自体脂肪填充术后脓肿分枝杆菌感染

报告2例皮肤脓肿分枝杆菌感染.2例患者均为面部自体脂肪填充术后相继发生脓肿,脓液涂片抗酸染色阳性,培养鉴定均为脓肿分枝杆菌.根据药敏结果给予阿奇霉素、环丙沙星及阿米卡星治疗.提醒临床医师应提高对该病的认识,尤其在局部外伤、手术或局部穿刺后出现脓肿者,对可疑病例行分枝杆菌培养及鉴定.     

美容注射术后皮肤脓肿分枝杆菌感染临床分析

对2018年12月至2019年12月我院确诊的7例皮肤脓肿分枝杆菌感染患者的临床资料进行回顾性分析。本文患者均在非正规医院行美容注射术,术后注射部位都发生脓肿分枝杆菌感染。7例患者均为多发皮损,且为美容注射后发病,表现为红斑、结节、脓肿、溃疡。病理呈感染性肉芽肿改变。6例皮损组织脓液培养结果为脓肿分枝杆菌,1例行组织PCR扩增提示脓肿分枝杆菌感染。诊断为皮肤脓肿分枝杆菌感染。给予克拉霉素、利福平、左氧氟沙星治疗,皮损均消退,随访半年无复发。     

非结核分枝杆菌感染致皮肤慢性溃疡

报告1例非结核分枝杆菌感染致皮肤慢性溃疡。患者男,19岁。左踝溃疡2年,逐渐扩大,并伴钉外踝溃疡2个月。溃疡为无痛性,深达肌层,边界清楚,溃疡边缘有黑褐色色素沉着。皮损组织病理检查：真皮肉芽肿忡炎症;抗酸染色（＋）;溃疡新鲜组织分枝杆菌共同引物PCR扩增阳性。诊断：非结核分枝杆菌感染致皮肤慢性溃疡。采用利福半、克拉霉素、乙胺丁停及左氧氟沙星治疗1个月余,溃疡缩小并行植皮手术,术后创面愈合良好。     

注射美容致皮肤脓肿分枝杆菌感染三例并文献复习

目前有多篇外科手术、美容手术、美容注射、文身后发生皮肤脓肿分枝杆菌感染的报道,更有在整容手术或抽脂的诊所中发生爆发事件的报道,其中一些病例的发生与未经批准的药物注射和不规范的操作相关,本文报道3例美容注射后罹患皮肤脓肿分枝杆菌感染的病例并复习相关文献.     

面部脓肿分枝杆菌感染2例

报告2例美容注射手术后面部感染脓肿分枝杆菌.例1.女,32岁.肉毒素注射1周后面部出现多发脓肿.例2.女,35岁.面部自体脂肪填充术2周后注射部位出现多发性脓肿.通过对2例患者脓液行各项检查鉴定出脓肿分枝杆菌,证实2例患者均为脓肿分枝杆菌感染.例1治疗3个月后基本痊愈,例2仍在随访中.     

溃疡型皮肤结节病

报告1例溃疡型皮肤结节病。患者女,53岁。右额部一红色小结节3年余,增大并破溃3个月就诊。皮肤科检查:右侧额部一红色浸润斑块,表面溃烂及结痂,右唇上方圆形红色浸润斑块,境界清楚,表面粗糙伴少量鳞屑。皮损组织病理检查:真皮内上皮样细胞肉芽肿,部分裸结节,部分包含朗汉斯巨细胞,中央可见纤维蛋白样变性。结核感染特异性T细胞检测(T.SPOT-TB)及抗酸染色均阴性。予规范抗结核及抗非结核分枝杆菌治疗无效,结合患者临床皮损、实验室检查和皮损组织病理检查结果,诊断为溃疡型皮肤结节病。     

异透明质酸治疗皮肤溃疡临床观察

异透明质酸治疗皮肤溃疡临床观察张文君，刘万顺，张学成青岛医学院二附院皮肤科（邮政编码２６６０４２）皮肤粘膜溃疡为常见病；原因复杂，疗法较多，疗效各异。１９９２年以来，用我科同青岛海洋大学生物系协作共同研制的异透明质酸（Ａｌｌｂｈｙａｌｕｒｏｎｉｃａｃ...     

