婴幼儿孢子丝菌病20例临床分析

目的总结婴幼儿孢子丝菌病的临床特征、病理特点和治疗效果,提高临床医生对本病的认识,减少误诊。方法对7年间经真菌培养确诊的20例婴幼儿孢子丝菌病进行回顾分析,并与文献报告相比较。结果本组病例发病部位均为面部。皮损表现为炎性肉芽肿或结痂渗出性斑块。其中固定型15例(75.00%),淋巴管型5例(25.00%)。主要病理类型为非特异性炎性肉芽肿改变。20例患儿应用特比萘芬7.5~10mg/(kg·d),连续服用3个月后,均治愈,且无不良反应。结论婴幼儿孢子丝菌病并非少见,口服特比萘芬7.5~10mg/(kg·d)安全有效,耐受性好。     

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。     

64例孢子丝菌病临床分析

分析2006年11月至2010年4月我院门诊疑诊抱子丝菌感染病例,利用真菌培养检查和/或皮肤组织病理检查对64例疑诊孢子丝菌病进行统计分析.64例真菌培养阳性(可见孢子丝菌生长),10例皮肤组织病理切片、PAS染色找到真菌孢子或星状体.发病部位主要在裸露部位58例(90.63%),如手部、前臂、面部和小腿等.有明确外伤史11例,皮损类型主要为固定型、皮肤淋巴管型、化脓性肉芽肿卫星型.各种因素(建筑、环境污染、自然灾害等)和腐生菌大量繁殖生长是导致孢子丝菌感染的重要原因,外伤和昆虫叮咬是重要致病条件.     

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。     

孢子丝菌病25例临床治疗分析

目的：对近年临床积累的孢子丝菌病例进行临床治疗总结分析。探讨菌子丝菌病的临床、组织病理特点，诊断及有效的治疗方法。方法：对门诊疑为皮肤孢子丝菌病的患者进行真菌学镜检培养和组织病理检查。对确诊病例进行治疗观察。结果：经临床和真菌学检查共25例皮肤孢子丝菌病，病理上按炎性浸润类型的不同，分4型。所有患者确诊后口服10％碘化钾溶液10nd每日3次，大多病例2至2．5个月治愈。结论：本病淋巴管型临床诊断不难，固定型因皮疹形似其他皮肤病易误诊，因此对慢性顽固难治的溃疡及可疑病例应作深部真菌检查培养及时明确诊断。该病治疗首选碘化钾，如单独口服碘化钾效果不明显或皮损面积较大者可考虑联合应用其他抗真菌药物及局部治疗或手术切除。     

孢子丝菌病38例临床分析

经真菌培养,涂片和病理检查而确诊３８例孢子丝菌病,其中皮肤淋巴管型２１例,皮肤限局型１７例。采用１０％碘化钾２－３个月治疗,达到临床治愈。     

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     

原发皮肤接种性孢子丝菌病14例报告

孢子丝菌病由申克氏孢子丝菌所致慢性传染病.1898年Schenck首先报告本病以来,其后关于本病的临床分类繁多.根据Lever 19T5年对本病的分类^①,本文报告的14例应属于原发皮肤接种性孢子丝菌病.14例中男性11例女性3例,9例有明显外伤史.均在病理组织内发现了申克氏孢子丝菌的星状体和孢子.3例霉菌培养证实申克氏孢子丝菌.本组14例病人均经服用碘化钾液而临床治愈.     

Clinical analysis of 140 cases of children sporotrichosis

目的:分析总结140例儿童皮肤型孢子丝菌病病例,明确近年来儿童孢子丝菌病的临床和流行病学特点.方法:对2007年1月-2010年10月于我院皮肤科确诊的≤14岁儿童孢子丝菌病病例进行回顾性分析.结果:140例患儿中男女比例1:0.73,平均年龄5.8岁,平均病程4.59个月,冬春季节发病比率最高,但夏秋季发病并不少见.居住于农村者132例(94.29%),有外伤史者占22.86%.临床分型以固定型最常见(107例,占76.43%),其次为淋巴管型(32例,占22.86%),还有不确定型1例(占0.71%).受累部位以面部最多(125例,占89.29%).采用10%碘化钾溶液、伊曲康唑、特比萘芬单独或联合治疗,资料完整的患儿6个月治愈率达100%,无严重不良反应.结论:近年来儿童孢子丝菌病并不少见,累及面部和表现为固定型者较常见.采用10%碘化钾溶液、伊曲康唑及特比萘芬治疗安全有效.     

