西安地区浅部真菌病的流行病学调查研究

目的：了解近年来西安地区浅部真菌病痛原菌的种类和构成情况，获取流行病学的资料。方法：对1999年8月至2004年8月来我院就诊的西安地区有典型临床表现且真菌镜检阳性的患者进行了致病真菌的分离培养。结果：共分离出浅部致病真菌l200株，其中须癣毛癣菌306株(25．50％)，红色毛癣菌241株(20．08％)，白念珠菌228株(19．00％)。结论：须癣毛癣菌仍占优势；白念珠菌从1996年的第5位上升至第3位，说明在西安地区，白念珠菌已成为重要病原菌。     

79例家庭宠物致浅部真菌皮肤病的病原学分析

目的：了解近年来家庭宠物致人类浅部真菌皮肤感染的类型以及病原菌分布特点。方法：对2012年1月-2016年3月到本中心就诊的79例均有家庭宠物密切接触史的浅部皮肤真菌病患者,做皮肤真菌学镜检、真菌分离培养鉴定的结果进行分析。结果：79例患者标本中,皮肤镜检阳性为77例,阳性率为94．5％;培养阳性为68例,阳性率为86．1％,其中分离出的致病菌为犬小孢子菌40例（58．8％）、须癣毛癣菌14例（20．6％）、絮状表皮癣菌8例（11．7％）、红色毛癣菌3例（4．4％）、石膏样小孢子菌2例（3．0％）、断发毛癣菌1例（1．5％）。结论：患者主要是青少年儿童,临床表现主要为头癣和体癣,致病菌以犬小孢子菌为主,其次为须癣毛癣菌。     

承德地区789例真菌培养阳性的浅部真菌病病原学特点

目的 了解承德地区浅部真菌病的病原学特点以便更好地防治浅部真菌病.方法 分析真菌培养阳性浅部真菌病病原体的菌种特点和分布特点.结果 在789例真菌培养阳性的浅部真菌病病例中包括6个菌种,其中,须癣毛癣菌和红色毛癣菌检出率均显著高于其他真菌(P<0.01),须癣毛癣菌检出率又显著高于红色毛癣菌(P<0.01);须肆毛癣菌和红色毛癣菌在甲癣、体癣、手癣、足癣、股癣中检出率最高,白色念珠菌在念珠菌病中检出率最高,犬小孢子菌在脓癣和头癣中检出率最高.结论 在承德地区,须癣毛癣菌是浅部真菌病的首位病原菌,红色毛癣菌位列第二,两者主要导致甲癣、体癣、手癣、足癣、股癣;犬小孢子茼与白色念珠菌并列第三,犬小孢子菌主要导致脓癣和头癣,白色念珠菌主要导致念珠菌病.     

浅部皮肤真菌病毒1670例病原学分析

目的:了解我院浅部皮肤真菌病患者病原菌菌种分布特点.方法:对1 670例患者的标本进行直接镜检、培养及菌种鉴定.结果:镜检阳性率为65.4%,培养阳性率为51.3%;菌种分布主要为红色毛癣菌490株(56.9%),大小孢子菌133株(15.4%),须癣毛癣菌43株(5.0%),念珠菌及酵母菌129株(15%),曲霉菌15株(1.7%),青霉菌10株(1.2%).结论:在浅部皮肤真菌病病原菌菌种中皮肤癣菌仍占主导地位,红色毛癣菌为优势致病菌,犬小孢子菌所占比例有上升趋势.     

承德地区浅部真菌病病原学研究

目的了解承德地区浅部真菌病病原学分布情况,为临床提供病原学资料。方法采用真菌培养对浅部真菌病病原菌进行分析。结果培养出779株真菌菌株,6个菌种,以须癣毛癣菌为主（71.5%）,红色毛癣菌次之（22.3%）。结论承德地区浅部真菌病病原菌以须癣毛癣菌为主。     

785例甲真菌病分析

目的:了解深圳地区甲真菌病病原菌的种类和构成情况,获取流行病学资料。方法:2004年11月-2007年6月对直接镜检阳性的785例甲真菌病患者进行了真菌分离培养及流行病学调查。结果:共培养出604株病原菌,皮肤癣菌、酵母、非皮肤癣菌霉菌所占比例分别为60.96%,31.02%,8.02%。皮肤癣菌中红色毛癣菌占82.02%,酵母中白念珠菌居首,占29.35%,非皮肤癣菌霉菌中以曲霉和青霉为主。结论:甲真菌病病原菌为皮肤癣菌、酵母菌和非皮肤癣菌霉菌,其中以红色毛癣菌和白念珠菌为主。     

