海分枝杆菌皮肤感染一例

患者,女,38岁。处理海鲈鱼时,双手多处被鱼刺扎伤。后于受伤部位出现浸润性斑块、溃疡。清创治疗、抗细菌及抗真菌治疗无效。组织活检病理提示感染性肉芽肿,组织培养海分枝杆菌阳性,组织DNA行特异性real time PCR检测海分枝杆菌阳性。予以患者利福平、克拉霉素、乙胺丁醇治疗3个月,皮疹完全消退。随访一年未复发。     

累及皮肤和肌腱的难治性海分枝杆菌感染一例

患者,男,53岁。右上肢结节半年。皮肤科查体：右上肢见多发暗红色丘疹、结节,部分结节破溃,可见脓血性分泌物,伴右手肿胀,皮温正常,轻度压痛。皮肤组织病理检查符合感染性肉芽肿;组织分枝杆菌培养为海分枝杆菌;海分枝杆菌qPCR(组织)为阳性,B超提示右手指伸肌腱腱鞘炎,结合临床表现及实验室检查诊断为海分枝杆菌感染。给予米诺环素、克拉霉素治疗2个月,效果欠佳,结合药敏结果调整方案为利福平、克拉霉素、多西环素、氨苯砜治疗,5个月后右上肢丘疹、结节基本消失。     

海鲈鱼刺伤引发的海分枝杆菌感染四例临床分析

对2019年10月30日至2019年11月25日我院确诊的4例海分枝杆菌感染患者的临床资料进行回顾性分析。4例患者（男1例,女3例）,发病年龄39～60岁,均被海鲈鱼刺伤后发病,表现为手部和上肢的浸润性结节,病理呈感染性肉芽肿改变,皮损组织培养出非典型分枝杆菌,克拉霉素联合利福平、乙胺丁醇治疗有效。     

Sporotrichoid Mycobacterium marinum infection of the face following a cat scratch

Mycobacterium marinum infections in humans uncommonly affect the face and are not known to be associated with cat scratches. We describe a 24-year-old woman who presented with a 3-month history of multiple tender, occasionally discharging cystic nodules involving the left side of her face in a sporotrichoid distribution. She had suffered a cat scratch to her left lower eyelid 3 weeks before the onset of the eruption and owned multiple tropical fish tanks. She was systemically well and had no lymphadenopathy. She had a background history of a 4.5-mm-thick nodular melanoma of her temple treated by wide local excision and negative sentinel lymph node biopsy 4 years prior. Skin biopsies showed multiple variably sized granulomas surrounded by thick cuffs of lymphocytes involving the superficial and deep dermis with no organisms seen on Ziehl–Neelsen, peroidic acid-Schiff and methenamine silver stains. Laboratory investigations showed a mildly raised erythrocyte sedimentation rate but normal full blood count and C-reactive protein. Fluid from the left cheek grew an acid-fast bacillus identified as Mycobacterium marinum . The skin eruption cleared after 5-month treatment with oral clarithromycin 500 mg twice daily and rifampicin 600 mg daily.     

Identification of Mycobacterium marinum in sea-urchin granulomas

BACKGROUND: Sea-urchin granuloma is a chronic granulomatous reaction arising after injury with sea-urchin spines. Classified as an allergic foreign-body type of granuloma, it is believed to be a delayed-type reaction to an as yet unidentified antigen. In a clinicopathological study, 50 biopsy specimens from 35 patients diagnosed as having sea-urchin granuloma caused by Paracentrotus lividus, we found different inflammatory patterns that in some cases suggested a mycobacterial infection. OBJECTIVES: To investigate and identify mycobacterial DNA in formalin-fixed and paraffin-embedded skin biopsy specimens diagnosed as sea-urchin granulomas. METHODS: A search combining polymerase chain reaction amplification using Mycobacterium genus-specific primers, and subsequent restriction enzyme analysis enabling identification to the species level, was performed in 41 samples. RESULTS: Amplification of a 924-bp DNA fragment encoding mycobacterial 16S rRNA gene was positive in eight biopsy specimens from seven patients (21%). M. marinum-specific restriction patterns were identified in three samples. CONCLUSIONS: Although further controlled studies are necessary, from these data it would appear that mycobacteria may play a pathogenic role in some cases of sea-urchin granuloma.     

TB.IGRA在海分枝杆菌感染诊断和鉴别诊断中的应用

目的:探讨结核感染T细胞γ-干扰素释放实验(TB.IGRA)在海分枝杆菌感染诊断和鉴别诊断中的应用价值。方法:回顾性分析在我院门诊诊疗的疑似海分枝杆菌感染患者,排除结核病患者,根据患者海分枝杆菌qPCR是否阳性分为海分枝杆菌感染组和真菌、普通细菌感染组。应用TB.IGRA检测患者外周血中结核感染特异性T细胞,比较分析TB.IGRA和抗酸染色诊断海分枝杆菌感染的灵敏度、特异度、预测值和似然比;比较不同年龄组中TB.IGRA的灵敏度、特异度差异以及海分枝杆菌感染患者的γ-干扰素水平。结果:共纳入87例海分枝杆菌感染和25例真菌、普通细菌感染患者。TB.IGRA诊断海分枝杆菌感染的灵敏度、特异度分别为73.6%、64.0%,灵敏度较抗酸染色高,特异度较抗酸染色低;其阳性、阴性预测值和似然比分别为87.7%、41.0%、2.04和0.41;青年、中年和老年组的灵敏度分别为70.0%、73.5%、74.4%,中年组特异度最高(88.9%),老年组最低(46.2%)。结论:TB.IGRA在海分枝杆菌感染的诊断和鉴别诊断中具有重要的应用价值。     