粤东地区皮肤深部真菌病临床及致病菌种分析

目的 探讨粤东地区皮肤深部真菌病的发病特点及致病菌种分布情况.方法 分析我院确诊的39例皮肤深部真菌病临床特点及皮损组织真菌培养结果.结果 中老年男性农民是好发人群,79.5％患者发病前存在伤口感染史.真菌培养检出申克氏孢子菌(41％)是主要致病菌种;其次为酵母样菌(15.4％).结论 本地区皮肤深部真菌病以申克氏孢子菌感染引起的孢子丝菌病为主,酵母样菌等机会致病性真菌活跃增殖成为致病菌的病例应引起关注和警惕.     

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。     

Proposal of a histopathological predictive rule for the differential diagnosis between American tegumentary leishmaniasis and sporotrichosis skin lesions

Background American tegumentary leishmaniasis (ATL) and sporotrichosis exhibit similar histopathology and low frequencies of microorganism detection. Objectives This study seeks to identify microscopic alterations that can distinguish between these diseases. Methods Haematoxylin and eosin stained slides of 171 ATL and 97 sporotrichosis samples from active cutaneous lesions were examined for histopathological alterations. The lesions were diagnosed by isolating the agent (which was not visible) in culture. An intuitive diagnosis was assigned to each slide. The strength of the association between the histopathological findings and the diagnosis was estimated by an odds ratio, and each finding was graded according to a regression model. A score was assigned to each sample based on the histopathological findings. A study of the interobserver reliability was performed by calculating kappa coefficients of the histopathological findings and intuitive diagnoses. Results The markers ‘macrophage concentration’, ‘tuberculoid granuloma’ and ‘extracellular matrix degeneration’ were associated with ATL. ‘Suppurative granuloma’, ‘stellate granuloma’, ‘different types of giant cells’, ‘granulomas in granulation tissue’ and ‘abscess outside the granuloma’ were associated with a diagnosis of sporotrichosis. ‘Macrophage concentration’ and ‘suppurative granuloma’ had the highest (substantial and almost perfect, respectively) reliability. The regression model score indicated 92·0% accuracy. The intuitive diagnosis had 82·5% diagnostic accuracy and substantial reliability. Conclusions Taking into account the clinical and epidemiological context, some histopathological alterations might be useful for the differential diagnosis between ATL and sporotrichosis cutaneous lesions in cases in which the aetiological agent is not visible.     

Cutaneous sporotrichosis: a six-year review of 19 cases in a tertiary referral center in Malaysia

Background Sporotrichosis is a subcutaneous fungal infection caused by a thermally dimorphic aerobic fungus, Sporothrix schenckii. It results from traumatic inoculation or contact with animals. Most cases were reported mainly in the tropics and subtropics. Objective The objective of our study is to assess the clinical characteristic of cutaneous sporotrichosis among our patients. Methodology We performed a retrospective review of all cases diagnosed with cutaneous sporotrichosis from July 2004 to June 2010. Patients’ medical records were retrieved and analyzed according to demography, preceding trauma, sites of lesions, clinical subtypes, treatment, and clinical response. Results Nineteen cases were diagnosed with cutaneous sporotrichosis with a male/female ratio of 9 : 10. Thirteen cases (68.4%) were able to recall preceding trauma, and seven of them reported cat scratches or cat bites. Lymphocutaneous sporotrichosis was observed in 13 cases (68.4%) followed by four cases of fixed cutaneous sporotrichosis and two cases of disseminated sporotrichosis. Histologically, 11 cases (57.8%) demonstrated a granulomatous reaction. Sporothrix schenckii was cultured in 12 cases (63.2%). Thirteen cases (68.4%) were successfully treated with oral itraconazole alone for a mean duration of 15.6 weeks. Two cases with disseminated cutaneous sporotrichosis were treated with intravenous amphotericin B. Conclusion Lymphocutaneous sporotrichosis was the most common subtype of cutaneous sporotrichosis in our series, with cat scratches or bites being the most common preceding trauma. Oral itraconazole was highly effective for the localized subtypes, whereas intravenous amphotericin B was required in disseminated cutaneous sporotrichosis.     