糖尿病性皮肤溃疡36例临床分析

目的　探讨糖尿病皮肤溃疡的预防及治疗。方法　回顾性分析36例糖尿病皮肤溃疡患者的完整资料。结果　36例经降血糖、抗感染、改善微循环及创面局部处理, 30例于26~130天溃疡愈合, 6例溃疡缩小后转外科手术治疗。结论　严格控制血糖,对治疗糖尿病皮肤溃疡十分重要,教育患者加强自我防护,是预防糖尿病皮肤溃疡的有效措施。     

老年下肢静脉性皮肤溃疡1例

 报道老年下肢静脉性皮肤溃疡1例。患者女,84岁,因双下肢溃疡伴疼痛1月就诊。皮肤科检查：右足背红肿,见11 cm×4 cm大小溃疡,有脓苔及黑色结痂,内踝见20 cm×5 cm大小溃疡,左小腿散在结痂面。D 二聚体4.81 mg/L。皮损组织病理示：表皮缺失,溃疡面坏死、渗出,毛细血管周围大量炎性细胞,肉芽肿形成。下肢静脉彩超：右小腿见数条肌腱静脉增宽,最宽处约4.8 mm,未见明显血流信息。诊断：右下肢静脉性皮肤溃疡。予低分子量肝素钠针、血栓通冻干粉针抗凝治疗14天及对症处理,出院时溃疡好转但血栓未通;出院后内服中药活血理气汤3周,溃疡恢复,下肢静脉彩超血栓消失。     

Sporotrichoid dermatosis caused by Mycobacterium abscessus from a public bath

Infections caused by nontuberculous mycobacteria (NTM) are usually associated with immunocompromised states. More recently, however, NTM infections are being diagnosed with greater frequency in patients lacking traditional risk factors. However, cutaneous infection with rapidly growing mycobacteria is uncommon, and diagnosis may be difficult. Herein we present a case of sporotrichoid dermatosis on both forearms caused by Mycobacterium abscessus in a 34-year-old female (case 1). Mycobacterium abscesus was identified by culture as a colorless colony with rapid growth and by comparative sequence analysis of the rpoB gene. The patient was suspected to have been infected in a public bath in which she worked, it was located in a famous hot spring area in Korea. The condition was first noticed after she had been working in the bath for two years and after another employee (case 2) suffered similar lesions which had responded to treatment. The patient's skin lesions were successfully treated with anti-tuberculous drugs for six months.     

Mycobacterium abscessus infection following penetrations through wetsuits

Mycobacterium abscessus is a rapidly growing mycobacterium which is reportedly increasing in prevalence. Infection of the skin and soft tissue with M. abscessus is rare but typically associated with trauma. We present two cases of M. abscessus infection linked by penetration through wetsuits.     

脓肿分枝杆菌临床分离株药物敏感性初探

目的:分析脓肿分枝杆菌临床分离株对常用抗生素的体外药物敏感性.方法:临床菌株分离自2019年9月至2021年6月就诊于陆军军医大学大坪医院皮肤科的脓肿分枝杆菌皮肤软组织感染患者,用微量肉汤稀释法检测其对克拉霉素、阿奇霉素、阿米卡星、莫西沙星、环丙沙星、米诺环素、美罗培南、利奈唑胺、异烟肼、利福平、头孢西丁的最小抑菌浓度...     

Mycobacterium abscessus infection complicating a professional tattoo

A healthy 23-year-old man presented with a tender papular eruption confined to the grey pigment of a recently acquired professional tattoo. Atypical mycobacterial infection was suspected and culture of a tissue specimen grew Mycobacterium abscessus. He was successfully treated with minocycline and subsequently, clarithromycin. We present a brief review of M. abscessus infection, with a particular focus on its role in nosocomial infections and in the post-tattoo setting.     

