姐妹同患脓癣2例

例1.女,11岁。胸部红斑2个月,头部脓肿4周,先后在我科和儿科门诊用青霉素、妥布霉素等静脉滴注治疗头部感染9d,病情仍渐加重,遂于2002年8月1日由儿科转入我科。体格检查:体温37.4℃,脉搏92次/min,体重29kg。头部局限性隆起十余处,质软,蚕豆至胡桃大,最大达10cm×13cm,其上头发松动、脱落,挤压有脓液溢出,双侧耳后淋巴结增大。前胸大片不规则红斑(图1A)。实验室检查:白细胞15.4×109/L,中性粒细胞0.81。肝、肾功能正常。胸部鳞屑镜检查见菌丝,病发镜检见发外孢子,培养均为石膏样毛癣菌。头部脓液培养为金黄色葡萄球菌。诊断:体癣伴多发性脓…     

须癣毛癣菌和犬小孢子菌共同致面癣1例

报道罕见由须癣毛癣菌和犬小孢子菌共同感染引起的面癣1例。患者女性,70岁,反复左面部红斑伴瘙痒1年。取皮损鳞屑直接真菌镜检可见菌丝,培养分离鉴定为须癣毛癣菌和犬小孢子菌。给予口服特比萘芬及外用抗真菌软膏3周后治愈。随访3月无复发。     

须癣毛癣菌致成人脓癣及体癣1例

患者女 ,41岁。头顶部直径约 6cm大圆形斑块 ,由毛囊性丘疹、丘疱疹、脓疱融合而成 ,可挤出脓汁 ,其上毛发易拔除。左前臂儿掌大环形脱屑性红斑 ,边缘呈堤状。皮疹真菌直接镜检 (+ ) ,真菌培养鉴定为须癣毛癣菌。诊断为脓癣、体癣。伊曲康唑口服配合剃除病发及外用药治疗效果好     

脓癣201例病原菌分布及流行病学分析

目的了解武汉市及其周边地区脓癣病原菌分布情况。方法回顾性分析2000年1月-2011年12月本科门诊及住院脓癣患者的病例资料,并对国内同期正式发表的文献资料进行汇总和比较。结果 201例脓癣患者中,男70例,女131例;年龄4个月～89岁;2.5～10岁占64.68%。主要病原菌:紫色毛癣菌62株(30.85%)、犬小孢子菌46株(22.89%)和须癣毛癣菌43株(21.39%)。其中,亲人性皮肤癣菌95株(47.26%)、亲动物性皮肤癣菌89株(44.28%)、亲土性皮肤癣菌17株(8.46%)。2006-2011年与2000-2005年相比,紫色毛癣菌检出率显著升高,石膏样小孢子菌检出率显著降低。>18岁组的亲人性皮肤癣菌比例显著高于各儿童组,<10岁组的亲动物性皮肤癣菌比例显著高于各成人组。国内同期报道脓癣552例,主要为犬小孢子菌(38.95%)、须癣毛癣菌(29.71%)和红色毛癣菌(14.49%)感染。结论脓癣病原菌分布有显著的年龄特征,武汉地区脓癣的亲动物性皮肤癣菌比例显著低于国内各地区,而亲人性皮肤癣菌比例显著高于国内各地区;并以紫色毛癣菌为首要致病菌。     

婴儿脓癣一例北大核心CSCD

患儿男,30 d龄。因头顶部脓疱、斑块5 d,于2017年1月1日来我院皮肤科门诊就诊。患儿出生25 d时无明显诱因右侧头顶部出现数个粟粒大小红色丘疹,渐增多。家长予外用“湿疹药膏”（具体不详）无效。皮疹渐融合形成隆起性斑块,有数个粟粒大小脓疱,部分破溃、糜烂,干燥后形成黄色结痂。于当地医院诊断为脓疱疮,外用“红霉素软膏”2 d,     

婴儿脓癣伴体癣1例

患儿女,8个月。额头上发际处红斑丘疹1月余,头皮丘脓疱疹及右上臂圆形环状红斑1周。真菌镜检可见发外大量真菌孢子,皮屑中有透明分隔菌丝。根据培养镜下形态和鉴别试验鉴定为须癣毛癣菌。诊断为脓癣伴体癣。采用灰黄霉素口服配合外用药疗效明显。治疗期间无任何不良反应。     

头癣156例病原菌分析

头癣是一种常见的真菌感染头皮毛发引起的传染性皮肤病，在许多国家和地区传播流行。为了了解头癣的流行状况和菌种变迁，北京友谊医院1995年8月-2004年5月对临床诊断的156例资料完整的头癣病例进行了病原菌分析，现报告如下。     

