国内首见真皮毛孢子菌引起皮肤感染一例

目的 报道1例真皮毛孢子菌引起的皮肤感染。方法 取皮损作直接镜检、真菌培养和组织病理学检查,分离菌株行DNA序列分析、API 20C AUX试剂盒检测、明胶液化试验、温度试验和体外药敏试验。结果 70岁男性患者,右内踝植物刺伤后出现肿块、溃疡9个月。皮损直接镜检阴性,组织病理显示真皮内菌丝和孢子。沙氏葡萄糖琼脂培养基培养出奶黄色酵母样菌落,微量培养可见假菌丝、真菌丝、关节孢子和芽生孢子,API 20C AUX试剂盒检测结果提示为土生念珠菌,DNA序列分析属于真皮毛孢子菌。菌株不能液化明胶,可在25 ～ 40 ℃环境下生长,对两性霉素B、伊曲康唑、伏立康唑、制霉菌素敏感。伊曲康唑治疗4个月后皮损完全愈合。结论 根据其形态学特点和DNA序列分析,菌株被鉴定为真皮毛孢子菌。伊曲康唑治疗有效。     

克柔念珠菌引起的皮肤念珠菌性肉芽肿一例国内首报

患者女,80岁,左手腕部3 cm×6 cm大小浸润性肿块,部分表面覆盖增厚焦痂.临床拟诊:皮肤真菌感染.皮损样本送真菌培养、组织病理检查及特殊染色.组织病理检查,真皮内有大量淋巴细胞、中性粒细胞及浆细胞浸润,特殊染色见有大量的真菌孢子及菌丝.真菌培养及鉴定证实为克柔念珠菌.给予伊曲康唑口服治疗5个月,皮损消退.     

囊肿型痤疮合并毛囊虫和念珠菌感染1例

患者男,18岁。双侧面部丘疹、粉刺、囊肿及脓肿2个月,皮肤真菌镜检和革兰染色镜检,见有酵母菌孢子、芽生孢子及瘦长毛囊虫,皮损真菌培养为念珠菌。皮损组织病理检查符合囊肿型痤疮,并发毛囊虫感染。体外药敏试验显示对伊曲康唑、两性霉素B、制霉菌素高度敏感,酮康唑、克霉唑低度敏感,氟康唑耐药。给予口服伊曲康唑200 mg,每天1次和甲硝唑片400 mg,每天3次,连续14天;局部外用10%硫磺炉甘石洗剂 甲硝唑片6片(研碎),治疗3周后病情明显好转。     

球黑孢霉引起白色浅表型甲真菌病一例

目的 报道1例球黑孢霉引起的白色浅表型甲真菌病.方法 取病变趾甲作直接镜检、真菌培养和组织病理学检查,分离菌株行DNA序列分析、明胶液化试验、体外药敏试验和甲板受侵试验.结果 21岁男性患者,右足拇趾甲板白色病变5个月.病变甲屑直接镜检发现孢子、菌丝和叶状分生孢子梗,组织病理显示甲板内有大量孢子及菌丝.沙氏葡萄糖琼脂培养基培养出黑色羊毛状菌落,DNA序列分析提示为黑孢霉属.菌株可液化明胶和侵犯甲组织,对制霉菌素、伊曲康唑、两性霉素B、克霉唑高度敏感.伊曲康唑冲击治疗5个疗程后,病甲恢复正常.结论 根据其形态学特点和DNA序列分析,菌株被确定为球黑孢霉.球黑孢霉引起的白色浅表型甲真菌病为国内首例报道,伊曲康唑治疗有效.     

疣状瓶霉引起皮肤暗色丝孢霉病一例

患者男,19岁,耳后、面部红斑、结节6年。取皮屑10％ KOH镜检,见有棕黄色分隔菌丝;沙堡弱培养基（SDA）培养出局限性、绒状、黑色菌落;马铃薯葡萄糖琼脂培养基（PDA）小培养,瓶梗生于菌丝顶端或侧生于菌丝上,领口结构清晰,顶端喇叭状,瓶孢子半内生呈圆形或椭圆形,由黏液包裹聚集于瓶梗顶端如花朵状。体外药敏实验对伊曲康唑、特比萘芬和两性霉素B敏感,对氟康唑耐药。皮损组织病理检查,PAS染色及银染色均见真皮内棕色菌丝和芽生酵母孢子。分子生物学检查与疣状瓶霉的ITS1-ITS4片段序列比对,结果98%符合。诊断：疣状瓶霉所致的皮肤暗色丝孢霉病。治疗：口服伊曲康唑胶囊400 mg/d有效。     

