股癣患者致病菌与足趾间分离皮肤癣菌的同源性分析

目的:探讨股癣患者足趾间分离的皮肤癣菌与股癣致病菌之间的关系。方法:对26例股癣患者进行趾间取材真菌镜检及培养。趾间与股部培养菌株如经鉴定相同,则进一步采用巢式PCR扩增真菌rDNA非转录间隔区(NTS)中Trs-1片段,检测基因多态性。结果:26例股癣患者中,19例足部培养阳性。其中,4例与股部分离菌株不同;15例与股部分离菌株相同,均为红色毛癣菌。进一步对15例两部位分离的共30株红色毛癣菌进行基因多态性检测,发现5例两部位菌株型别不一致。股部与趾间分离菌株不一致者共9例,占34.6%(9/26)。结论:不同部位皮肤癣菌感染可能为不同菌种或不同型别菌株的混合感染。本实验的发现有助于进一步了解皮肤癣菌感染的流行病学特征。     

Culturing dermatophytes rapidly from each toe web by fingertip

The diagnosis of tinea pedis is usually confirmed by microscopy and culture of skin scrapings. Isolating dermatophytes by fungal culture gives more reliable proof of infection and has the advantage of identifying the causative organisms. Nevertheless, culture examination is complementary to microscopy and is not routinely performed because it is time- and cost-consuming. Herein, we propose a new culturing method, the 'finger-sampling method', for collecting dermatophytes from patients' toe webs using the examiner's fingertip as a sample collection tool. Using this method, four toe webs of a foot can be examined at one time on one culture dish. Every toe web of 50 patients with untreated tinea pedis were examined, and dermatophytes were grown from 83 out of 107 (78%) KOH positive toe webs. The isolation ratio by the finger-sampling method was comparable to that by traditional slant culture of skin scrapings performed by skilled practitioners. Culture results were also positive in 19 out of 53 (36%) diseased but KOH negative toe webs and in 38 (16%) normal toe webs, suggesting the existence of unidentified infection. Additionally, we confirmed the efficacy of this method for detecting dermatophyte attachment on the healthy toe web skin of volunteers who had just been exposed to contaminated areas, i.e. Japanese public baths or a bath mat stepped on by a patient disseminating dermatophyte propagules.     

Transition and isolation ratios of dermatophytes from house dust of patients with tinea

House dust samples from 7 families of 13 patients with tinea due to T. mentagrophytes (5 patients), M. gypseum (1 patient) and M. cants (6 patients) were cultured several times during their clinical courses. In all cases, the numbers of colonies and positive culture plates of the etiologic dermatophytes decreased in number during tinea treatment. T. mentagrophytes was not isolated from house dust any more by the time the patients were cured; M. canis was still isolated after the tinea lesions had healed. These results seem to indicate: 1) cat fur, the source of infection, is difficult to remove by simple cleaning of the house (or clothing). 2) The parasitic form of the fungus is much more resistant and the numbers of dermatophytes in the fur are greater than those in the scales of the patients.     

Prevalence of toe nail onychomycosis in diabetic patients

Onychomycosis among diabetic patients has been reported in some studies to be of high prevalence. This study aimed to investigate the prevalence of onychomycosis among diabetic patients at a Danish University Hospital. Clinical and mycological examinations were performed on type 1 and 2 diabetic patients from in- and out-patient clinics. A total of 271 patients were enrolled, 72% males, mean age 61.3 years, 26% of the patients had diabetes type 1. The prevalence of toe nail onychomycosis (positive culture and/or microscopy) was 22% (n = 59) of which 55 cases were caused by dermatophytes (93%) and 4 cases by yeasts (7%). A correlation was found between onychomycosis and age (p =0.02) and severity of nail changes (p <0.001), respectively. However, no significant correlation was found to gender, type of diabetes, lower extremity arterial disease, neuropathy, toe amputation or oedema. Onychomycosis occurred with a high prevalence in diabetic patients, especially among older patients and those with severe nail changes.     

Association of human papillomavirus 7 with warts in toe webs

Background There have been no studies on the prevalence of types of human papillomavirus (HPV) in cutaneous warts that focus on warts in toe webs (WTW). There is no documented association between HPV 7 and WTW. Objectives To explore the clinical and histopathological features of WTW, and the distribution of HPV genotypes in patients with WTW. Methods The study group consisted of 20 patients with WTW; 31 patients with typical verruca vulgaris (VV) were enrolled as the disease control group, and 53 patients with tinea pedis and 48 healthy volunteers were enrolled as the disease‐negative control group. Tissue specimens were analysed for clinical and histological features and distribution of HPV genotypes. Polymerase chain reaction (PCR)‐based direct sequencing, TA cloning and type‐specific PCR (TS‐PCR) were performed in the WTW and VV groups. Interdigital scale specimens from patients with tinea pedis and from healthy volunteers were analysed for HPV DNA by nested PCR and TS‐PCR (HPV 7). Results All the patients with WTW were male and nearly all were immunocompetent; their mean age was 41 ± 10 years. The lesions presented mainly as soft, friable and vegetating clusters. HPV 7 was the predominant genotype in WTW with a frequency of 80% (16/20). Fourteen specimens were taken for histopathological examination. The most frequent histological results (seven out of 14) revealed characteristics of HPV 7 infections such as heavily stained cells containing medium‐sized keratohyaline granules and a pronounced hyperkeratosis with parakeratosis. TA cloning showed that the sequence shared 90% or more homology with the HPV genotype in direct sequencing. No HPV 7 DNA was found in the scales taken from toe webs without warts. Conclusions This is the first study evaluating the prevalence of HPV types in WTW and the first report of the association between HPV 7 and specific subgroups of patients with warts.     

