries, though some had been in Britain for many years. Infections were confined to the hands and feet, which showed scaling skin and dystrophic nails. Four of the patients presented with these symptoms, the remaining six having presented with other skin conditions. The presence of brown-walled hyphae in nail tissue and the repeated isolation of H. toruloidea in pure culture are taken as evidence that this species was infecting the tissues. In each of two patients there was evidence of concurrent infection by a ringworm fungus in one of the sites examined.     

Hendersonula toruloidea infection of the nails in Caucasians

Hendersonula toruloidea is a member of the Sphaeropsidales, a subgroup of the Fungi Imperfecti. It has been noted to cause disease similar to foot and nail ringworm in natives of the tropics resident in temperate climates. We report four cases of the disease in Caucasians, presumably acquired during short trips abroad. As travel to the tropics becomes more common, this infection should be considered in the differential diagnosis of certain nail dystrophies. Unfortunately, Hendersonula toruloidea does not respond to currently available antifungal agents.
     

我国首见由地霉引起的脓癣一例及实验研究

目的 报道我国首见由地霉所致脓癣一例。方法 患者为9岁男孩,头部出现脓癣样皮损,耳后淋巴结肿大,全面临床检查排除其他疾病。取头顶皮损表面痂皮及病发多次真菌培养、直接镜检证实为真菌病;通过真菌培养、扫描电镜、生化学实验及DNA序列分析进行菌种鉴定;通过扫描电镜及毛发受侵试验观察菌株对毛发的感染情况;通过动物试验观察菌株的致病力;观察临床抗真菌治疗效果及体外药敏实验。结果 真菌学培养均有同样菌落生长,菌落表面平坦,27℃培养边缘有菌丝生长,37℃培养为湿润的酵母样菌落。镜下见大小不一的矩形关节孢子及大量圆形或卵圆形孢子,出芽或不出芽,并可见有分支的菌丝。菌种经生化学实验等鉴定为地霉菌,DNA序列分析证实该菌属于昔维考拉地霉(Geotrichum silvicola)或其姐妹株。动物实验证明该菌有致病性。经特比萘芬治疗4周后好转,真菌学检查阴性。结论 此例地霉所致脓癣为我国首见;特比萘芬治疗可以治愈。     

长穗离蠕孢引起暗色丝孢霉病一例

目的 分离和鉴定1株引起颅内感染的罕见病原菌。方法 从患者脑脊液取材,涂片及培养,并经小鼠致病性研究重现组织病理学特征,结果 根据直接镜检和培养的菌落形态及显微镜下分生孢子的大小,排列及芽管形成的位置等特征,鉴定为长穗离蠕孢,并经动物试验证实其致病性,在小鼠脑组织标本中可见菌丝及类似厚壁孢子的肿胀细胞,菌丝分隔且有色素,与暗色丝孢霉病相符。结论 该病例为国内首报的由长穗离蠕孢引起的暗色丝孢霉病,其致病力强,预后不良。     

国内首见球毛壳菌所致暗色丝孢霉病

报告一例由球毛壳菌所致的皮肤和甲暗色丝孢霉病。患者男性 ,13岁 ,江苏农民。主诉面部、四肢、掌跖、臀部出现暗红色结节、斑块伴溃疡和结蛎壳样厚痂 5年。组织病理显示为慢性肉芽肿样反应 ,见大量淡棕色分枝分隔的菌丝。损害中分离出的真菌 2 5℃和 37℃生长良好。菌落灰褐色 ,有大量棕黑色子囊壳。根据子囊壳、顶生附属丝、侧生附属丝和子囊孢子形态学特点本菌被定为球毛壳菌。     

Scytalidium dimidiatum in Australia

Six patients with Scytalidium dimidiatum (Hendersonula toruloidea) infections of their skin and nails are presented. Two of these patients originated in tropical areas where the fungus is endemic and four were Australian born. Three of the Australian-born patients had no history of travel to areas where the fungus is endemic. It appears that S. dimidiatum is present in Australia.     

Clinical features of superficial fungal infections caused by Hendersonula toruloidea and Scytalidium hyalinum

The clinical appearances of infections in 128 patients caused by the mould fungi Hendersonula toruloidea (102) and Scytalidium hyalinum (37) are described. All the patients originated from the tropics or subtropics but those infected with S. hyalinum came from either the Caribbean or West Africa. Forty-one per cent of those studied had a concurrent dermatophyte infection. While the clinical features of Hendersonula and Scytalidium infections resembled those seen in 'dry type' Trichophyton rubrum infections, there were a number of distinctive features. These included the absence of dorsal infection on the feet, lateral and distal onychomycosis with extensive onycholysis and the development of paronychia on the fingers. The majority of affected patients showed no serious underlying abnormality or predisposing skin disease which could facilitate invasion. The routine incorporation of cycloheximide, which inhibits the growth of these organisms, in mycological media may explain why they are infrequently diagnosed.     

多发性毛盘瘤国内首例报告

目的 报告1例多发性毛盘瘤。患者男,31岁。主诉右下肢出现多发性高梁米粒至小豆大小坚实性皮色丘疹15年,左膝关节、左小腿部同样皮损近1年,无自觉症状。方法和结果 组织病理显示表皮棘层肥厚,真皮上部为细网状胶原纤维增殖和局灶性黏蛋白沉积,细小血管和神经纤维成分增多,弹力纤维增殖限局于毛囊和表皮突周围。增生毛囊见于病变两侧边缘,呈衣领状向下延伸。超微结构示Merkel细胞-轴突复合体位于表皮下基底板上方,真皮上部见有髓神经纤维。血管超微结构有的基底板显示层状结构,时见血管壁纤维成分增殖,管壁增厚。结论 本病罕见,系来源于毛盘的一种错构瘤。