着色芽生菌病一例

患者男,46岁,某宾馆垃圾清运员.因右膝关节下方皮损1年余,进行性增大于2008年2月17日来我科就诊.1年前右膝关节下方内侧区不明原因出现一元钱硬币大小斑块,上覆黄色厚痂,无自觉症状,自行用刀片削除.     

着色芽生菌病研究进展

着色芽生菌病是一种难治的真菌感染疾病。本文对该病的命名，病原学，流行病学，组织病理学和免疫学作了综合分析，对命名的统一，真菌学分类及鉴定标准和诊断作了全面讨论。有益于消除对此病认识上的一些混乱。     

着色芽生菌病的治疗进展

着色芽生菌病是暗色真菌引起的感染性疾病中最为常见的一种。患者多是通过外伤将病原菌接种于机体而导致皮肤及皮下感染。该病治疗困难且易复发,至今仍无治疗的金标准。目前多采用手术疗法、物理疗法(CO_2激光、冷冻治疗)、化学疗法及联合疗法等,光动力、免疫调节剂等新的治疗手段和方法也应用于临床。本文就目前该病的治疗进展进行综述。     

手部着色芽生菌病

报告1例由紧密着色菌感染引起的着色芽生菌病.患者男,51岁.右手部皮肤溃疡及肉芽肿增生10余年.皮肤科检查:右前臂可见疣状和乳头瘤样增生,皮损形状不规则,呈污秽状,可见溃疡和褐色痂皮,部分瘢痕形成,部分压之有少许脓液流出;皮损表面散在黑点,边缘清楚,周围皮肤呈暗红色浸润.皮损组织病理检查:角化过度及角化不全的鳞状上皮细...     

裴氏着色芽生菌病1例

患者女，40岁，10年前无明显诱因，左踝部出现米粒大红色结节，渐增大，增多，自学轻微痛痒，部分皮损表面破溃，有分泌物及黄色痂皮。曾外用糖皮质激素，抗真菌药及口服抗结核药物治疗，均无效。于2003年12月11日来我院就诊，体格检查：一般情况可，左侧小腿远端近踝部可见绿豆至黄豆大结节及斑块，结节质地硬，表面结灰黄色痂皮，挤压后可见脓性分泌物渗出，部分皮损融合。     

紧密着色霉菌所致着色芽生菌病一例

患者男, 43岁,保管员。就诊前 3年工作时,左侧颈部皮肤不慎被铁屑刺伤如米粒大小,半年后局部出现黄豆大小的结节,暗红色,自认为是瘢痕。此后皮损缓慢发展扩大。 3年中先后在几家医院就诊,诊断为湿疹、神经性皮炎,给予相应的治疗无效。皮损也多次取鳞屑 10％ KOH涂片直接镜检,查见菌丝,改用多种抗真菌药外用治疗,见效甚微。 1999年 4月来本院门诊。当时所见局部有界限清楚的红色斑块,边缘隆起呈盘状,伴有毛孔扩张,中央有粘着性鳞屑而怀疑盘状红斑狼疮,遂予以活组织病理检查。 图 1患者临床皮损 图 2紧密着色霉菌的形态特点 …     

皮肤着色芽生菌病1例

1临床资料 患者男,35岁,农民,主因右下肢皮肤疣状结节斑块破溃、渗出,反复发作进行性加重13年,于2003年4月26日收住院.患者入院前13年,小腿内侧外伤后出现散在黄豆及蚕豆大小暗红色疣状结节,逐渐增大形成斑块,表面破溃,有脓性分泌物.     

裴氏着色真菌致着色芽生菌病1例

患者男,70岁。左上肢斑块、瘢痕30余年,伴肘关节功能阻碍3年。左上肢泛发暗红色斑块,疤痕、结痂,伴肘关节活动障碍。真菌镜检见成堆硬壳小体和棕色分枝分隔菌丝、经真菌培养鉴定为裴氏着色真菌,组织病理PAS染色见棕红色分隔的硬壳小体。诊断:裴氏着色真菌所致着色芽生菌病。     

裴氏着色霉致着色芽生菌病一例

患者,男,62岁.左下肢红斑结节10年余,逐渐加重1年.皮肤组织病理示真皮内可见散在棕色孢子样结构.PAS染色示真皮内见圆形、厚壁硬壳小体.真菌培养示着色霉属;菌落基因测序鉴定为裴氏着色霉.     

