儿童孢子丝菌病（附7例报道）

儿童孢子丝菌病（附７例报道）万沐芳，陈映玲我们近２年遇到７例儿童孢子丝菌病，报道如下：一般资料：７例中男５例，女２例，年龄９个月～１２岁，病程２～８月，皮损发生于面部６例，（面颊３例，鼻翼１例，眼睑２例），上肢肘后１例。临床表现：皮损初起为米粒大小暗...     

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。     

阴囊孢子丝菌病1例及申克孢子丝菌基因型检测

孢子丝菌病是由申克孢子丝菌引发的一种皮肤、皮下组织和附近淋巴管的慢性感染性疾病,多发于四肢等容易暴露受伤的部位.本文报道1例发生于阴囊的固定型皮肤孢子丝菌病,并对申克孢子丝菌进行了形态学和分子生物学水平的鉴定.     

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.     

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。     

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.     

皮肤型孢子丝菌病585例临床分析

目的 对近3年吉林地区585例皮肤型孢子丝菌病病例进行总结,分析其临床和流行病学特征。方法 对2007-2009年我院皮肤科确诊的孢子丝菌病病例进行回顾性分析。结果 585例患者中男女比1 ∶ 1.35,平均年龄40.5岁,发病年龄以51 ～ 60岁最多见（22.05%）;平均病程6.78个月;冬春季节发病者所占百分比最高;居住于农村者551例（94.19%）,有外伤史者占25.47%。临床表现以固定型最常见（56.58%）,其次为淋巴管型（39.66%）,皮肤播散型和不确定型各占1.88%。受累部位以四肢（50.94%）及面部（43.76%）最多。治疗采用10%碘化钾溶液、伊曲康唑、特比萘芬或联合治疗。失访250例,余335例已治愈289例,平均疗程2.09个月,其余46例仍在治疗随访中。结论 孢子丝菌病近年来仍然是吉林地区的多发病,其临床及流行病学特点与以往报道相似,但中老年患者所占比例及皮损不典型病例增加,碘化钾、伊曲康唑和特比萘芬是治疗孢子丝菌病安全有效的药物。     

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。     

皮肤孢子丝菌病误诊为皮肤结核病2例

孢子丝菌病是由申克孢子丝菌污染受损伤的皮肤发病。我们在临床工作中遇到2例孢子丝菌病患者，长期被误诊、误治为皮肤结核病，现报道如下。病例1，女，62岁，农民。因左下肢结节状皮损流脓，久治不愈，于2002年3月21日来诊。患者于2001年10月29日在田间割草，左内踝处被石头碰破出血，未作适当处理，13天后皮损处出现仡生米大紫红     

特比萘芬治疗儿童孢子丝菌病的临床疗效及抗真菌药敏试验研究

<正>孢子丝菌病是由申克孢子丝菌复合体引起的一种常见的深部真菌病。在吉林省为常见、多发的深部真菌病,且患者多为劳动人群,目前儿童孢子丝菌病患者发病率增多~([1])。国内外文献报道,伊曲康唑、特比萘芬及碘化钾溶液均可用于治疗儿童和婴幼儿孢子丝菌病,疗效和安全性与成人相当~([2])。特比萘芬是一种丙烯胺类的新型广谱抗真菌药物,治疗孢子丝菌病患者皮肤及淋     

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。     

儿童皮肤型孢子丝菌病56例临床与病理分析

目的分析儿童孢子丝菌病的临床、病理特点,提高临床医生对本病的认识。方法对2006年1月-2010年12月经真菌培养确诊的56例儿童孢子丝菌病进行回顾分析。结果本组病例淋巴管型15例(26.78%),固定型41例(73.21%)。发病部位主要为面部(76.78%)。主要病理类型为混合细胞型肉芽肿(64.29%)。结论儿童孢子丝菌病并非少见,真菌培养是确诊的金标准,组织病理可提供诊断线索,斯皮仁诺口服治疗本病安全有效。     

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.     

Report of 457 sporotrichosis cases from Jilin province,northeast China,a serious endemic region

Background Most reported sporotrichosis cases came from South American countries, the USA, India and Japan. This mycosis is also endemic in Northeast China. However, the situation is not clear for international researchers due to lack of large series reported in English. Objectives To report and analyse 457 sporotrichosis cases. Methods Retrospective study of 457 cases of sporotrichosis diagnosed by fungal culture at the First Hospital of Jilin University from 1 January 2007 to 31 December 2009. Results In this series, the male: female ratio was 1:1.42. Mean age was 41.2 years. Cases from age group 51–60 years accounted for most of the cases (22.54%). A total of 434 patients lived in rural areas (94.97%). The onset of symptoms in 67.61% cases happened in cold seasons (winter and spring). History of trauma presented in 133 cases (29.1%). The mean duration of the symptoms before the presentation was 6.41 months. A total of 190 (41.58%) showed lymphocutaneous form, 252 patients (55.14%) showed fixed form, 8 patients (1.75%) showed disseminated cutaneous sporotrichosis and the clinical form of 7 patients (1.53%) could not be defined. Extremities and nodules were the most frequently involved sites and founded manifestation. Main histopathology findings were suppurative granuloma, tuberculoid granuloma and mixed inflammatory granuloma. A total of 75 cases (19.74%) had fungal elements revealed by Periodic Acid‐Schiff staining. Patients responded well to potassium iodide (KI), itraconazole, terbinafine and combinations of these agents with a mean course of 2.17 months to resolve. Conclusion As the first report of a large series of sporotrichosis cases from China to be published in English literature, our study indicated a serious sporotrichosis endemic situation in Jilin province, Northeast China, with epidemiological and clinical characteristics similar to those of previous Chinese reports, but different from those in other countries. KI, itraconazole and terbinafine are effective for the treatment.     

