特比萘芬成功地治疗皮肤孢子丝菌病

孢子丝菌病是由申克氏孢子丝菌引起的。口服碘化钾和局部加热常被用于治疗固定型及皮肤淋巴管型孢子丝菌病而获得成功。最近报道一种新的口服抗真菌药特比萘芬治疗皮肤孢子丝菌病有效。该药属丙烯胺类,为高效、广谱的抗真菌制剂,抗菌谱包括皮肤癣菌、酵母菌和霉菌。作者用该药125mg每日1次治疗3例皮肤淋巴管型孢子丝菌病 获得成功。     

孢子丝菌病的临床表现诊疗与变迁

孢子丝菌病是由申克孢子丝菌复合体感染皮肤、皮下组织、黏膜和局部淋巴系统所引起的慢性感染性疾病。临床表现多样,皮损主要表现为慢性炎症性肉芽肿损害。自1898年报道第一例孢子丝菌病后,对孢子丝菌病的认识越来越深刻,包括孢子丝菌病原体的变迁及其诊断和治疗方法的改进。病原体从申克孢子丝菌单一菌种到目前孢子丝菌复合体的认识。诊断方法包括真菌学检查、组织病理检查、孢子丝菌素以及分子生物学诊断;治疗方法包括碘化钾、伊曲康唑、特比萘芬、两性霉素B口服以及物理和手术疗法等。     

申克孢子丝菌基因差异、致病力与孢子丝菌病临床型别的关系

目的 探讨申克孢子丝菌基因差异、致病力与孢子丝菌病不同临床型别的关系。方法 ①收集不同临床型别孢子丝菌病的申克孢子丝菌分离株并提取DNA,进行随机扩增多态DNA(RAPD)扩增。②BALB/c小鼠接种不同临床型别孢子丝菌病的分离株菌悬液,观察实验动物发病及病变情况。③发病小鼠皮肤及内脏组织病理学检查,观察接种不同临床型别孢子丝菌病的分离株菌悬液后小鼠病变内申克孢子丝菌孢子数量及分布。结果 ①不同临床型别孢子丝菌病的申克孢子丝菌分离株聚合酶链反应产物电泳带型差异较明显:播散型分离株可见1800bp、850bp、500bp、180bp,皮肤淋巴管型分离株见1400bp、800bp、700bp、500bp,皮肤固定型分离株见2500bp、1400bp、1000bp、700bp。②注射播散型孢子丝菌病分离株菌悬液的BALB/c小鼠比注射皮肤淋巴管型分离株小鼠发病早、病变部位广且死亡率高;注射皮肤淋巴管型分离株的小鼠较注射固定型孢子丝菌病分离株小鼠皮损出现早、病变范围广且严重。③实验BALB/c小鼠病变皮肤及内脏组织病理学检查显示:注射播散型孢子丝菌病分离株的小鼠病变内孢子数量明显多于注射皮肤淋巴管型分离株小鼠病变内孢子数量,而后者较注射固定型孢子丝菌病分离株的小鼠病变内孢子数量多。结论 不同临床型别孢子丝菌病的申克孢子丝菌的基因差异、致病力与孢子丝菌病不同临床型别的关系密切。     

一株引起皮肤播散性孢子丝菌病的孢子丝菌临床分离株的基因型鉴定

孢子丝菌病是由申克孢子丝菌引起的常见深部真菌病,临床多见于淋巴管型及固定型,播散性孢子丝菌病少见.孢子丝菌进入人体后引起不同临床类型的孢子丝菌病与机体免疫状态有关^[1],但是否与菌型有关尚无定论.为此,我们从一皮肤播散性孢子丝菌病患者皮损中分离1株孢子丝菌菌株,利用常规真菌学和分子生物学方法对其进行鉴定,并探讨该菌株与皮肤淋巴管型孢子丝菌在基因水平上的异同.     

