172例皮下组织真菌感染分析

目的了解近年来广东地区皮下组织真菌感染的临床流行病学特征及菌学动态变化。方法回顾分析了1991年1月-2004年12月间我科门诊172例皮下组织真菌病患者。结果①真菌学变化:申克孢子丝菌仍是皮下组织真菌感染最常见的致病菌,其次为念珠菌属、裴氏着色霉。但近7年孢子丝菌病病例数明显减少,由70．3％减少至50．6％。马尔尼菲青霉所致皮下组织感染迅速增多,由2．2％增长至9．9％,②年龄构成:患病数最多的为60岁以上患者,构成比为34．9％,近年15岁以下患者明显增多,由6．5％增至18．5％。③易感因子:仅74例(43．0％)患者有明确诱因,外伤最常见,蚊虫叮咬伤、HIV感染逐年增多。结论申克孢子丝菌仍是最常见致病菌,但近年发病人数明显减少。马尔尼菲青霉引起的皮下组织感染、儿童皮下组织真菌病近年日益增多。     

加强对新现临床真菌感染的认识

临床上真菌感染是一个日益严峻的问题,致病真菌种类不断变化,新现临床真菌感染不断增多,类型主要包括：由新识别的菌种引起的真菌感染,如新认识的着色霉中的Fonsecaea monophora和Fonsecaea nubica引起的着色芽生菌病等。目前真菌分类学从表型分类向基因型分类转变,使得对已知的疾病病原体有了新的认识,如我国孢子丝菌病的主要病原菌为球形孢子丝菌而非申克孢子丝菌;已知病原菌引起的新感染形式,如葡萄状维朗那霉（Veronaea botryosa）引起的着色芽生菌病;病原菌在新的地方流行,国际人员交流的增多使一些地区流行性真菌感染如球孢子菌病等逐渐变成全球性疾病。为了加强临床医务人员对日益增多的机会性真菌感染防范意识,我们在评价我国近年来新现和疑难真菌病的诊疗状况及面临的挑战基础上［1］,就近5年我国新现的机会性真菌感染进行回顾……     

对几种皮下真菌病的新认识

真菌感染好发于具有免疫功能抑制者 ,正逐渐成为一个公共卫生问题。近来还出现了一些鲜为人知的真菌感染。通过对着色芽生菌病、孢子丝菌病、暗色丝孢霉病、皮下接合菌病、链状芽生菌病和马内菲青霉病等临床上较少见的 6种皮下真菌病的文献复习 ,就其病原体、临床表现、诊断及治疗等方面的进展进行了综述。     

对几种皮下真菌病的新认识

真菌感染好发于具有免疫功能的抑制者,正逐渐成为一个公共卫生问题,近来还出现了一些鲜为人知的真菌感染,通过对着色芽生菌病、孢子丝菌病、暗色丝孢霉病、皮下接合菌链状芽生菌病和马内菲青霉病等临床上较少见的6种皮下真菌病的文献复习,就其病原体、临床表现、诊断及治疗等方面的进展进行了综述。     

手背深部真菌感染2例

报告2例手背深部真菌感染。例1女,46岁。右手背红斑、肿胀、脓疱半年余,脓液真菌培养鉴定为申克孢子丝菌。诊断:孢子丝菌病。例2女,53岁。左手背红斑、丘疹、脓疱4月,脓液真菌培养鉴定为裴氏着色真菌。诊断:着色芽生菌病。     

着色芽生菌病治疗现状

着色芽生菌病（chromoblastomycosis，CBM）是由暗色真菌感染引起的皮肤及皮下组织的慢性肉芽肿性疾病，治疗困难且易复发。对该病的治疗方法主要有物理疗法、化学疗法及联合疗法等。该文就着色芽生菌病治疗的国内外现状及进展作一综述。     

