一株引起皮肤播散性孢子丝菌病的孢子丝菌临床分离株的基因型鉴定

孢子丝菌病是由申克孢子丝菌引起的常见深部真菌病,临床多见于淋巴管型及固定型,播散性孢子丝菌病少见.孢子丝菌进入人体后引起不同临床类型的孢子丝菌病与机体免疫状态有关^[1],但是否与菌型有关尚无定论.为此,我们从一皮肤播散性孢子丝菌病患者皮损中分离1株孢子丝菌菌株,利用常规真菌学和分子生物学方法对其进行鉴定,并探讨该菌株与皮肤淋巴管型孢子丝菌在基因水平上的异同.     

鼻部孢子丝菌病36例临床分析

孢子丝菌病为东北地区常见的皮下组织真菌病.我科从2007年1月至2009年6月共确诊孢子丝菌病患者501例,其中初发皮损在鼻部者36例,现将这组鼻部孢子丝菌病临床资料总结如下.     

2010—2019年吉林省某三甲医院儿童和成人孢子丝菌病的临床特征比较

【摘要】 目的 比较2010—2019年吉林大学第一医院确诊的儿童和成人孢子丝菌病的临床特征差异。方法 回顾性分析2010年1月1日至2019年12月31日吉林大学第一医院皮肤科3 124例孢子丝菌病患者的临床资料，其中儿童（< 18岁）911例，成人（≥ 18岁）2 213例。所有患者均经皮损真菌培养确诊为孢子丝菌病。采用χ2检验比较儿童与成人孢子丝菌病的临床特征差异。结果 911例儿童患者中，男女比例为1.4∶1，720例（79.0%）发生于寒冷季节（1 - 3月及10 - 12月），790例（86.7%）为皮肤固定型孢子丝菌病，835例（91.7%）皮损发生于面部。2 213例成人患者中，男女比例为1∶2.5，1 450例（65.5%）发生于寒冷季节，1 523例（68.8%）为皮肤固定型孢子丝菌病，1 090例（49.3%）皮损累及四肢，975例（44.1%）累及面部。儿童孢子丝菌病在寒冷季节发病的比例明显高于成人（χ2 = 55.55，P < 0.001），皮肤固定型孢子丝菌病比例亦显著高于成人（χ2 = 107.55，P < 0.001）。两组皮损分布差异有统计学意义（χ2 = 599.91，P < 0.001）。结论 儿童与成人孢子丝菌病的流行病学特征和临床表现存在差异。     

固定型皮肤孢子丝菌病:皮损内注射皮质类固醇引起少见的组织病理学改变

固定型皮肤孢子丝菌病由于其临床表现多种多样,皮损组织病理活检又很难检出申克氏孢子丝菌体,故难以诊断。作者报告了两名孢子丝菌病患者,由于皮损误诊为其它炎症性皮肤病而予皮质类固醇皮损内注射,结果在皮损内出现少见的组织病理学改变——见大量的酵母细胞。现报告如下。例1男、12岁,左手背见一环状斑块3个月。斑块系由数个鲜红色丘疹融合而成,诊断为环状肉芽肿。予去炎松0.3mI(5mg/ml)皮损内注射,3周     

从一只猫获得的孢子丝菌病

皮肤孢子丝菌病的发生,常与职业接触植物有关.其病原菌申克氏孢子丝菌,为植物中的一种腐生菌.本文报告两例兽医的助手,因管理同一只感染的猫而患皮肤孢子丝菌病.     