528例临床标本浅部真菌学检测分析

目的通过对浅部真菌病患者临床标本病原菌的检查,了解大丰地区致病真菌的分布情况。方法采用直接镜检、培养等方法对临床标本进行检验和鉴定,大部分标本检测出病种。结果 528例标本中,直接镜检阳性率达48.11%,培养法阳性率达36.17%,而镜检结合培养法的阳性率达60.23%。上述3种方法的检出率比较差异有统计学意义(P0.005)。结论镜检结合培养法的阳性率显著高于单一镜检或培养法的阳性率,在患者标本真菌镜检阴性时,应选择培养法进一步检测,不要轻易排除浅部真菌感染情况。大丰地区浅部真菌的病种以体、股癣最多见,浅部致病真菌的分布以红色毛癣菌占首位,念珠菌为第2位,马拉色菌为第3位。     

头癣病与家养宠物的病原学关系初探

目的：了解本地区头癣病原菌的流行分布情况。方法：采集1995年－1999年来本院就诊的头癣患及其所养宠物的皮屑和毛皮,通过镜检和沙氏琼脂培养基培养现原菌种类。结果：在715例头癣病人中,708例查出真菌,阳性率98．04％,包括3个属8个种,其中638株羊毛状小孢子菌（占89．23％）,28株紫色毛癣菌（占3．92％）,17株铁锈色小孢子菌（占2．835）。在426只家养宠物中,389例查出真菌,阳性率91．31％。其中365株为羊毛状小孢子菌（占93．83％）,21株石膏样小孢子菌（占5．40％）,3株石膏样毛癣菌（占0．80％）。结论：亲人性的铁锈色小孢子菌的减少和亲动物性的羊毛状小孢子菌的增加,说明家养宠物是头癣的主要传染源,同时头癣集团性感染的可能性小。     

甲真菌病临床特点及致病菌谱的研究

目的探讨甲真菌病流行病学特点如发病年龄、临床形态学分型、易感因素,以及致病菌谱状况。方法对2010年12月—2011年12月我院328例甲真菌病的病甲进行拍照和真菌检查（包括直接镜检、真菌培养）,并对所有真菌检查阳性患者进行临床形态学分型,其中113例填写调查问卷调查易感因素。结果 328例甲真菌病统计结果显示,男性发病率高于女性,男女比例为1.45∶1,最主要的发病年龄为20～29岁（35.7%）。370例指甲及趾甲的临床形态学分型中最常见的是远端侧缘甲下型（51.4%）,其次为全甲毁损型（24.3%）,白色浅表型（18.6%）,近端甲下型（5.7%）。196例甲标本培养阳性结果中皮肤癣菌最常见（82.7%）,其次为念珠菌属（11.2%）和非皮肤癣菌的霉菌（6.1%）如曲霉属、青霉属、镰刀菌属等。皮肤癣菌中最常见的是红色毛癣菌,其次须癣毛癣菌。念珠菌属中最常见的是白念珠菌。113例经调查显示易感因素为家族性感染（11.5%）,慢性肾病（4.4%）及肾移植（0.9%）,糖尿病（1.8%）,甲外伤（1.8%）,白血病（0.9%）和特发性血小板较少性紫癜（0.9%）。结论临床通过对甲真菌病患者的流行病学特点及菌种分布等情况进行了解,可指导临床治疗及采取相应的预防措施。     

572例真菌培养结果分析

目的：研究本地区真菌感染现状及真菌培养鉴定的意义。方法：取自本科门诊患者病患部位的皮屑或甲屑，对986例送检标本经镜检呈阳性的572例进行分离培养，用TDR-200B细菌签定仪进行鉴定。结果：986例送检标本检出572例真菌，检出率为58．01％。红色毛癣菌仍为主要菌种，亲动物性皮肤癣菌占较大比例。结论：真菌感染率有所上升，而临床医生对此认识不足。因此临床医生要提高真菌培养鉴定及必要的药敏试验的意识，以便合理选择抗真菌药物。     

Sertaconazole nitrate shows fungicidal and fungistatic activities against Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum, causative agents of tinea pedis

The fungistatic and fungicidal activities of sertaconazole against dermatophytes were evaluated by testing 150 clinical isolates of causative agents of tinea pedis, Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum. The overall geometric means for fungistatic and fungicidal activities of sertaconazole against these isolates were 0.26 and 2.26 μg/ml, respectively, although values were higher for T. mentagrophytes than for the others. This is the first comprehensive demonstration of the fungicidal activity of sertaconazole against dermatophytes.     