HPV7相关趾间疣合并肛周疣一例

患者男,35岁.因趾间、肛周湿润柔软赘生物1年就诊.趾间疣组织病理检查:角层角化不全、轻度角化过度,乳头瘤样增生,棘层高度肥厚,中上层较多的空泡化细胞,真皮内血管扩张,周围淋巴样细胞浸润.趾间及肛周疣体组织DNA通用引物PCR扩增HPV保守片段,测序法判定两者型别均为HPV7,型特异性引物PCR显示HPV7阳性,HPV6、11、16、18均阴性,与测序法结果 一致.     

HPV7相关趾间疣合并肛周疣一例

患者男,35岁.因趾间、肛周湿润柔软赘生物1年就诊.趾间疣组织病理检查:角层角化不全、轻度角化过度,乳头瘤样增生,棘层高度肥厚,中上层较多的空泡化细胞,真皮内血管扩张,周围淋巴样细胞浸润.趾间及肛周疣体组织DNA通用引物PCR扩增HPV保守片段,测序法判定两者型别均为HPV7,型特异性引物PCR显示HPV7阳性,HPV6、11、16、18均阴性,与测序法结果 一致.     

HPV7相关趾间疣合并肛周疣一例

患者男,35岁.因趾间、肛周湿润柔软赘生物1年就诊.趾间疣组织病理检查:角层角化不全、轻度角化过度,乳头瘤样增生,棘层高度肥厚,中上层较多的空泡化细胞,真皮内血管扩张,周围淋巴样细胞浸润.趾间及肛周疣体组织DNA通用引物PCR扩增HPV保守片段,测序法判定两者型别均为HPV7,型特异性引物PCR显示HPV7阳性,HPV6、11、16、18均阴性,与测序法结果 一致.     

HPV7相关趾间疣合并肛周疣一例

患者男,35岁.因趾间、肛周湿润柔软赘生物1年就诊.趾间疣组织病理检查:角层角化不全、轻度角化过度,乳头瘤样增生,棘层高度肥厚,中上层较多的空泡化细胞,真皮内血管扩张,周围淋巴样细胞浸润.趾间及肛周疣体组织DNA通用引物PCR扩增HPV保守片段,测序法判定两者型别均为HPV7,型特异性引物PCR显示HPV7阳性,HPV6、11、16、18均阴性,与测序法结果 一致.     

HPV7相关趾间疣合并肛周疣一例

患者男,35岁.因趾间、肛周湿润柔软赘生物1年就诊.趾间疣组织病理检查:角层角化不全、轻度角化过度,乳头瘤样增生,棘层高度肥厚,中上层较多的空泡化细胞,真皮内血管扩张,周围淋巴样细胞浸润.趾间及肛周疣体组织DNA通用引物PCR扩增HPV保守片段,测序法判定两者型别均为HPV7,型特异性引物PCR显示HPV7阳性,HPV6、11、16、18均阴性,与测序法结果 一致.     

HPV7相关趾间疣合并肛周疣一例

患者男,35岁.因趾间、肛周湿润柔软赘生物1年就诊.趾间疣组织病理检查:角层角化不全、轻度角化过度,乳头瘤样增生,棘层高度肥厚,中上层较多的空泡化细胞,真皮内血管扩张,周围淋巴样细胞浸润.趾间及肛周疣体组织DNA通用引物PCR扩增HPV保守片段,测序法判定两者型别均为HPV7,型特异性引物PCR显示HPV7阳性,HPV6、11、16、18均阴性,与测序法结果 一致.     

HPV7相关趾间疣合并肛周疣一例

患者男,35岁.因趾间、肛周湿润柔软赘生物1年就诊.趾间疣组织病理检查:角层角化不全、轻度角化过度,乳头瘤样增生,棘层高度肥厚,中上层较多的空泡化细胞,真皮内血管扩张,周围淋巴样细胞浸润.趾间及肛周疣体组织DNA通用引物PCR扩增HPV保守片段,测序法判定两者型别均为HPV7,型特异性引物PCR显示HPV7阳性,HPV6、11、16、18均阴性,与测序法结果 一致.     

HPV7相关趾间疣合并肛周疣一例

患者男,35岁.因趾间、肛周湿润柔软赘生物1年就诊.趾间疣组织病理检查:角层角化不全、轻度角化过度,乳头瘤样增生,棘层高度肥厚,中上层较多的空泡化细胞,真皮内血管扩张,周围淋巴样细胞浸润.趾间及肛周疣体组织DNA通用引物PCR扩增HPV保守片段,测序法判定两者型别均为HPV7,型特异性引物PCR显示HPV7阳性,HPV6、11、16、18均阴性,与测序法结果 一致.