申克孢子丝菌接种的无毛小鼠皮损处蛋白酶抑制剂的作用

Chymostatin和 Pepstatin能分别抑制申克孢子丝菌产生的蛋白酶 和 ,为了证明在孢子丝菌病中 Chymostatin和 Pepstatin能通过抑制这些酶的活性而抑制真菌的生长 ,我们研究了在小鼠的皮损上外用蛋白酶抑制剂的效应 ,用 0 .1% Chymostatin,0 .1% pepstatin和 0 .1% chymostatin+0 .1%pepstatin软膏涂于无毛小鼠的申克孢子丝菌接种部位与对照组相比 ,单用一种成分时 ,皮损处结节大小的变化曲线表现分轻度抑制 ,而用含 chymostatin和 pepstatin的软膏 ,则强烈地抑制了结节的形成。本研究不仅证明了两种蛋白酶对申克孢子丝菌在体内生长的作用 ,而且还发展了一种新的局部药物治疗方法     

孢子丝菌病的超微结构观察

本文报道5例孢子丝菌病的超微结构改变.在TEM下,角朊细胞间晾增宽和桥粒减少,在表皮内可见嗜中性粒细胞、巨噬细胞、淋巴细胞和浆细胞浸润.超微结构提示在初发皮损的表皮颗粒层中,可见炎性细胞吞噬的吞噬体和中克氏孢子丝菌,而非初发皮损表皮颗粒层中不见石噬体和申克氏孢子丝菌.真皮浅层中可见固编的孢子和炎性细胞浸润.     

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。     

接触泥炭藓所致的孢子丝菌病

孢子丝菌病是由申克氏孢子丝菌所引起的.此菌广泛地存在于腐生物中.本病为一职业病,主要发生在苗圃、农业和林业工人中.绝大部分病人为皮肤淋巴管型,极少数累及内脏和骨.作者报道了3例皮肤型孢子丝菌病,患者都是明尼苏达州东部的一个苗圃的工人,由于接触泥炭藓(Sphagnum Moss)而引起发病,从藓中发现了申克氏孢子丝菌,此藓产于威斯康星州.作者报道的3例患者均为上肢皮肤淋巴型损害.除活检作组织病理检查(包括HE染色、改良Brown-Brenn革兰氏染色、PAS染色和Gomori乌洛托品银染色)和真菌培养外,同时也取泥炭藓标本作培养.其结果是3例组织和泥炭藓标本培养均见相同     

山苍子油抗申克孢子丝菌的动物实验研究

目的探讨山苍子油灌胃治疗实验性小鼠皮肤孢子丝菌感染的疗效。方法制备小鼠皮肤孢子丝菌(包括临床分离固定株和淋巴管株)感染的动物模型,造模成功后给予山苍子油灌胃治疗,同时设10%K I治疗组和生理盐水治疗组(空白对照组),观察治疗前后皮损的直径变化。结果山苍子油灌胃治疗4周后,小鼠皮损明显缩小,甚至消退,其皮损直径变化与空白对照组比较差异有显著性,与10%K I治疗组比较差异无显著性。结论山苍子油灌胃治疗对小鼠皮肤孢子丝菌病有一定的疗效。     

申克孢子丝菌基因差异、致病力与孢子丝菌病临床型别的关系

目的 探讨申克孢子丝菌基因差异、致病力与孢子丝菌病不同临床型别的关系。方法 ①收集不同临床型别孢子丝菌病的申克孢子丝菌分离株并提取DNA,进行随机扩增多态DNA(RAPD)扩增。②BALB/c小鼠接种不同临床型别孢子丝菌病的分离株菌悬液,观察实验动物发病及病变情况。③发病小鼠皮肤及内脏组织病理学检查,观察接种不同临床型别孢子丝菌病的分离株菌悬液后小鼠病变内申克孢子丝菌孢子数量及分布。结果 ①不同临床型别孢子丝菌病的申克孢子丝菌分离株聚合酶链反应产物电泳带型差异较明显:播散型分离株可见1800bp、850bp、500bp、180bp,皮肤淋巴管型分离株见1400bp、800bp、700bp、500bp,皮肤固定型分离株见2500bp、1400bp、1000bp、700bp。②注射播散型孢子丝菌病分离株菌悬液的BALB/c小鼠比注射皮肤淋巴管型分离株小鼠发病早、病变部位广且死亡率高;注射皮肤淋巴管型分离株的小鼠较注射固定型孢子丝菌病分离株小鼠皮损出现早、病变范围广且严重。③实验BALB/c小鼠病变皮肤及内脏组织病理学检查显示:注射播散型孢子丝菌病分离株的小鼠病变内孢子数量明显多于注射皮肤淋巴管型分离株小鼠病变内孢子数量,而后者较注射固定型孢子丝菌病分离株的小鼠病变内孢子数量多。结论 不同临床型别孢子丝菌病的申克孢子丝菌的基因差异、致病力与孢子丝菌病不同临床型别的关系密切。     