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

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3124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)2213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。2213例成人患者中,男女比例为1∶2.5,1450例(65.5%)发生于寒冷季节,1523例(68.8%)为皮肤固定型孢子丝菌病,1090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。     

2010-2019年山东省梅毒流行特征分析

目的：了解山东省梅毒流行特征及趋势,为梅毒防治措施的制定提供科学依据。方法：对2010-2019年山东省16个地级市报告的梅毒病例资料进行流行病学分析,描述梅毒报告病例的三间分布,计算发病率、构成比、年均增长率,采用χ2趋势检验分析梅毒的发病趋势。结果：山东省梅毒报告发病率由2010年6.15/105增至2019年20.24/105,呈逐年增长趋势（χ2=12475.40,P<0.01）,年均增长率为14.15%。其中,隐性梅毒占比增长最快,由2010年的31.98%增至2019年的74.28%。高发地区为鲁东半岛的威海市、青岛市及鲁南地区的枣庄市,年均报告发病率在20/105以上。各年女性报告病例数均多于男性,男女性别比为0.89∶1。从年龄分布来看,20~35岁人群梅毒报告病例数占比最多,占总病例数的39.41%;60~79岁人群报告发病率增速最快,年均增长率为22.82%。20类职业中,农民报告病例数最多,占43.94%。结论：山东省梅毒报告发病率呈较快增长,其中隐性梅毒增长尤为迅速。需加强梅毒筛查和防治,特别是高发地区及高发人群。     

Efficacy of oral minocycline and hyperthermic treatment in a case of atypical mycobacterial skin infection by Mycobacterium marinum

We report a case of atypical mycobacterial dermal infection caused by M. marinum, which was effectively treated with oral administration of minocycline and local hyperthermic treatment using chemical pocket warmers. A daily oral dose of 200 mg of minocycline was given, and local hyperthermic treatment was applied every evening for 5-6 hours with a disposable chemical pocket warmer. After 2.5 months of therapy, the lesion healed completely with scar formation. At 24 months after the completion of treatments, there is no sign of recurrence.     

山东省某医院2015-2019年梅毒流行特征分析

对2015-2019年我院11602例性病门诊送检的梅毒标本检测结果及患者资料进行回顾性分析.结果示2015-2019年每年TPPA阳性率均明显高于RPR阳性率,差异均具有统计学意义(均P<0.05);女性与男性梅毒阳性率差异无统计学意义.农村、县城、市区梅毒阳性率依次升高,且差异具有统计学意义(均P<0.05).梅毒...     

系统性红斑狼疮患者医院感染的临床特点及影响因素

目的探讨系统性红斑狼疮(SLE)患者发生医院感染的临床特点及影响因素,为预防控制医院感染的发生提供参考。方法采取床旁调查和查阅住院病历相结合的方法,根据2001年卫生部《医院感染诊断标准》,将295例SLE患者是否符合医院感染标准分为医院感染组与对照组进行相关因素分析。结果呼吸道及皮肤黏膜是SLE患者最常见的感染部位,其感染率分别为45.6%和18.4%。最常见细菌感染(57.6%),革兰阴性菌、革兰阳性菌分别占38%和19.6%,其中铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌、金黄色葡萄球菌分别占13.0%、8.7%、5.4%、5.4%;其次为疱疹病毒感染(20.7%);真菌感染占16.3%,其中白色假丝酵母菌占8.7%。使用糖皮质激素治疗后真菌感染率为40.0%,明显高于疱疹病毒及结核感染率,差异有统计学意义(P0.05);低蛋白血症患者普通细菌感染率为63.3%,明显高于真菌、疱疹病毒和结核感染率,差异有统计学意义(P0.05);白细胞减少患者结核感染率为9.1%,与其他组的结核感染率比较,差异无统计学意义(P0.05);从影响医院感染相关因素看,SLE患者住院时间、两个以上器官受损、感染前使用过抗生素治疗、使用糖皮质激素及免疫抑制剂治疗、低蛋白血症和24 h尿蛋白3.5 g是医院感染的主要危险因素,其感染率明显高于对照组。结论呼吸道及皮肤黏膜是SLE患者最常见的感染部位,医院感染病原体以革兰阴性菌为主,其次为革兰阳性菌。通过缩短住院时间、有效控制病情、谨慎使用糖皮质激素和免疫抑制剂、合理使用抗生素、防止多器官功能损伤等有可能减少SLE患者医院感染的发生。