左下肢沿淋巴管扩散的着色芽生菌病1例

着色芽生菌病是由暗色孢科中的一组致病性着色真菌感染所引起的一种皮肤和皮下组织的深部真菌病。病程慢性,以在皮肤上形成肉芽肿性疣状增殖、结节、斑块为特征。最常见累及部位为四肢,多数患者的病灶为单侧性,可沿淋巴管扩散或自身接种。沿淋巴管扩散的着色芽生菌病临床上较少见,现报告1例。     

孢子丝菌病和芽生菌病并发感染:一罕见病例

孢子丝菌病和芽生菌病都是由双相真菌引起的深部真菌感染。皮肤孢子丝菌病比较常见。芽生菌病主要是系统感染,皮肤受累较少。本文首次报导孢子丝菌病和芽生菌病在同一损害内并发的病例。患者男21岁,体健,菲律宾人。发现顽固性干咳数周,约8周后在双面颊各出现一个结节。几周内结节逐渐长大,不痛不痒不出血。用双氯青霉素治疗咳嗽无效。大约3年前移居威斯康辛的一个乡镇。病前数周曾到威斯康辛北部猎鹿。否认与植物及蔬菜有损伤性接触,亦无宠物及其它动物接触史。体检:不发热,左上肺少许啰音,淋巴结未触及。鼻旁面颊对称分布一个1 cm大小的疣     

孢子丝菌病的治疗

1概述 孢子丝菌病（sporotrichosis）是由申克氏孢子丝菌（Sporothrixschenckii）及其卢里变种（Sporothrix schenckii var．luriei）引起的皮肤、皮下组织和局部淋巴系统的感染,偶可播散至全身,引起多系统损害,严重时可危及生命。1898年,孢子丝菌病由美国Shenck首先报道,并分离出病原菌;1916年,刁信德报道国内首例孢子丝菌病,但未做真菌培养。     

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。     

Cromomicosis en paciente inmunodeprimido

Deep fungal skin infections are chronic diseases, caused by various groups of fungi traumatically introduced into skin and subcutaneous tissue. Their incidence is very low in our country; and most cases occur in tropical and subtropical regions. Sporotrichosis, mycetoma and chromoblastomycosis are the most common subcutaneous mycoses.We report the case of a 73 year-old woman on immunosupressive treatment after a heart transplant operation, who developed a 9-month-long traumatic ulcer on her left leg. Histological examination of the affected skin and mycological culture confirmed the diagnosis of chromoblatomycosis. She showed a good response to itraconazole, with complete healing after 3 months of treatment.     

Tropical dermatology: fungal tropical diseases

Fungal infections are common in tropical countries and can have an important impact on public health. Lobomycosis is a common fungal infection in the tropical rain forest of South America, and paracoccidioidomycosis (South American blastomycosis) is a widespread and sometimes severe illness. Penicilliosis marneffei is an opportunistic infection of AIDS patients in southeast Asia. Chromoblastomycosis and mycetomas are causes of morbidity around the world. Sporotrichosis is a worldwide subcutaneous mycosis with a high incidence in tropical countries and is an important illness in immunocompromised patients. Rhinosporidiosis was classed as a fungal infection but is now considered a protistan parasite that belongs to the class Mesomycetozoea. It is included in this review because of its historical classification. In the past, most of these mycoses were restricted to specific geographic areas and natural reservoirs. There are, however, situations in which people from other regions come in contact with the pathogen. A common situation involves an accidental contamination of a traveler or worker who has contact with a tropical mycosis. Even minor trauma to the skin surface or inhalation of the fungal conidia can infect the patient. Thus recognition of the clinical symptoms and the dermatologic findings of the diseases, as well as the geographic distribution of the pathogens, can be critical in diagnosis of the tropical mycoses. This review discusses some of the more common tropical subcutaneous and systemic mycoses, as well as their signs, symptoms, methods of diagnosis, and therapies. LEARNING OBJECTIVE: At the completion of this learning activity, participants should be able to recognize the clinical and histologic presentations of tropical fungal diseases with cutaneous manifestations and be familiar with the appropriate therapies.     