孢子丝菌病的治疗

孢子丝菌病( sporotrichosis)由双相真菌申克孢子丝菌(Sporothrix schenckii)感染所致,该病为最常见的深部真菌病之一,临床上分为固定型、淋巴管型、皮肤播散型和皮肤外型4种类型,其中前三种类型主要累及皮肤、皮下组织和淋巴管,皮肤外型罕见,主要发生于免疫抑制和免疫缺陷者,常累及肺、脑膜、骨关节和眼等,治疗困难,可危及生命.目前孢子丝菌病的治疗主要依靠药物,外科手术等可作为补充疗法. 一、常用的治疗药物和治疗方法     

巴基斯坦籍孢子丝菌病1例

孢子丝菌病是申克孢子丝菌所引起的皮肤、皮下组织及其附近淋巴管的慢性感染,可致化脓、溃烂及渗出,有时可波及各脏器.1现将我院诊治的1例孢子丝菌病报道如下.     

阴囊孢子丝菌病1例及申克孢子丝菌基因型检测

孢子丝菌病是由申克孢子丝菌引发的一种皮肤、皮下组织和附近淋巴管的慢性感染性疾病,多发于四肢等容易暴露受伤的部位.本文报道1例发生于阴囊的固定型皮肤孢子丝菌病,并对申克孢子丝菌进行了形态学和分子生物学水平的鉴定.     

申克孢子丝菌对小鼠感染后的临床特征与其感染途径及菌本身的致病性有关

孢子丝菌病主要以皮肤及淋巴管型为主,感染肺等内脏甚少见。作者观察了由皮肤(4株)及肺部(3株)孢子丝菌病中分离的菌株对BALB/c小鼠分别进行皮下、静脉及腹腔内攻击以研究其感染机理。     

孢子丝菌病119例临床及药物敏感性分析

目的：分析皮肤型孢子丝菌病的临床特征,为孢子丝菌病诊疗及用药选择提供依据。方法：选取2016—2021年山东第一医科大学附属皮肤病医院皮肤科确诊的119例皮肤型孢子丝菌病患者,回顾性分析其临床特征、治疗方法、基因分型及流行病学资料,同时应用分子生物学方法对致病菌进行分型并进行体外药物敏感性试验。结果：119例患者中以中老年人（≥40岁）为主,占比93.3%,临床主要表现为固定型（46.2%）和淋巴管型（47.1%）。治疗药物为伊曲康唑、特比萘芬与碘化钾,对其中90例患者进行分子生物学鉴定及药敏试验,结果显示所有患者均为球形孢子丝菌感染,且孢子丝菌对特比萘芬最为敏感,其次是伊曲康唑,而氟康唑敏感性最差。除7例失访患者外,其余患者均治愈,随访无复发患者。结论：中老年患者是孢子丝菌病的易感人群,临床以淋巴管型及固定型为主,分子鉴定均为球形孢子丝菌,伊曲康唑、特比萘芬与碘化钾对皮肤型孢子丝菌病具有较好疗效,不同疾病类型的疗程与疾病类型、患者年龄、感染部位以及是否存在合并症相关,但个人具体用药仍需在药敏试验结果指导下选择。     

黑龙江省502例孢子丝菌病患者临床分析

目的对黑龙江地区502例孢子丝菌病患者临床资料进行回顾性分析,探讨近年孢子丝菌病的发病特点,为今后防治孢子丝菌病提供有力依据。方法对2014年4月—2017年4月至哈尔滨医科大学第二附属医院就诊,经过临床表现、组织病理检查及真菌培养确诊为孢子丝菌病的502例患者进行回顾性分析。结果患者男女比例1:2,平均年龄49.7岁,以41～65岁人群最为多见。66.5%的患者在冬春两季发病,76.2%的患者为农民,37.8%的患者有明确外伤史。皮肤固定型占74.9%、皮肤淋巴管型24.9%、皮肤播散型0.2%。患者对碘化钾、特比萘芬治疗反应良好。结论孢子丝菌病在黑龙江地区发病率高,其流行病学特点与吉林省、辽宁省相似,但不同于其他国家。碘化钾、特比萘芬、伊曲康唑是其有效的治疗药物。     