紫色毛癣菌所致儿童脓癣伴癣菌疹1例

患儿女,8岁。头枕部出现肿块10d,无自觉症状,面、颈、胸、背部突然出现皮疹4d,自觉瘙痒。当地医院疑诊为疖肿和皮炎,给予普鲁卡因青霉素、鱼石脂软膏、复方康纳乐霜等治疗无效,枕部肿块逐渐扩大伴有压痛,于1998年9月18日来我科就诊。体格检查:一般情况尚可,全身表浅淋巴结未触及,心、肺、腹未见异常。皮肤科检查:右枕部可见约5.5cm×6.5cm的肿块,触之稍硬,波动感不明显。表面有与毛囊一致的粟粒大脓疱(图1)。头发松动易拔除,部分头发脱落。面、颈、胸、背部可见粟粒至米粒大毛囊性丘疹,散在分布。实验室检查:白细胞11.0×109/L,白细胞分类…     

96例面癣临床和真菌学分析

目的:探讨面癣的临床特点、易感年龄和致病菌种等相关因素。方法:采用病例回顾性分析,对2012年1月~2014年6月本院96例拟诊为面癣的患者,取皮屑真菌直接涂片镜检,检查有无菌丝或孢子,同时进行真菌培养鉴定。记录并分析患者的一般资料、皮损数目及特征、有无动物接触史、有无并发其他部位浅部真菌病、用药史。结果:面癣见于各年龄段,在青少年和老年人之间各有一个发病高峰;55.2%的面癣患者临床表现不典型,56.2%的患者合并一种或一种以上其他部位浅部真菌病;分离红色毛癣菌48株(50.0%)、犬小孢子菌31株(32.3%)、须癣毛癣菌6株(6.3%)、石膏样小孢子菌5株(5.2%)、念珠菌属3株(3.1%)。结论:面癣的常见致病真菌大多数为红色毛癣菌和犬小孢子菌,其发病可能与患者自体接种或接触患病动物相关,合并其他浅部真菌病、使用激素类药物、动物接触史是面癣发病的重要因素。不典型的面癣容易误诊。     

188例头癣病原菌分析

目的:分析188例头癣患者病原菌菌种的分布。方法:回顾性分析2013年1月至2016年7月188例头癣患者的临床及真菌学资料。结果:188例头癣患者中,男133例,女55例,年龄1个月~81岁,7岁以下患者120例(63.8%)。共分离出菌株117株,其中须癣毛癣菌47株(40.2%),犬小孢子菌43株(36.8%),石膏小孢子菌14株(11.9%),红色毛癣菌复合体11株(9.4%),紫色毛癣菌1株(0.85%),苏丹毛癣菌1株(0.85%)。结论:188例头癣主要致病菌为须癣毛癣菌和犬小孢子菌,主要感染人群为学龄前儿童。     

Trichophyton tonsurans‐induced kerion celsi with decreased defensin expression and paradoxically increased interleukin‐17A production

We report a case of kerion celsi due to Trichophyton tonsurans. An 18‐year‐old male student judo practitioner had alopecic patches, black dots and subcutaneous abscesses on the right temporal region. The damaged hair represented endothrix infection with T. tonsurans, as assessed by mycological examinations. He was treated with oral itraconazole without any therapeutic effect, followed by terbinafine with good effect. A skin biopsy showed neutrophil, lymphocyte and histiocyte infiltration into the dermis and subcutaneous tissue with abscesses around a number of dilated hair follicles. Immunostaining showed that the expression level of human β‐defensin 2 (HBD‐2) was decreased in the epidermis of the alopecic and adjacent skin. Because interleukin (IL)‐17A generally induces HBD‐2 production by epidermal keratinocytes, we also immunohistochemically investigated IL‐17A expression. Unexpectedly, many IL‐17A‐bearing cells were found around destructed hair follicles, indicating that IL‐17A expression was not attenuated, but rather increased in the skin lesion. Our case suggests that IL‐17A‐upregulated antimicrobial peptide expression is disordered in kerion celsi, and severe inflammation with IL‐17A may cause tissue damage and resultant scar.     