Subcutaneous fungal infections

Subcutaneous mycoses are caused by a variety of mostly tropical organisms, usually when they are implanted into the dermis or the subcutaneous tissue. They rarely disseminate or become systemic. Sporotrichosis, mycetoma, and chromoblastomycosis are more common subcutaneous mycoses than are rhinosporidiosis, zygomycosis, pheohyphomycosis, and lobomycosis.     

Fungal infections in children

Fungal infections of the skin represent a relatively common problem in pediatric dermatology. Although fungal infections of the feet, nails, and groin are uncommon in the pediatric age group, fungal infections of the scalp are very common and must be diagnosed early because they may lead to permanent hair loss if left untreated. Perhaps the most significant change in fungal infections in children has occurred in tinea capitis, including the causative agent and the type of infection this organism may produce; these factors are focused upon in this article. Also discussed are infections caused by the yeast organisms Candida albicans and Pityrosporum orbiculare, as well as the deep mycoses, specifically chromoblastomycosis and cutaneous aspergillosis.     

Chromoblastomycosis imported from Malta

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissues caused by pigmented fungi. It is primarily a disease of the tropics and subtropics. It is uncommon in the UK where it may occur as an imported disease. We describe a 42-year-old lady who developed chromoblastomycosis on her right forearm from Cladosporium, after visiting Malta. The lesion resolved after treatment with itraconazole for 6 months. To our knowledge there are no previous reports of chromoblastomycosis from Malta. We review the clinical course, diagnosis and management of this condition.     

Subcutaneous mycoses: chromoblastomycosis,sporotrichosis and mycetoma

Subcutaneous mycoses are common in subtropical and tropical regions of the world. They are rarely observed in Europe. These mycoses are heterogeneous, but all are caused by penetrating trauma of the skin. Most cases in Europe are observed in returning travelers, aid workers, archaeologists and immigrants. Therefore, a careful, thorough history is essential in order to reach a proper diagnosis. We provide up‐to‐date epidemiological, clinical, diagnostic, and therapeutic data on the three most important imported subcutaneous mycoses in Europe: chromoblastomycosis, sporotrichosis and mycetoma.     

Tumoral chromoblastomycosis: a rare manifestation with typical complementary exams

Chromoblastomycosis is a chronic subcutaneous fungal infection caused by traumatic implantation of dematiaceous fungi in the skin. The clinical presentation is usually a verrucous plaque lesion and the diagnosis is confirmed by the visualization of muriform bodies at direct examination or at the histologic study. This report describes a rare case of tumoral chromoblastomycosis confirmed by histologic study and whose agent was identified by culture and micromorphology.     

Chromoblastomycosis: report of two cases from Nepal

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi. The first case, a 67-year-old male farmer, presented with itchy hyperkeratotic, scaly plaques with scarring and black dots on the lateral aspects of his left arm and dorsum of his left hand of 28 years duration. The case was clinically diagnosed as chromoblastomycosis. The second case, a 75-year-old farmer, presented with erythematous, crusted, scaly plaques on the dorsum of the left foot of 30 years duration. Initially, a clinical diagnosis of lupus vulgaris was made, but treatment with anti tuberculosis therapy showed no improvement. On the basis of histopathological examinations of skin biopsies and isolation of fungus on culture, both cases were diagnosed as chromoblastomycosis. To the best of our knowledge, these two cases are the first case reports of chromoblastomycosis from Nepal and are presented for their academic interest.     

Potassium iodide remains the most effective therapy for cutaneous sporotrichosis

Sporotrichosis is a subcutaneous fungal infection caused by the dimorphic fungus Sporothrix schenckii. Itraconazole has largely replaced older therapies, but we present a case of lymphocutaneous sporotrichosis that failed to respond to an adequate course of itraconazole yet responded dramatically to treatment with saturated solution of potassium iodide (SSKI).