SPOROTRICHOSIS

Five cases of cutaneous sporotrichosis were seen at the Stanford University Department of Dermatology from 1966 to 1977, where the disease was previously unreported. The possibility of sporotrichosis should be considered when suppurative cutaneous lesions do not respond to antibacterial agents. Skin biopsy of sporotrichotic lesion is often nonspecific, while culture is the best method of diagnosis.     

Rapid identification of Sporothrix schenckii in biopsy tissue by PCR

Background The dimorphic fungus Sporothrix schenckii is the etiological agent of sporotrichosis, an important cutaneous mycosis with a worldwide distribution. At present, it is challenging to rapidly discover and identify Sporothrix schenckii in biopsy tissues nowadays. Aims To explore new methods for rapid diagnosis of sporotrichosis. Materials and Methods We screened specific primers for Sporothrix schenckii using 50 clinical isolates from patients with sporotrichosis. DNA was extracted from the lesions of 30 cases of clinically suspected sporotrichosis using the Graham s method of CTAB and amplified by PCR using the screened specific primers. Results The primer S2‐R2 was applicable for the identification of S. schenckii from different geographic areas and clinical types with high specificity and sensitivity. Twenty‐five out of the thirty cases (83.3%) amplified using the primer S2‐R2 showed positive bands. Further positive bands were observed in 95.6% of cases tested positive by fungal culture. Conclusions Using the PCR technique and specific primers, we developed a new diagnostic method that can rapidly diagnose sporotrichosis with tissues obtained from clinical biopsies.     

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.     

Sporotrichosis

Sporotrichosis is a chronic fungal infection that most commonly involves the skin and lymphatics. It is classified into five forms: classic lymphocutaneous, fixed cutaneous, disseminated cutaneous, primary pulmonary, and systemic sporotrichosis. Its diagnosis is established by fungal culture or by direct immunofluorescence. Safe effective therapy for cutaneous sporotrichosis exists in the form of oral potassium iodide and local heat therapy. However, itraconazole, one of the newer triazole antimycotic agents, appears quite effective against Sporothrix schenckii and may provide a means of reducing both the length of therapy and the relapse rate. Systemic sporotrichosis, although still rare, is becoming more common, especially in immunosuppressed patients. Because of multisystem involvement, both diagnosis and management of patients with systemic sporotrichosis are difficult. Serologic antibody tests such as the slide latex agglutination test are useful to confirm the diagnosis and to determine the effectiveness of antifungal therapy. Intravenous amphotericin B is still considered the drug of choice for systemic sporotrichosis, but the search for a less toxic agent continues. Also, combination drug therapy and surgical intervention are necessary for some patients with extracutaneous sporotrichosis.     

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.     

655例孢子丝菌病临床流行病学特征分析

 目的:分析孢子丝菌病临床流行病学特征,为孢子丝菌病诊疗及流行提供依据。 方法:回顾性分析2016年6月至2018年6月确诊且资料完整的655例皮肤型孢子丝菌病患者,分析患者一般资料、临床表现、皮损分布、既往诊治情况等。结果： 655例患者中,男253例,女402例,男女比例1  ∶1.59;年龄3个月~81岁,36~65岁占67.79%;病程4天~8年,2~4个月占60.92%。临床以固定型（77.25%）和淋巴管型（21.83%）为主,以丘疹结节损害居多,主要分布于面部（51.45%）和四肢（43.82%）。133例有明确外伤史。499例（76.18%）患者有该病既往外院就诊史,其中误诊293例（58.72%）。误诊疾病以皮肤感染、皮炎诊断最多。结论:孢子丝菌病临床表现多样,以固定型和淋巴管型表现为主,主要累及面部、躯干,误诊率高,临床医师应提高对该病的认识。