伊曲康唑治疗孢子丝菌病的疗效观察

目的观察伊曲康唑治疗孢子丝菌病的疗效。方法选择在本院皮肤科就诊的明确诊断为孢子丝菌病患者30例,随机分为两组,分别予单独服用伊曲康唑和伊曲康唑与碘化钾联合治疗。结果联合用药组3个月痊愈率为55.0%,6个月痊愈率为100.0%;伊曲康唑组分别为40.0%,100.0%。结论单独口服伊曲康唑治疗孢子丝菌病疗效确切。     

类似环状肉芽肿的面部皮肤型孢子丝菌病一例

患者,女,54岁。左面颊红斑、丘疹、结节1个月。皮肤科查体见左侧面部类似环状肉芽肿的簇集浸润性环状红色斑块。皮损组织病理检查及真菌培养,确诊为“面部皮肤型孢子丝菌病”。给予伊曲康唑胶囊口服治疗3个月,皮损消退,随访6个月无复发。     

特比萘芬治愈孢子丝菌病1例

孢子丝菌病的治疗首选碘化钾 ,伊曲康唑也有效〔1〕。但作者曾遇 1例 ,经碘化钾和伊曲康唑正规治疗 5个月无效 ,来我院用特比萘芬治疗 3个月痊愈。现报告如下。患者男 ,36岁 ,一年前因洗鱼缸被玻璃划破右手食指(鱼缸内投放有青霉素 ) ,数天后手指划破处红肿 ,轻度压痛 ,用各种抗生素内外治疗无效。 2月后 ,皮损未愈 ,同时前臂内侧先后出现结节 3个 ,线状排列。半年后到一省级医院住院 ,经培养无细菌生长 ,组织病理学检查报告为“感染性肉芽肿” ,结合临床诊断为孢子丝菌病 ,开始用伊曲康唑0 2 1次 /日 ,10 %碘化钾溶液 10ｍｌ 3次 /日治疗 …     

国内首例总状共头霉所致原发性皮肤毛霉病及文献复习

目的:报道1例总状共头霉所致的原发性皮肤毛霉病并进行文献复习。方法:患者,女,67岁。反复右踝结节、渗液伴疼痛3年。取患者皮损进行真菌镜检及培养,对皮损进行组织病理检查,并对分离菌种行r DNA ITS测序鉴定。结果:显微镜下可见宽而无分隔、成直角分支的菌丝。培养见白色菌落生长,生长较快,菌落呈疏松絮状,灰褐色绒毛状,边缘呈羊毛状向外延伸。皮损组织病理示:真皮全层弥漫性炎细胞浸润,散在多核巨细胞,可见大量团块状菌丝。PAS和嗜银染色阳性。分子测序鉴定为总状共头霉。确诊后外科结合伊曲康唑等治疗取得良好效果。结论:该病例致病菌为总状共头霉,外科治疗结合伊曲康唑治疗有效。     

播散性红色毛癣菌肉芽肿一例

目的报道1例播散性红色毛癣菌肉芽肿。方法对患者的临床资料、真菌学检查、组织病理及疗效进行分析。结果患者为46岁女性,手足、躯干红斑、脱屑30年,头皮、躯干、上肢结节、溃破2年。检查见头皮、颈、躯干和上肢有紫红色浸润性斑块、结节,部分皮损表面破溃、渗液、结痂。皮损内穿刺液及甲直接镜检菌丝阳性,培养为红色毛癣菌生长。皮损病理检查:真皮内可见上皮细胞样肉芽肿,其中央大片坏死,周围见结节样上皮样细胞团块,伴少许多核巨细胞、淋巴细胞及嗜酸粒细胞浸润。PAS染色真皮内见真菌菌丝。诊断为播散性红色毛癣菌肉芽肿。伊曲康唑治疗3个月后皮损消退,遗留萎缩性瘢痕。用药期间未见不良反应。结论播散性红色毛癣菌肉芽肿临床少见,伊曲康唑疗效满意。     