Oxiconazole nitrate: pharmacology, efficacy, and safety of a new imidazole antifungal agent

Oxiconazole nitrate (1%) cream became available in the United States in 1989 for the once-daily treatment of tinea pedis, tinea cruris, and tinea corporis. It has also proved valuable in the once-daily treatment of tinea (pityriasis) versicolor. In vitro oxiconazole is highly effective against many dermatophytes, including Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton tonsurans, and Epidermophyton floccosum. After application to the skin, oxiconazole is rapidly absorbed into the stratum corneum, maximum concentrations often being attained within 100 minutes. Fungicidal concentrations are maintained in the epidermis, upper corium, and deeper corium for at least five hours, and levels exceeding the minimum inhibitory concentrations of susceptible fungi are present in the corneum, epidermis, upper corium, and the hair follicle for over 16 hours. Applied once daily for four weeks in the treatment of tinea pedis or for two weeks in the treatment of tinea corporis, tinea cruris, and tinea versicolor, 1% oxiconazole cream has produced mycologic and clinical cures in at least 80% of patients. In plantar-type tinea pedis caused primarily by T rubrum, once-daily oxiconazole cream resulted in a mycologic cure in 76% of patients. The efficacy of once-daily and twice-daily regimens is similar. In comparative clinical trials of various types of dermatophytoses, oxiconazole was shown to be as effective as or more effective than miconazole, clotrimazole, and tolnaftate creams, and as effective as econazole and bifonazole creams. Tolerability of oxiconazole and the other antifungal creams was similar; in irritation studies oxiconazole was better tolerated than econazole. Oxiconazole cream exerts no detectable systemic effect since only a negligible amount is absorbed from the skin. Once-daily use of oxiconazole cream could be valuable in patients with a history of noncompliance with multiple-daily regimens of other topical antifungal agents.     

Expression and potential function of cathelicidin antimicrobial peptides in dermatophytosis and tinea versicolor

OBJECTIVES: This study was designed to characterize the role of the human cathelicidin LL-37 in fungal skin infections such as dermatophytosis and tinea versicolor. METHODS: The in vitro antimicrobial activity of synthetic antimicrobial peptides including the human cathelicidin LL-37 against Malassezia furfur and several dermatophytes was determined. Immunostaining was performed to determine expression of cathelicidin in skin biopsies from patients with tinea pedis, tinea corporis and tinea versicolor. Cathelicidin peptide expression was evaluated by western blotting and mRNA expression was studied in keratinocytes exposed to M. furfur or Trichophyton rubrum. RESULTS: LL-37 inhibits the growth of fungi with an MIC of 20-30 microM for M. furfur and 12.5 microM for Trichophyton mentagrophytes and T. rubrum. LL-37 also shows fungicidal activity with a minimum fungicidal concentration (MFC) of 12.5 and 25 microM for T. mentagrophytes and T. rubrum, respectively. An increase in cathelicidin expression was observed in human skin tissue infected with fungi compared with healthy skin. Western blotting of skin scrapings demonstrated that human cathelicidin is processed from its precursor into an active peptide in both healthy and infected plantar skin. CONCLUSIONS: These findings support a hypothesis that antimicrobial peptides such as cathelicidins can play a role in skin defence against dermatophytes and M. furfur.     

Results of German multicenter study of antimicrobial susceptibilities of Trichophyton rubrum and Trichophyton mentagrophytes strains causing tinea unguium. German Collaborative Dermatophyte Drug Susceptibility Study Group.

Thirty-two strains of Trichophyton rubrum and 16 strains of Trichophyton mentagrophytes isolated from patients with tinea unguium in various parts of Germany were subjected to a microdilution test with six systemic or topical antimycotic agents. Apart from griseofulvin, there were no species-specific differences between the two species. Terbinafine was the most active antimycotic agent, with a MIC not exceeding 0.05 micrograms/ml.     

Ciclopirox olamine lotion 1%: bioequivalence to ciclopirox olamine cream 1% and clinical efficacy in tinea pedis

Studies were conducted to assess the bioequivalence of a new antimycotic formulation, ciclopirox olamine lotion 1%, to an established compound, ciclopirox olamine cream 1%. Results of in vitro studies, using skin samples from human cadavers and domestic pigs, demonstrated that the two formulations equally penetrate all layers of the stratum corneum and inhibit the growth of Trichophyton mentagrophytes and Candida albicans. In vivo studies in guinea pigs and in human volunteers demonstrated the comparable therapeutic efficacy of the lotion and the cream in experimental trichophytosis. In addition, a multicenter, double-blind clinical trial was undertaken to compare ciclopirox olamine lotion 1% with the vehicle alone in the treatment of patients with tinea pedis. Patients with plantar, interdigital, or vesicular tinea pedis were enrolled in the studies. Patients were treated for 28 days. Clinical and mycological responses were determined during treatment and two weeks posttreatment. Ciclopirox olamine lotion 1% was found to be significantly more effective than its vehicle in the treatment of patients with common tinea pedis. Minor localized side effects (pruritus, burning sensation) were reported in 2% of 89 patients treated with ciclopirox olamine lotion 1%. The results demonstrate the bioequivalence of ciclopirox olamine lotion 1% and ciclopirox olamine cream 1% and confirm the clinical effectiveness and safety of the lotion in the treatment of tinea pedis, a generally recalcitrant fungal infection. It is concluded that ciclopirox olamine lotion 1% can be used as an alternative to ciclopirox olamine cream 1% for treatment of tinea pedis, tinea versicolor, tinea cruris, tinea corporis, and cutaneous candidiasis when the convenience and/or cosmetic elegance of a lotion is desired.     