Fixed cutaneous sporotrichosis: Unusual histopathology following intralesional corticosteroid administration

The fixed cutaneous type of sporotrichosis is difficult to diagnose because clinical lesions are variable in appearance and the cells of Sporothrix schenckii are usually scarce in skin biopsy specimens. We have described two patients with lesions of fixed cutaneous sporotrichosis that resembled other inflammatory skin conditions and were treated with intralesional corticosteroids. Subsequent skin biopsies from these lesions demonstrated an unusually large number of yeast cells.     

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。     

Sporotrichosis in Uttarakhand (India): a report of nine cases

Background Sporotrichosis is a chronic granulomatous infection caused by Sporothrichum schenckii. The disease has worldwide distribution. Majority of cases from India are reported from North‐eastern states. Methods The demographic, clinico‐investigative profile and therapeutic results of nine patients with cutaneous sporotrichosis attending the Dermatology Outdoor Department between January 2005 and June 2006 have been compiled. Results Out of nine (male‐4, female‐5) patients, five had lymphocutaneous‐type sporotrichosis while four had fixed cutaneous sporotrichosis. The average age of these patients was 40.8 years. The duration of complaints ranged from 1 month to 15 months (average 8.6 months). Two patients were able to recall traumatic injury. Six patients had lesions over lower extremities, two over face and one over upper extremity. Histopathologically, all cases showed granulomatous process with mixed inflammatory infiltrate comprising of lymphocytes, plasma cells, histiocytes and small neutrophil abscesses. Two cases were positive for fungal cells on PAS staining. Fungal culture on skin tissue was positive in all cases. Eight patients were treated with saturated solution of potassium iodide (SSKI) and they responded very well to SSKI in 12–16 weeks. One patient was pregnant and therefore was advised thermotherapy. Conclusion Sporotrichosis is also present in north‐western region of India as it is reported from north‐eastern part. This is the first series of cutaneous sporotrichosis being reported from Uttarakhand, a state situated in the north‐western region of India.     

孢子丝菌病患者皮损中Toll样受体2、4及髓样分化因子88的表达

【摘要】 目的 通过观察孢子丝菌病患者皮损中Toll样受体2、4（TLR2、TLR4）以及髓样分化因子88（MyD88）的表达情况,探讨其在孢子丝菌病免疫识别及免疫介导中的作用。 方法 选择孢子丝菌病患者19例及健康人对照12例,应用免疫组化法分别检测患者组皮损及对照组皮肤组织中TLR4及MyD88的表达情况,同时应用实时荧光定量PCR技术检测TLR2及MyD88 mRNA的表达情况。所有结果数据以■ ± s表示,采用SPSS17.0统计软件进行数据分析,两组间比较采用独立样本t检验,P ＜ 0.05认为差异有统计学意义。 结果 免疫组化分析：孢子丝菌病患者皮损中TLR4、MyD88的表达部位主要是除角质层外的表皮全层和真皮及皮下组织中的浆细胞和淋巴细胞。对照组皮肤几乎不表达TLR4,MyD88于真皮及皮下组织呈弱表达。孢子丝菌病组TLR4表达水平（63.767 ± 3.829）高于对照组（5.167 ± 3.246）,差异有统计学意义（t = 4.82,P ＜ 0.05）;MyD88表达水平（57.236 ± 4.744）亦高于对照组（10.588 ± 1.640）,差异有统计学意义（t = 3.30,P ＜ 0.05）。实时荧光定量PCR分析：孢子丝菌病患者皮损TLR2 mRNA和MyD88 mRNA的相对表达水平分别为1.974 ± 1.452和2.028 ± 2.061,均显著高于对照组（分别为1.430 ± 1.073和0.688 ± 0.422）,均P ＜ 0.05。 结论 孢子丝菌病发病可能与真菌通过Toll样受体途径作用于机体免疫系统有关。     

