甄氏外瓶霉致暗色丝孢霉病

报告1例甄氏外瓶霉感染所致的暗色丝孢霉病.患者男,59岁.右小腿外踝上方肿块伴瘙痒5个月,皮损为一直径约3 cm的暗红色斑块.皮损组织病理PAS染色见分隔菌丝,组织块马铃薯葡萄糖琼脂(PDA)培养基上25℃培养长出黑色酵母样菌落,分离菌株最高生长温度37℃,小培养下见分枝分隔菌丝,环痕产孢,分生孢子聚集在环痕梗顶端,分离菌株ITS1区测序结果与甄氏外瓶霉98.54%同源.根据分离菌株生物学特点,菌株被确定为甄氏外瓶霉.     

外瓶霉和暗色丝孢霉病

外瓶霉是暗色真菌的一个属,可以引起皮肤、皮下组织及系统性暗色丝孢霉病,对人类的健康危害较大。随着器官移植、免疫抑制治疗的广泛使用及实验室诊断技术的提高,外瓶霉感染的病例报告日趋增加。治疗较为困难,皮肤及皮下组织感染,经手术及抗真菌药物治疗效果较好,但系统性感染者预后较差。     

外瓶霉和暗色丝孢霉病

外瓶霉是暗色真菌的一个属，可以引起皮肤、皮下组织及系统性暗色丝孢霉病，对人类的健康危害较大。随着器官移植、免疫抑制治疗的广泛使用及实验室诊断技术的提高，外瓶的霉素感染的病例报告日趋增加。治疗较为困难，皮肤及皮下组织感染，经手术及抗真菌药物治疗效果较好，但系统性感染者预后较差。     

外瓶霉引起咽部暗色丝孢霉病

报告１例瓶霉引起咽部暗色丝孢霉病。病原真菌经真菌学检查初步鉴定为甄氏外瓶霉ｌｅｃａｎｉｉ－Ｃｏｒｎｉ变种。口服伊曲康唑和５氟胞嘧啶有明显效果。文章讨论了外瓶霉的致病情况及治疗方法。     

甄氏外瓶霉所致皮肤暗色丝孢霉病1例

患者女,57岁。右前臂伸侧出现红色斑块、溃疡5月余。皮损组织病理示:角化过度,表皮增生,真皮浅层及中层可见弥漫性以嗜中性粒细胞为主的混合炎性细胞浸润,伴红细胞渗出,真皮组织中存在真菌孢子及菌丝样结构。真菌种属鉴定示:甄氏外瓶霉。诊断:甄氏外瓶霉所致暗色丝孢霉病。伊曲康唑与特比萘芬口服联合治疗效果显著。     

甄氏外瓶霉所致暗色丝孢霉病1例

暗色丝孢霉病是一大组暗色条件致病性真菌引起的皮肤、皮下组织和系统性感染。皮肤暗色丝孢霉病在我国已有多篇报道，浙江地区尚未见报道，我们报道1例甄氏外瓶霉所致的皮肤暗色丝孢霉病。     

葡萄孢佛隆那霉引起皮肤暗色丝孢霉病一例

患者女,16岁,左耳廓、面颊斑块3年。皮损取材真菌培养：沙氏葡萄糖琼脂培养基上菌落呈灰黑或灰褐色短绒毛状;马铃薯葡萄糖琼脂培养基小培养见分生孢子梗不分支或偶有分支,多芽合轴式产孢,分生孢子不分隔或有1 ~ 2个横隔,顶端钝圆,基底呈截断样;最适生长温度26 ℃ ~ 30 ℃,能液化明胶,水解淀粉。体外药敏实验对伊曲康唑、特比萘芬和两性霉素B敏感,对氟康唑耐药。组织病理检查见棕色菌丝和芽生孢子。PCR扩增ITS1-ITS4片段并测序,与基因库中葡萄孢佛隆那霉标准株序列比对,结果99%同源。诊断：葡萄孢佛隆那霉所致的皮肤暗色丝孢霉病。治疗：口服伊曲康唑胶囊100 mg每日2次,疗程约8个月,皮损逐渐消退。     

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。     

疣状瓶霉引起皮肤暗色丝孢霉病一例

患者男,19岁,耳后、面部红斑、结节6年。取皮屑10％ KOH镜检,见有棕黄色分隔菌丝;沙堡弱培养基（SDA）培养出局限性、绒状、黑色菌落;马铃薯葡萄糖琼脂培养基（PDA）小培养,瓶梗生于菌丝顶端或侧生于菌丝上,领口结构清晰,顶端喇叭状,瓶孢子半内生呈圆形或椭圆形,由黏液包裹聚集于瓶梗顶端如花朵状。体外药敏实验对伊曲康唑、特比萘芬和两性霉素B敏感,对氟康唑耐药。皮损组织病理检查,PAS染色及银染色均见真皮内棕色菌丝和芽生酵母孢子。分子生物学检查与疣状瓶霉的ITS1-ITS4片段序列比对,结果98%符合。诊断：疣状瓶霉所致的皮肤暗色丝孢霉病。治疗：口服伊曲康唑胶囊400 mg/d有效。     

我国首见的疣状瓶霉所致皮肤着色霉菌病3例报告

近5年来,我们在江苏省苏北地区发现3例由疣状瓶霉所引起的着色霉菌病,鉴于国内尚未见到类似报道,今简要报告如下.     