Primary Lymphocutaneous Nocardiosis Due to Nocardia otitidiscaviarum: The First Case Report from Japan

We report a case of lymphocutaneous syndrome caused by Nocardia otitidiscaviarum (formerly known as N. caviae) in a 78-year-old woman who underwent long-term therapy with prednisolone for bronchial asthma. Histological examination showed granulomatous reaction with multiple polymorphonuclear leukocytes and revealed a Gram positive filament in the dermis. Grampositive, slightly acid-fast branched filaments were also found in the smear of the purulent material. The cell wall constituents of the isolate were meso-diaminopimelic acid, arabinose, and galactose; the mycolic acid pattern of the isolate was Nocardia type. The organism decomposed xanthine and hypoxanthine, but not tyrosine or casein, which distinguished it from N. asteroides and N. brasiliensis. The skin lesions responded to minocycline and later to a combination of doxycycline and ofloxacin. This primary lymphocutaneous nocardiosis due to N. otitidiscaviarum is the first in Japan.     

Potassium iodide in dermatology: a 19th century drug for the 21st century-uses, pharmacology, adverse effects, and contraindications

Potassium iodide (KI) is a useful drug in the dermatologic armamentarium. It is successfully used for inflammatory dermatoses, most notably erythema nodosum, subacute nodular migratory panniculitis, nodular vasculitis, erythema multiforme, and Sweet's syndrome. KI is also successfully used for cutaneous and lymphocutaneous sporotrichosis. The precise mechanism by which KI acts is unknown. Although many minor side effects are common with this drug, major side effects can occur in pregnant patients and those with a history of kidney or thyroid disease. This article reviews the pharmacology, mechanism of action, indications, contraindications, and adverse effects of KI as a therapeutic agent.     

Sporotrichosis with widespread cutaneous lesions: report of 24 cases related to transmission by domestic cats in Rio de Janeiro,Brazil

Background Sporotrichosis most commonly presents as a localized lymphocutaneous infection following traumatic inoculation of soil, vegetables or organic substrates contaminated with the dimorphic fungus Sporothrix schenckii. Cases of widespread cutaneous lesions are rare. There have been isolated reports of household outbreaks of sporotrichosis involving cats and humans. Methods We report 24 cases of culture‐proven sporotrichosis presenting with widespread cutaneous lesions. Results These 24 cases are part of an epidemic currently occurring in Rio de Janeiro. All patients reported contact with cats with sporotrichosis and 17 reported a history of a scratch or bite. Clinical manifestations included fixed lesions at multiple anatomical sites, and fixed lesions associated with the lymphocutaneous, bilateral lymphocutaneous and mucosal forms of the disease. Two patients were alcoholics and one patient was diabetic, while the remaining patients did not present any immunosuppressing condition. All patients responded to treatment with itraconazole. Conclusions The domestic cat has played an important role in the transmission of sporotrichosis in Rio de Janeiro and seems to have contributed to this unusual clinical manifestation.     

过碘酸-石炭酸副品红染色对某些真菌病及分枝杆菌病的诊断价值

目的：探讨过碘酸-石炭酸副品红(PA-CPR)染色对某些真菌病及分枝杆菌病的诊断价值。方法：采用PA-CPR染色法对皮肤淋巴性感染的皮肤活检标本染色，进行组织病理学和微生物学检查。结果：3例过碘酸复红(PAS)染色和抗酸(AF)染色阴性标本，采用PA-CPR染色2例查见真菌，1例查见分枝杆菌。结论：PA-CPR染色法可以替代PAS染色和AF染色，用于真菌病及分枝杆菌病的初步定性诊断和鉴别诊断。     

Unusually located lymphocutaneous nocardiosis caused by Nocardia brasiliensis

Summary We report a patient with primary lymphocutaneous Nocardia brasiliensis infection affecting the face and left arm. The mode of infection was via skin abrasions which occurred 2 weeks prior to the development of the skin lesions. Treatment with intravenous minocycline for 4 weeks resulted in a cure. We also review 12 previously reported Japanese cases of lymphocutaneous nocardiosis.     