A case of lymphangitic sporotrichosis occurring on both forearms with a published work review of cases of bilateral sporotrichosis in Japan

The patient, 56-year-old man who was working as a clerk and a farmer, presented with nodules that had appeared on the dorsa of both his hands 3 months earlier. At the first examination, there were multiple dark-red nodules scattered on the fingers, dorsa and wrists of both hands. The nodules were up to 3 cm in diameter and had crusts in the incenters. The patient was suspected to suffer from prurigo and was subsequently treated with topical steroid, but the nodules did not respond. Therefore, a skin biopsy and fungal culture were performed, and the patient was finally diagnosed as having bilateral multiple sporotrichosis. He was then successfully treated with local thermotherapy and oral potassium iodide. Bilaterally-distributed lymphangitic sporotrichosis is very rare and often difficult to diagnose. Careful attention is required to avoid misdiagnosis.     

Botryomycosis in an HIV-positive subject

A 28-year-old male AIDS patient with generalized painful skin ulcers, fever and malaise presented to us. The differential diagnosis included varicella zoster infection, herpes simplex infection, actinomycosis, sporotrichosis and botryomycosis. Histopathology revealed clusters of gram-positive coccoid bacteria in the deep dermis, surrounded by a mixed dense inflammatory infiltrate. A bacterial culture grew Staphylococcus aureus. Viral cultures remained negative. Based on these findings botryomycosis was diagnosed. Large lesions were excised surgically and with antimicrobial therapy all skin symptoms disappeared. We discuss this case with reference to a short review of the literature on botryomycosis in relation to HIV infection.     

Sporotrichosis with widespread cutaneous lesions: report of 24 cases related to transmission by domestic cats in Rio de Janeiro,Brazil

Background Sporotrichosis most commonly presents as a localized lymphocutaneous infection following traumatic inoculation of soil, vegetables or organic substrates contaminated with the dimorphic fungus Sporothrix schenckii. Cases of widespread cutaneous lesions are rare. There have been isolated reports of household outbreaks of sporotrichosis involving cats and humans. Methods We report 24 cases of culture‐proven sporotrichosis presenting with widespread cutaneous lesions. Results These 24 cases are part of an epidemic currently occurring in Rio de Janeiro. All patients reported contact with cats with sporotrichosis and 17 reported a history of a scratch or bite. Clinical manifestations included fixed lesions at multiple anatomical sites, and fixed lesions associated with the lymphocutaneous, bilateral lymphocutaneous and mucosal forms of the disease. Two patients were alcoholics and one patient was diabetic, while the remaining patients did not present any immunosuppressing condition. All patients responded to treatment with itraconazole. Conclusions The domestic cat has played an important role in the transmission of sporotrichosis in Rio de Janeiro and seems to have contributed to this unusual clinical manifestation.     

Epidemic cutaneous sporotrichosis: Report of 16 cases in Queensland due to mouldy hay

We report an epidemic of sporotrichosis in a south-east Queensland rural community. Sporotrichosis is a fungal infection due to the organism Sporothrix schenckii , typically presenting with cutaneous lesions. Sixteen cases of cutaneous sporotrichosis were seen over a 9 month period in the Darling Downs region of Queensland. All patients had had contact with a batch of mouldy hay presumed to be contaminated by Sporothrix schenckii . Nine of 16 patients were male; the youngest patient was aged 11 and the oldest was 67 years of age. Lymphocutaneous sporotrichosis was seen in 50% of patients; the rest demonstrated the fixed cutaneous form. No cases of disseminated cutaneous or systemic sporotrichosis were seen. One case demonstrated lymphangitis related to sporotrichosis. No apparent difference in the duration to diagnosis was demonstrated to exist between lymphocutaneous or fixed cutaneous types.