皮炎外瓶霉致皮肤暗色丝孢霉病一例

患者男,78岁,右前臂红肿1个月,加重伴破溃半月。患者1个月前无明显诱因右前臂出现小片状红斑,无自觉症状,表面皮温稍高,无压痛、水疱、破溃,无畏寒、发热,自行外用喜辽妥无改善,红斑面积渐扩大。半月前红斑上出现血疱,很快形成溃疡,伴有渗出,疼痛明显,来我院就诊,予青霉素抗感染治疗无改善。后考虑可能为血管炎类疾病,予泼尼松治疗,皮损很快扩大,溃疡加重,疼痛明显,收住入院治疗。既往病史无特殊……     

Subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei in collagen disease patient

Phaeohyphomycosis is a rare fungal infection that is more commonly associated with compromised patients. We present herein an 81‐year‐old man with collagen disease and chronic interstitial pneumonia who developed subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei. The main pathogen of phaeohyphomycosis had been considered to be E. jeanselmei complex. This has recently been divided into several species by using a molecular technique. The main pathogen of phaeohyphomycosis is Exophiala xenobiotica, and E. jeanselmei is rather a rare pathogen of this disease. Although p.o. itraconazole and terbinafine administration was not effective for this patient, these antifungal agents were used for preventing systemic dissemination in this immunocompromised host.     

Primary cutaneous phaeohyphomycosis caused by Drechslera spicifera

A primary cutaneous lesion in a 5-year-old boy who had recently received chemotherapy for acute lymphocytic leukemia was found to be caused by a dematiaceous fungus, Drechslera spicifera. The lesion was an erythematous macule that rapidly developed necrotic ulcerations. The fungus, which is commonly found in soil and as a plant pathogen, was isolated from cultures of the lesion and from an excisional biopsy specimen. Hyphae and swollen hyphal cells resembling chlamydospores were observed in the biopsy specimen. Septate pigmented hyphae were found in the tissue, which is consistent with phaeohyphomycosis. Resolution of the infection occurred following excisional biopsy and systemic amphotericin B therapy. There was a concomitant recovery from neutropenia.     

Necrotizing cutaneous infection caused by Curvularia brachyspora in an immunocompetent host

A case of necrotizing cutaneous infection in an immunocompetent host caused by the dematiaceous fungus, Curvularia brachyspora is presented. A 58-year-old man was transferred to the Prince Henry Hospital for treatment of necrotizing cellulitis involving both thighs that developed following cryotherapy. The patient did not respond to antibacterial therapy and hyperbaric oxygen. He was empirically commenced on intravenous amphotericin B and began to respond even before the pathogen C. brachyspora was identified.     

国内首见草本枝孢所致暗色丝孢霉病1例

目的：报告1例国内首见的芏本枝孢所致的暗色丝孢霉病。方法：取患者皮肤分泌物及活检组织部分行组织病理,部分做真菌培养。结果：组织切片PAS染色,肉芽肿组织内有多数巨细胞,细胞内有多数棕色薄壁真菌细胞。培养多次为同一黑色真菌生长。CMA玻片培养,25℃16天,分生孢子梗直立或弯曲,淡棕色,光滑,长约200μm,宽约5μm。产生分枝性向顶性分生孢子。结论：经美国CDC专家鉴定为芏本枝孢（Cladosporiun herbarum(Pers.)Link ex Gray）。     

基底细胞上皮瘤伴棘状外瓶霉所致的暗色丝孢霉病一例

患者女,67岁,农民。5年前左头顶部长出一无痛性绿豆大小暗红色结节,逐年扩大、隆起,并延及左颞部。近3个月结节、肿块迅速增大,并出现溃疡。肿块经组织病理检查,诊断为基底细胞上皮瘤,肿瘤细胞巢之间和坏死组织内有褐色菌丝、孢子、芽生孢子。真菌培养为深橄榄黑色酵母样菌落,潮湿有光泽,边缘一圈灰色短绒毛状菌丝。方块小培养镜下见褐色分支分隔菌丝,其顶端与侧缘有成直角长出的棘状分生孢子梗,梗尖端有鼻状突起,顶尖及其周围有成堆光滑的椭圆形小分生孢子,梗远端可见清晰的多个环痕,鉴定为棘状外瓶霉,并经DNA序列分析证实。依据临床特征、组织病理学检查、真菌培养鉴定及基因鉴定结果,确诊为棘状外瓶霉致暗色丝孢霉病伴基底细胞上皮瘤。经光动力学治疗10次,中途合用伊曲康唑后临床痊愈。随访1年无复发。     

Phaeohyphomycosis caused by Phialophora richardsiae

A case of phaeohyphomycosis caused by Phialophora richardsiae is presented. The patient was a 30-year-old man with end stage malignant lymphoma. A subcutaneous abscess that developed on the dorsum of the right foot was removed surgically but immediately recurred. The causative mold was isolated from the pus in the lesion and identified as P. richardsiae. This is the fifth known case of phaeohyphomycosis caused by P. richardsiae and the first recorded in Japan.