儿童头皮及光滑皮肤组织对体外培养犬小孢子菌PQ-LRP表达水平的影响

目的探讨儿童头皮与光滑皮肤组织对体外培养犬小孢子菌膜绑定蛋白编码基因(PQ-LRP)表达水平的影响。方法以18SrRNA基因为内参,应用RT-PCR方法检测SDA培养基中自患儿皮损处分离的头癣株、体癣株第1代及第5代PQ-LRP的mRNA水平;检测体外经儿童头皮及光滑皮肤组织诱导培养后头癣株及体癣株PQ-LRP的mRNA水平。结果 IODPQ-LRP/IOD18S rRNA(SDA第1代头癣株)为1.0352±0.11279,IODPQ-LRP/IOD18S rRNA(SDA第5代头癣株)为1.1157±0.11530,二者差异无统计学意义(P>0.05);IODPQ-LRP/IOD18S rRNA(头皮组织诱导后头癣株)为2.1375±0.11093,与未经诱导者相比差异有统计学意义(P<0.01);IODPQ-LRP/IOD18S rRNA(SDA第1代体癣株)为0.5921±0.12025,IODPQ-LRP/IOD18S rRNA(SDA第5代体癣株)为0.6712±0.12177,二者差异无统计学意义(P>0.05);IODPQ-LRP/IOD18S rRNA(光滑皮肤诱导后体癣株)为1.4734±0.13125,与未经诱导者相比差异有统计学意义(P<0.01)。结论 PQ-LRP在犬小孢子菌中有活性表达,且在头癣株中表达活性明显高于体癣株。SDA培养基中犬小孢子菌PQ-LRP呈稳定表达状态,而儿童头皮组织与光滑皮肤组织对PQ-LRP表达水平存在诱导作用,以头皮组织尤为显著。     

五例成年女性头癣临床表现及病原菌分析

成人头癣感染因症状轻微,临床表现不典型,易造成误诊误治,本文回顾性分析5例成人头癣患者的临床表现、病原菌检查及治疗。5例患者均为女性,年龄26～75岁,平均年龄54.4岁,其中4例绝经,1例有使用免疫抑制剂史。3例患者为紫色毛癣菌感染,并有使用同一理发器具史,临床表现为脂溢性皮炎样及脓疱损害,轻微脱发。2例患者为犬小孢子菌感染,表现为局限性脱发、红斑、脓疱等。5例患者均给予伊曲康唑胶囊联合外用硝酸舍他康唑乳膏,3例患者已痊愈,随访半年,未见复发。2例患者用药不规律,治疗效果欠佳,后失访。     

Optimizing the therapeutic approach in tinea capitis of childhood with itraconazole

BACKGROUND: Tinea capitis is the most common dermatophytosis of childhood with increasing incidence. Whereas griseofulvin is considered by many as the mainstay of treatment, newer oral antifungal agents, including fluconazole, itraconazole and terbinafine have demonstrated higher efficacy, resulting in shorter treatment durations. OBJECTIVES: We aimed to determine the optimum regimen for the treatment of childhood tinea capitis with itraconazole. METHODS: A mycological culture outcome-dependent combination of a 28-day continuous and facultative additional 14-day courses with itraconazole was used in 42 children (20 girls; 22 boys) aged 12-140 months (mean 66) with tinea capitis due to Microsporum canis (n = 26) and Trichophyton violaceum (n = 16). The drug was given orally according to the patients' body weight (50 mg daily for < 20 kg; 100 mg daily for > or = 20 kg) over 4 weeks. Direct microscopy and fungal culture as a parameter for efficacy were repeated 2 weeks after termination of treatment. Assessment of efficacy was based on the evaluation of results from light microscopy and culture at 8 weeks after initiation of treatment, and in the case of a further positive mycological culture at 14 and 20 weeks, respectively. A positive fungal culture at these times resulted in an additional course for 2 weeks with the initially chosen itraconazole dosage. RESULTS: In 34 of 42 patients a single 4-week course of itraconazole resulted in a complete mycological cure of lesions as demonstrated by light microscopy and mycological culture. Four of 42 patients had to be treated by a second itraconazole course for 2 weeks, and four children received a third course of itraconazole for 2 weeks until all lesions showed negative direct microscopy and mycological culture. No abnormal haematological or biochemical results occurred. Apart from transient, completely reversible indigestion in two children, no side-effects were observed. CONCLUSIONS: A culture-based 28-day continuous therapeutic regimen plus facultative cultural outcome-dependent additional 14-day courses of a body weight-adapted dosage of itraconazole in tinea capitis due to M. canis and T. violaceum is discussed; this offers the advantage of an effective therapy with complete negative direct microscopy as well as negative cultural results, within a shorter active treatment period (cf. previous studies with continuous administration of itraconazole).     