Diagnosis of Mycobacterium abscessus/chelonae complex cutaneous infection: Correlation of tissue culture and skin biopsy

Mycobacterium abscessus and M. chelonae belong to the rapid-growing nontuberculous mycobacteria (NTM) group, which are defined by their ability to form visible colonies on agar within 7 days of subculture. Cutaneous infections by this complex show a heterogeneous clinical presentation with varied histopathologic findings. However, the presence of vacuoles in many specimens has been reported as a specific histologic finding. Herein, we correlate the histopathology of patients with tissue-culture positive M. abscessus/M. chelonae complex in order to identify features that may prompt a rapid categorization of the infectious etiology. The cohort includes 33 skin punch biopsy specimens from 28 patients who had associated positive tissue cultures. The most frequent clinical presentation was a single or multiple nodule. Twenty-seven specimens (81.81%) were found to have vacuoles. The observation of certain histologic features (ie, polymorphonuclear microabscesses and epithelioid granuloma formation) should raise the possibility of infection by NTM. In addition to these findings, we believe the presence of vacuoles in the dermal and subcutaneous inflammation should raise suspicion for NTM.     

脓肿分枝杆菌致全身播散性皮肤感染一例

目的 报道1例罕见的全身播散性脓肿分枝杆菌皮肤感染.方法 对患者作全面临床检查.应用流式细胞仪检测患者细胞免疫水平,同时进行组织病理检查、组织培养.用PCR-RFIJP、基因测序方法对分离自患者皮损的分枝杆菌做鉴定.结果 患者女,22岁,1年多前,无明显诱因面颈部出现对称性红斑,并在此基础上渐出现丘疹、结节和斑块,逐渐扩展至躯干四肢;患者CD4⁺T细胞低于正常,HIV抗体检测阴性.对皮损进行两次多管体外培养,3～5天后,Löwenstein-Jensen培养基上(37℃和32℃)出现阳性菌落.PCR-RFLP比较分析发现,临床分离株的酶切(BstEⅡ和HaeⅢ)图谱与脓肿分枝杆菌的酶切图谱相符合;对临床分离株的hsp65、16S rRNA基因进行了序列分析,发现该二序列与脓肿分枝杆菌同源性最接近,分别是99.75%和100%.予以患者口服利福平、异烟肼、左氧氟沙星、克拉霉素,胸腺肽肌内注射,2个月后皮损明显好转.复查该患者的免疫状况,CD4⁺T细胞已在正常范围;6个月后颈部、躯干及四肢皮损基本痊愈.结论 结合表型特征、DNA酶切图谱和序列分析,临床分离株符合脓肿分枝杆菌;抗生素联合化疗辅以免疫调节剂综合治疗有效.     

Buruli ulcer and current situation in Japan: A new emerging cutaneous Mycobacterium infection

Buruli ulcer (BU) is a new emerging disease and the third most common chronic mycobacterial infection in humans, caused by Mycobacterium ulcerans. Approximately 5000 cases are reported annually from at least 33 countries around the globe, but more from the tropical nations. A total of 32 cases have been reported from Japan sporadically since 1980. None of the cases were related to international travel. Of the total reported, M. ulcerans ssp. shinshuense, a subspecies speculated to be domestic to Japan or in Asia, has been isolated from 23 cases. The mode of transmission and its incubation period remain unclear, despite several proposed hypotheses, including several vectors and cutaneous wound as port of entry for the pathogen. M. ulcerans invades the skin, subcutaneous tissue, fascia and eventually forms extensive ulceration. Smear, culture, histopathology and polymerase chain reaction are established diagnostic tools to identify M. ulcerans. Multiple antimicrobial therapy is a commonly used therapeutic method, but patients often need extensive debridement and, at times, skin grafting, especially when diagnosis is delayed. Thus, expanding a system for improved awareness and diagnosis in Japan and Asia is important, together with elucidating the candidate vector and the mode of transmission. Here, to establish a base for future progress in better understanding of this infectious disease, we reviewed the characteristics of the disease together with an update of reported cases in Japan.