着色芽生菌病1例

<正>1临床资料患者男,71岁,农民,因右足、右小腿多发丘疹、疣状斑块伴瘙痒40余年,于2013年12月27日入住我院。患者40年前劳动外伤后右足背开始出现红斑、丘疹,伴瘙痒,当时未予处理,其后红斑、丘疹逐渐增多,并扩大蔓延至右小腿,部分丘疹逐渐扩大成结节、斑块,表面呈疣状,反复出现破溃、糜烂、渗液伴脓性分泌物,瘙痒剧烈,自行中药水外洗后     

Presence of hyphae in chromoblastomycosis examinations: an enigma to be solved

The detection of muriform cells in direct mycological or anatomopathological examination is considered pathognomonic for chromoblastomycosis. The morphological aspect that these fungal structures acquire were called “Borelli spiders”, when associated with hyphae. Reports of this association have been described for decades, initially related to more pathogenic agents of this mycosis. More recent studies have shown aspects related to the host's immunity that participate in this process, as well as an association with a worse disease prognosis. The present study discloses the findings of complementary examinations with the presence of “Borelli’s spiders” in a patient diagnosed with chromoblastomycosis.     

Accuracy of direct examination and culture as compared to the anatomopathological examination for the diagnosis of chromoblastomycosis: a systematic review

BackgroundChromoblastomycosis is a skin infection caused by dematiaceous fungi that take the form of muriform cells in the tissue. It mainly manifests as verrucous plaques on the lower limbs of rural workers in tropical countries.ObjectivesThe primary objective of this review is to evaluate the accuracy of diagnostic methods for the identification of chromoblastomycosis, considering the histopathological examination as the reference test.MethodsMEDLINE, LILACS and Scielo databases were consulted using the terms “chromoblastomycosis” AND “diagnosis”. The eligibility criteria were: studies that evaluated the accuracy of tests for the diagnosis of chromoblastomycosis. Eleven studies were selected. Statistical analysis included the calculation of sensitivity and specificity of the diagnostic methods.ResultsConsidering the histopathological examination as the reference test, the culture showed a sensitivity (S) of 37.5% - 90.9% and a specificity (Sp) of 100%; while direct mycological examination showed S = 50% - 91.6% and Sp of 100% . Considering the culture as the reference test, the serology (precipitation techniques) showed S of 36% - 99%; and Sp of 80% - 100%; while the intradermal test showed S of 83.3% - 100% and Sp of 99.4% - 100%.Study limitationsThe small number of studies and very discrepant sensitivity results among them do not allow the calculation of summary measures through a meta-analysis.ConclusionsDirect mycological examination, culture, intradermal test and serology show sensitivity and specificity values ??for the diagnosis of chromoblastomycosis with no significant difference between the studies.     

Relationship between tissue reactions and morphological changes of the fungi in chromoblastomycosis: morphometry and electron microscopy

Summary To investigate the histological distribution and the morphology of the fungi and the tissue reactions in chromoblastomycosis, especially in the process of trans-epidermal elimination, cutaneous lesions of two patients with this disease were studied morphometrically and ultrastructurally. In the dermis, most of the fungal elements appeared as sclerotic cells and their cell wall showed an irregular, worm-eaten leaf-like appearance; they seemed to be continuously attacked by polymorphonuclear neutrophils. The epidermis eliminated 10–20% of all the organisms in the skin lesions, and the hypha-forming activity tended to be higher in the epidermis than in the dermis. Ultrastructurally, basal keratinocytes facing the dermal abscess containing fungal elements frequently appeared as dark cells, suggesting an increased proliferation activity. Spinous keratinocytes facing intraepidermal microabscesses containing fungal elements showed an abnormal accumulation of tonofilaments and further early keratinization in the spinous cell layer. All of the morphological changes of the dermis and epidermis are regarded as defence reactions against the fungi existing in the skin lesions. There is a close relationship between tissue reactions and morphological changes of fungi in chromoblastomycosis.     