Short duration treatment with terbinafine for tinea capitis caused by Trichophyton or Microsporum species. The Study Group

Thirty-five patients with mycologically proven scalp infections were enrolled in a randomized, double-blind clinical trial with oral terbinafine (dose adjusted according to patient weight) for either 1 or 2 weeks. Patients were observed for 12 weeks; after 4 weeks, non-responders were offered an additional 4 weeks of treatment followed by a second observation period. The causative organisms were Microsporum canis (n = 12), Trichophyton tonsurans (n = 12) and other Trichophyton spp. (n = 11). The Trichophyton infections were treated effectively in five of nine (56%) patients treated for 1 week and 12 of 14 (86%) patients treated for 2 weeks. Three of the non-responders were treated for an additional 4 weeks, and one responded. In the Microsporum group only one of seven patients treated for 1 week and none of five treated for 2 weeks responded. However, treatment was effective in four of six (66%) patients treated for an additional 4 weeks. Mild to moderate adverse events believed to be drug related occurred in four patients in each of the two groups. Terbinafine is well tolerated, and requires 2 weeks of treatment in most patients with Trichophyton scalp infections and 4 weeks or more in Microsporum scalp infections, to achieve a successful clinical and mycological response.     

脓癣继发感染66例临床及病原菌分析

脓癣是由浅部真菌感染所致的一种特殊类型的头癣。近年来脓癣的病例时有报道〔1〕,但有关脓癣继发感染的报道尚未见到 ,现将我科 1996～ 1998年部分资料完整的病例报告如下 :1　临床资料1 1　一般资料　男性 42例 ,女性 2 4例 ,1～ 5岁 18例 ,6～10岁 36例 ,11～ 15岁 10例 ,大于 16岁 2例。其中多数为农村儿童 ,且多在夏秋发病。1 2　临床表现　患者头皮处均可见到单个或数个 1ｃｍ到6ｃｍ大小的脓肿。部分患儿可见头部瘢痕形成 ,遗留永久性秃发。皮损界限清楚 ,表面可见密集的毛囊性脓肿 ,触之疼痛 ,挤压后可见少许脓性及血性分泌物流出 ,…     

Dermatophytosis in children and adolescents: epidemiological, clinical, and microbiological aspects changing with age.

During a four year period, a total of 84 cases of dermatophytosis were seen in patients from 0 to 17 years of age attending our out-patient department. The sex distribution was about equal in preadolescents. Males predominated among adolescents. A peak incidence at early school age was due to cases of tinea capitis, mainly caused by Microsporum canis. A peak among adolescents was due to cases of tinea pedis, mainly caused by Trichophyton rubrum. In general, patients with Trichophyton rubrum infections were older than those with other types of dermatophytosis (p<0.05). Dermatophytosis due to Microsporum canis was most frequently seen in January and in September (p<0.01). Although onychomycosis due to dermatophytes was a comparatively rare disease, it did occur within all age subgroups. Entities which were very frequent in former times and which have become rare during the last decades, such as tinea capitis due to Trichophyton schönleinii, still contribute to the spectrum of dermatophytosis in childhood.     

红色毛癣菌、石膏样小孢子菌对人角质形成细胞TLR2/c-Jun、NF-κB信号通路的差异性诱导

 目的:探讨不同生态学分类皮肤癣菌对人角质形成细胞TLR2/c-Jun、NF-κB信号通路的诱导。 方法：将红色毛癣菌、石膏样小孢子菌分别与HaCaT细胞共培养24 h后,蛋白免疫印迹检测p65、relb、IκB、c-Jun的总蛋白及其磷酸化水平。然后将红色毛癣菌、石膏样小孢子菌分别与HaCaT细胞TLR2敲除细胞株（HaCaT TLR2-/-细胞）共培养24 h后,采用蛋白免疫印迹检测TLR2、c-Jun蛋白及其磷酸化水平。结果：HaCaT细胞感染红色毛癣菌后c-Jun蛋白磷酸化水平无明显变化,而感染石膏样小孢子菌后c-Jun蛋白磷酸化水平升高。p65、relb、IκB的总蛋白及其磷酸化水平在两种菌的感染下均无明显变化。HaCaT TLR2-/-细胞感染红色毛癣菌后c-Jun蛋白磷酸化水平明显降低,而感染石膏样小孢子菌后c-Jun蛋白磷酸化水平无明显变化。 结论：红色毛癣菌与石膏样小孢子菌都可以通过TLR2激活人角质形成细胞c Jun信号通路,但并未激活NF-κB信号通路。此外,TLR2可能和其他受体共同介导了红色毛癣菌、石膏样小孢子菌对c Jun信号通路的差异性诱导。