Lymphocutaneous sporotrichosis treated with three different modalities

Three cases of lymphocutaneous sporotrichosis were treated with three different modalities and oral saturated solution of potassium iodide was found to be best modality.     

Innate immune defense of the nail unit by antimicrobial peptides

BACKGROUND: The nail is susceptible to microbial invasion, yet is usually able to defend itself from infection. This occurs despite isolation from cell-mediated immunity. OBJECTIVE: The aim of this study was to determine whether soluble innate immune molecules are present in the nail environment that can protect against microbial colonization. METHODS: Chromatographic techniques were used to purify cationic antimicrobial molecules from porcine hoof extracts. Sections of human and mouse digits were immunostained with antibodies to each species' cathelicidin antimicrobial peptide. Liquid antimicrobial assays were used to determine the activity of these molecules against relevant pathogens. RESULTS: Human, porcine, and murine nails contain antimicrobial molecules, and the human cathelicidin LL-37 can kill Candida albicans. CONCLUSION: The presence of antimicrobial peptides in nails with activity against relevant nail pathogens may account for the ability of the nail unit to resist infection in the absence of direct access to the cellular immune system.     

Protective roles of the skin against infection: implication of naturally occurring human antimicrobial agents beta-defensins, cathelicidin LL-37 and lysozyme

Beside its physical barrier against invading microorganisms, the skin has the ability to produce a number of antimicrobial peptides and proteins, including human β-defensins, cathelicidin LL-37 and lysozyme that participate in the innate host defense. These antimicrobial agents are strongly active against a wide spectrum of various pathogens such as bacteria, viruses and fungi. Thus, antimicrobial agents are proposed to be promising candidates for innovative anti-infective drugs, and some antimicrobial peptides are currently used in clinical trials for treatment of various skin infections. In addition to their direct antimicrobial functions against invading pathogenic microorganisms, antimicrobial agents have also multiple roles as mediators of inflammation with the effects on epithelial and inflammatory cells, influencing cell proliferation, wound healing, cytokine/chemokine production and chemotaxis. This review describes the biology of these antimicrobial molecules and discusses their structure, expression and functions. Understanding the actions of antimicrobial agents in skin will provide further insight into the mechanism of innate cutaneous disease control, and yield novel therapeutic approaches to the treatment of skin disorders.     

Lymphocutaneous nocardiosis caused by Nocardia asteroides. Case report and literature review

A 22-year-old man developed erythematous nodules and an ulcer mimicking sporotrichosis on his right hand and forearm, which was subsequently diagnosed as lymphocutaneous nocardiosis caused by Nocardia asteroides. To our knowledge, 21 cases of lymphocutaneous nocardiosis have been reported, with the majority of those cases, except for a few that remain uncertain, being due to Nocardia brasiliensis. The case reported herein, the first known definitive case caused by N asteroides (to our knowledge), showed a more chronic course and less inflammatory manifestation compared with that caused by N brasiliensis. This is probably because N brasiliensis has a stronger virulence than N asteroides.     

A Case of Lymphocutaneous Nocardiosis with a Review of Lymphocutaneous Nocardiosis Reported in Japan

An 82-year-old Japanese male developed nodules and ulcers along the lymphatics after a fall in the garden of his house resulting in injuries to the dorsum of his left hand which lasted for 3 months. Nocardia brasiliensis was isolated from a nodule, supporting a diagnosis of the lymphocutaneous type of nocardiosis. He had previously developed generalized bone metastasis from prostatic cancer, and his resulting depressed immunity might have played a part in the nocardiosis genesis. Sixteen cases of the lymphocutaneous type of nocardiosis reported in Japan were reviewed.