国内首例慢性播散性副球孢子菌病

报道国内首例慢性播散性副球孢子菌病。患者男, 49岁, 因皮肤丘疹、结节1年, 口腔黏膜丘疹、溃疡2个月入院。皮肤科检查:左足水肿, 左足底多发溃疡, 表面结痂, 左足第3、4趾间及第4、5趾间溃疡, 基底呈颗粒状, 伴点状出血、渗出;左足背、左足内侧及左膝多发丘疹、结节、斑块, 中央溃疡、结痂;左腕部2个丘疹, 上唇左侧1个丘疹, 表面结痂;牙龈、颊黏膜、唇黏膜及上颚可见红色斑块伴溃疡、点状出血, 皮损以左侧为主。浅表淋巴结彩超:双侧颈部及锁骨上窝淋巴结肿大, 左侧为著。胸腹部计算机断层扫描图像示:双肺弥漫粟粒样结节影及条索状、云絮状、结节状高密度影, 左侧肾上腺明显增粗。口腔、左下肢皮损组织真菌免疫荧光染色, 可见酵母细胞。口腔黏膜、左下肢皮损组织病理:肉芽肿性炎, 多核巨细胞内外可见酵母细胞, 折射双膜, 无芽、单芽或多芽;过碘酸希夫染色、六胺银染色阳性。左下肢皮损组织真菌培养:25 ℃、37 ℃沙氏葡萄糖琼脂培养基中培养阳性, 均为菌丝相。口腔黏膜及肺泡灌洗液宏基因组学测序:巴西副球孢子菌。诊断:慢性播散性副球孢子菌病。予伊曲康唑胶囊400 mg/d口服, 1个月后皮肤、黏膜皮...     

PHAEOHYPHOMYCOSIS DUE TO PHIALOPHORA RICHARDSIAE

Phaeohyphomycosis, an infection characterised by dematiaceous yeast-like cells, hyphae and pseudohyphae in tissue, is an uncommon condition, often affecting immunosuppressed patients. A sixty four year old boat-builder, receiving treatment with prednisone and azathioprine developed multiple cutaneous nodules on the extremities. Histology showed a mixed dermal inflammatory infiltrate with scattered spores and hyphae. Culture revealed two organisms, Phialophora richardsiae and Exophiala jeanselmei. Fluorocytosine was initially given but the organism was found to be resistant. Since side effects have been associated with long term ketoconazole therapy, a less toxic and more potent triazole compound, itraconazole, was used. After three months, the lesions had completely resolved without adverse clinical or biochemical changes.     

Disseminated cutaneous Fusarium moniliforme infections in a leukemic child

A 5-year-old boy had a 10-month remission of acute lymphocytic leukemia (ALL) after chemotherapy. Re-induction chemotherapy was performed for relapse of ALL. Thereafter, he suffered from an episode of neutropenic fever with pneumonia. One week following control of the condition with antibiotics, a 1 x 1-cm, red, painful nodule appeared on the left thigh, which was initially suspected to be Pseudomonas infection. Parenteral ceftazidime and amikacin were administered, but persistent high fever, mild cough, and a few painful erythematous papulonodules on the face and lower extremities appeared several days later (Fig. 1). These lesions increased insidiously in diameter up to 2-5 cm with central necrosis. Hemogram showed neutropenia with a shift to the left [white blood cell (WBC) count, 2.1 x 10(9)/L; neutrophil count, 0.21 x 10(9)/L]. A skin biopsy showed heavy growth of hyaline branching septate hyphae in the deep dermis and subcutis, together with fat necrosis (Fig. 2). Invasion of molds into vessels and sweat glands was also seen. A culture from a lesion yielded Fusarium moniliforme, but no fungi were isolated from blood specimens. Only mild infiltrations on bilateral lower lung fields were detected by chest roentgenography. The skin lesions gradually healed and the fever subsided 2 weeks after the initiation of therapy with amphotericin B 30 mg and itraconazole 200 mg daily. Meanwhile, relapse of leukemia was detected by hemogram showing atypical leukocytosis (WBC count of 24,400 x 10(9)/L, with blast cells representing 78%). A course of chemotherapy with cytarabine, mitoxantrone, and VP-16 was prescribed, subsequently resulting in neutropenia (WBC count, < 0.1 x 10(9)/L; neutrophil count, 0/L) and spiking fever. Although the aforementioned antifungal therapy was continued, the centers of the originally healed lesions turned dusky red, swollen, necrotic, and ulcerative. There were more than 10 such ecthymiform lesions. After administration for 22 days, itraconazole was discontinued because of no appreciable effects. Granulocyte colony-stimulating factor (G-CSF) salvage was used, and the neutropenia gradually subsided 20 days later. In addition, the ecthymiform lesions gradually resolved. Amphotericin B was discontinued 1 week following neutrophil recovery. The patient died of Acinetobacter baumannii and Stenotrophomonas maltophilia sepsis 8 months later.     