Tumoral chromoblastomycosis: a rare manifestation with typical complementary exams

Chromoblastomycosis is a chronic subcutaneous fungal infection caused bytraumatic implantation of dematiaceous fungi in the skin. The clinicalpresentation is usually a verrucous plaque lesion and the diagnosis isconfirmed by the visualization of muriform bodies at direct examination orat the histologic study. This report describes a rare case of tumoralchromoblastomycosis confirmed by histologic study and whose agent wasidentified by culture and micromorphology.     

Successful treatment of chromoblastomycosis with 5-fluorocytosine

A case of chromoblastomycosis was successfully treated by oral and topical 5-fluorocytosine. Progress of treatment was monitored histologically, by culture of scrapings, and by estimation of blood levels of the drug.     

带状疱疹及其后遗神经痛治疗与预防

带状疱疹及带状疱疹后遗神经痛是皮肤科引起神经性疼痛的常见原因,其治疗和预防是常见临床问题.抗病毒药物能够降低疱疹严重程度、缩短疱疹持续时间,但对带状疱疹后遗神经痛的作用尚不明确.糖皮质激素、三环类抗抑郁药、抗惊厥剂、镇痛药等均能减轻带状疱疹相关疼痛.抗惊厥剂、麻醉性镇痛药、三环类抗抑郁药及局部用利多卡因贴剂和辣椒素软膏均对带状疱疹后遗神经痛有效.接种水痘一带状疱疹疫苗对带状疱疹及带状疱疹后遗神经痛的发病率有重要影响.     

Pulse itraconazole 400 mg daily in the treatment of chromoblastomycosis

Pulse itraconazole is effective in the treatment of chromoblastomycosis caused by Fonsecaea pedrosoi. Six patients, mean 62.3 years (range 45-79), mean duration 103 months (range 4 months to 30 years), were included in this study. F. pedrosoi was the only isolated organism. Four patients (66.7%) were cured by 12 months. Two patients (33.3%) failed to respond fully to treatment; however, one patient whose culture remained positive showed > 50% improvement at the end of study. Data showed that duration and severity were not predictive of treatment response. No side-effects were noted. Treatment should be continued until absence of organisms is proven by histology and tissue culture. Pulse regimen is more economical with better compliance than the conventional continuous 200-400 mg daily regimen, although optimum treatment duration depends on individual cases.     

Successful treatment of chromoblastomycosis with topical heat therapy

Four female patients with chromoblastomycosis were completely cured by prolonged topical application of tolerable heat from pocket warmers. The lesions involuted after 2, 3, and 6 months, respectively, in three patients who faithfully followed our strict treatment schedule, in contrast to the fourth patient who performed the topical heat therapy in an irregular manner at home over a 12-month period. In vitro studies showed that the mature colonies of Fonsecaea pedrosoi, isolated from three of the patients, withstood persistent heating at 42.5 degrees C for more than 1 month. This suggested that heat killing of the causative organisms is unlikely to have been the sole reason for the effectiveness of this simple therapeutic modality.     

卡氏支孢霉系统感染小鼠模型的建立

目的 采用卡氏支孢霉建立着色真菌病动物模型,并探讨卡氏支孢霉对小鼠的致病性.方法 小鼠分为健康和免疫抑制组,腹腔接种卡氏支孢霉,30d时处死进行肉眼观察、病理及真菌检查.结果 健康组和免疫抑制组小鼠感染发病率均为100%,腹腔内脏及系膜均见多发性黑色结节,组织病理H-E染色、PAS染色及真菌直接镜检均可见棕色菌丝及硬壳细胞,培养见卡氏支孢霉生长.健康组炎症反应较免疫抑制组强.结论 卡氏支孢霉无需经动物转种恢复毒力,直接腹腔接种免疫抑制和健康小鼠均可成功建立着色真菌病模型;本模型可以作为研究着色真菌病发病机制的一个手段.