Infant sporotrichosis in northeast China: a report of 15 cases

Background Sporotrichosis is a deep mycosis caused by Sporothrix schenckii. It is not uncommon in adults and children but is very rare in infants. Methods We collated a series of case reports. Clinical data and laboratory and therapeutic results in 15 infants with cutaneous sporotrichosis were analyzed. Results A total of 15 cases of sporotrichosis in infants aged <10 months (mean age: 5.2 months; 10 male, five female) were diagnosed at the Department of Dermatology and Venereology, First Hospital of Jilin University, Changchun, Jilin, China, between May 2007 and May 2009. The mean duration of the disease was 2.07 months (range: 1–4 months). All the patients had facial involvement. Fixed cutaneous and lymphocutaneous sporotrichosis were seen in 11 (73.3%) and four (26.7%) patients, respectively. All patients lived in rural areas and had not experienced prior trauma or had contact with soil, plants, animals, or other sporotrichosis patients. Sporothrix schenckii was isolated in all cases, and pathological findings showed suppurative granuloma, tuberculoid granuloma, or mixed inflammatory reaction. One of the 15 patients achieved a spontaneous resolution after biopsy. Fourteen were treated with oral agents, including potassium iodide (KI) alone in two cases, itraconazole alone in three cases, terbinafine alone in four cases, and a combination of KI and terbinafine in five cases. Twelve cases were followed for 4–24 months and were cured with a mean of 2.96 months of treatment (range: 2–4 months) without adverse effects. Conclusions Infant sporotrichosis usually presents as a solitary lesion on the face. This is the largest series of infant sporotrichosis to be reported in the literature.     

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.     

偏振光皮肤镜下玫瑰花瓣征的诊断价值

目的 探讨偏振光皮肤镜下玫瑰花瓣征的诊断意义。方法 回顾北京大学第三医院皮肤科2014年9月至2017年3月偏振光皮肤镜资料库中图片,选出出现玫瑰花瓣征的皮损,进一步选出有组织病理支持的皮损,分析玫瑰花瓣征与疾病的相关性。将上述有组织病理诊断的皮损分为光线性角化病（AK）组及非AK组,比较两组间临床和皮肤镜特征的差异,并用非参数检验比较AK与非AK组间、不同部位间玫瑰花瓣征数量的差异。结果 回顾性分析4 956例皮损的皮肤镜图像,144例（2.91%）出现玫瑰花瓣征,其中74例经组织病理确诊,37例为AK（50.00%）;AK组与非AK组间在皮损部位（是否位于面部,χ2 = 23.786,P < 0.001;是否位于曝光部位,χ2 = 12.921,P < 0.001）以及皮肤镜下表面鳞屑（χ2 = 7.056,P = 0.008）、角栓（χ2 = 6.167,P = 0.013）、毛囊口周围白晕（χ2 = 4.893,P = 0.027）出现频率方面差异有统计学意义。玫瑰花瓣征的数量在面部与非面部皮损间（Z = -2.581,P = 0.010）、曝光与非曝光部位皮损间（Z = -2.098,P = 0.036）差异有统计学差异。结论 玫瑰花瓣征最常见于AK;若位于面部或曝光部位的皮损表现出玫瑰花瓣征,且皮肤镜下可见鳞屑、角栓或毛囊口周围白晕,诊断AK的概率显著提高。     

Sporotrichosis in childhood: clinical and therapeutic experience in 25 patients

Abstract:  Sporotrichosis in an uncommon mycoses in childhood and is generally associated with injuries received as a consequence of farm work. We undertook a retrospective study of sporotrichosis in children and adolescents seen over a 10-year period, focusing on their clinical, epidemiologic, and mycologic features as well as treatment. We included 25 children with a mean age of 9.3 years. Most of those affected were schoolchildren (84%) from rural areas. The main clinical variety of sporotrichosis seen was the lymphocutaneous form (64%), followed by the fixed cutaneous form (36%), and one instance of the disseminated cutaneous form. Most lesions were located on the upper limbs (40%) and the face (36%). Sporothrix schenckii was isolated in all patients and 24 of 25 had a positive sporotrichin skin test. Nineteen patients were treated and cured clinically and mycologically with potassium iodide, three were cured with itraconazole and one with heat therapy.     

Neonatal Sporotrichosis

Abstract:  Sporotrichosis is caused by the dimorphic fungus, Sporothrix schenckii . Classically, infection occurs after implantation of the organism into the skin by abrasion of a puncture wound by contaminated thorns, hay, or sphagnum moss. Cats are also a commonly recognized source of sporotrichosis. In children, fixed cutaneous lesions are more common than lymphocutaneous lesions, and the face is a frequent location for infection. We present a neonate with a fixed cutaneous facial lesion and both pre-auricular and cervical lymphadenopathy who developed signs of infection at 3 weeks of age. This patient is currently the youngest reported case of sporotrichosis in the literature. The patient's family denied any trauma and denied contact with flowers, gardens, and cats; thus, the source of infection remains unknown.     

面部孢子丝菌病186例临床分析

目的探讨面部孢子丝菌病的临床特征。方法对2010-2011年确诊的面部孢子丝菌病进行回顾性分析。结果186例患者男女之比为1：1．16,平均年龄41．30岁,平均病程8．20个月,农民占68．82％,有明确外伤史的占34．41％,临床表现以固定型最多见,占70．97％。治疗分别采用10％碘化钾溶液、伊曲康唑或特比萘芬口服,用药3个月,治愈率达100％。41例留有瘢痕,占22．04％。结论孢子丝菌病是吉林省多发病,临床上与以往报道相似,但不典型皮损者要防止误诊误治。