系统性红斑狼疮伴棘状外瓶霉所致暗色丝孢霉病一例

患者女,27岁,右下肢结节、溃疡6个月,有系统性红斑狼疮病史2年。皮损脓液直接镜检可见分支、分隔链状菌丝和孢子,组织病理检查显示棕黄色菌丝、孢子。沙氏葡萄糖琼脂培养基（SDA）培养出深绿色绒状菌落,微量培养可见分支、分隔菌丝和棘状环痕孢梗,DNA序列分析属于棘状外瓶霉。菌株不能液化明胶,可在25 ~ 39 ℃环境下生长,对伊曲康唑、两性霉素B、特比萘芬敏感。动物实验发现免疫抑制小鼠感染比正常对照组严重。依据临床特征、组织病理学检查、真菌培养及基因鉴定结果,该例患者确诊为系统性红斑狼疮伴棘状外瓶霉所致的暗色丝孢霉病。     

裴氏着色芽生菌致下肢皮肤感染一例

患者女,53岁.右下肢条带状排列损害,反复起疹30余年.损害由结节和暗红色浸润斑块覆污秽色痂组成,部分损害表面有黑点.直接镜检和组织病理可见褐色厚壁孢子,真菌培养及分子生物学鉴定病原菌为裴氏着色芽生菌.体外真菌药敏试验显示对特比萘芬及伊曲康唑敏感.联合应用特比萘芬和伊曲康唑治疗,辅以手术切除和局部热疗.治疗10个月后,脓性分泌物消失,皮损面积缩小,治愈部位留下色素沉着.对着色芽生菌病联合特比萘芬和伊曲康唑口服,辅以红光热疗及手术切除,综合疗效较好.     

Trichosporon inkin subcutaneous infection in a rheumatoid arthritis patient

A 74-year-old woman presented with painful ulcerative nodules on the left forearm. She had received systemic steroid therapy for rheumatoid arthritis for several years. On physical examination, there were four hemorrhagic ulcerative nodules with a linear distribution on the left forearm (Fig. 1A). These nodules had developed over the course of 2 months, and the number of lesions had increased despite systemic antibiotic therapy. There was no sign of systemic dissemination of the disease. Biopsy of a nodule demonstrated suppurative granulomatous infiltration (Fig. 1B); the hyphae stained positive with periodic acid-Schiff (data is not shown) and Gomori-methenamine silver stains in the dermis (Fig. 1C). The biopsy specimen was cultured in Sabouraud's dextrose agar supplemented with cycloheximide with incubation at 26 degrees C. A yeast-like creamy colony grew in 1 week. The colony became yellowish gray in color and the surface folded radially after 4 weeks of incubation (Fig. 2A). Microscopic examination revealed arthroconidia and blastoconidia (Fig. 2B), and urease activity was positive. The fungus was identified as Trichosporon beigelii by yeast biochemical card (YBC, Biomerieux Vitek, Inc., Hazelwood, MO, USA). The sequences of rDNA obtained from the colony were amplified using polymerase chain reaction (PCR) primer, analyzing the sequences of the 5.8S and 28S rDNA regions for the genetic identification of the Trichosporon species. The sequences of the PCR product matched the corresponding sequences of the T. inkin strain with 99% accuracy (Fig. 2C). The patient was given oral itraconazole for 8 weeks with good clinical results.     

“ITS/CAL"靶位分子鉴定结合表型分析确诊狭义申克孢子丝菌致淋巴管型孢子丝菌病一例

患者女,54岁,农民.左上肢近手腕部外伤后出现豌豆大小的单一红色结节15d,后肿大、破溃,并在30 d内发展为多个成串状分布的结节.皮肤科检查:患者左上肢可见多个呈线性排列的紫红色结节,质硬;部分结节破溃,伴少许脓性分泌物.组织病理提示,感染灶呈混合炎性细胞浸润为主的化脓性肉芽肿炎症;过碘酸雪夫染色阴性,未见真菌孢子、菌丝及星状体.活检组织真菌培养阳性.根据培养物形态学分析和内部转录间隔区(ITS)及钙调蛋白(CAL)编码区靶位的分子生物学鉴定结果,确诊该病例为狭义申克孢子丝菌致淋巴管型孢子丝菌病.给予患者10％碘化钾溶液10 ml/次每日3次口服;治疗2个月后,患者自觉症状明显改善,后失访.本例报道提示联合应用表型鉴定和“ITS/CAL”靶位的基因分析能够准确将孢子丝菌复合体鉴定到种水平.