In vitro antifungal activity of KP-103, a novel triazole derivative, and its therapeutic efficacy against experimental plantar tinea pedis and cutaneous candidiasis in guinea pigs

The in vitro activity of KP-103, a novel triazole derivative, against pathogenic fungi that cause dermatomycoses and its therapeutic efficacy against plantar tinea pedis and cutaneous candidiasis in guinea pigs were investigated. MICs were determined by a broth microdilution method with morpholinepropanesulfonic acid-buffered RPMI 1640 medium for Candida species and with Sabouraud dextrose broth for dermatophytes and by an agar dilution method with medium C for Malassezia furfur. KP-103 was the most active of all the drugs tested against Candida albicans (geometric mean [GM] MIC, 0.002 microg/ml), other Candida species including Candida parapsilosis and Candida glabrata (GM MICs, 0.0039 to 0.0442 microg/ml), and M. furfur (GM MIC, 0.025 microg/ml). KP-103 (1% solution) was highly effective as a treatment for guinea pigs with cutaneous candidiasis and achieved mycological eradication in 8 of the 10 infected animals, whereas none of the imidazoles tested (1% solutions) was effective in even reducing the levels of the infecting fungi. KP-103 was as active as clotrimazole and neticonazole but was less active than lanoconazole and butenafine against Trichophyton rubrum (MIC at which 80% of isolates are inhibited [MIC(80)], 0.125 microg/ml) and Trichophyton mentagrophytes (MIC(80), 0.25 microg/ml). However, KP-103 (1% solution) exerted therapeutic efficacy superior to that of neticonazole and comparable to those of lanoconazole and butenafine, yielding negative cultures for all samples from guinea pigs with plantar tinea pedis tested. This suggests that KP-103 has better pharmacokinetic properties in skin tissue than the reference drugs. Because the in vitro activity of KP-103, unlike those of the reference drugs, against T. mentagrophytes was not affected by hair as a keratinic substance, its excellent therapeutic efficacy seems to be attributable to good retention of its antifungal activity in skin tissue, in addition to its potency.     

Short-term therapy with luliconazole, a novel topical antifungal imidazole, in guinea pig models of tinea corporis and tinea pedis

Luliconazole is a novel topical antifungal imidazole with broad-spectrum and potent antifungal activity. The drug is under clinical development in the United States for management of dermatophytosis with a short-term treatment regimen. The present study was undertaken to investigate the clinical benefit of short-term therapy with luliconazole cream in guinea pig models of tinea corporis and tinea pedis induced with Trichophyton mentagrophytes. The dose-dependent therapeutic efficacy of topical luliconazole cream (0.02 to 1%), measured by macroscopic improvement of skin lesions and by fungal eradication as determined by a culture assay, was demonstrated using a tinea corporis model. The improvement in skin lesions seen with luliconazole cream was observed even at a concentration of 0.02%, and its efficacy at 0.1% was equal to that of 1% bifonazole cream. The efficacy of short-term therapy with 1% luliconazole cream, which is used for clinical management, was investigated using the tinea corporis model (4- and 8-day treatment regimens) and the tinea pedis model (7- and 14-day treatment regimens). The 1% luliconazole cream completely eradicated the fungus in half or less of the treatment time required for 1% terbinafine cream and 1% bifonazole cream, as determined by a culture assay for both models. These results clearly indicate that 1% luliconazole cream is sufficiently potent for short-term treatment for dermatophytosis compared to existing drugs. Luliconazole is expected to be useful in the clinical management of dermatophytosis.     

中药联合1％联苯苄唑乳膏治疗手足癣临床观察

目的比较中药联合1％联苯苄唑乳膏及单用1％联苯苄唑乳膏治疗手足癣的疗效。方法将182例门诊确诊为手足癣的病人随机分成治疗组（92例）和对照组（90例）,治疗组用中药联合1％联苯苄唑乳膏,对照组单用1％联苯苄唑乳膏治疗。结果治疗组痊愈率91．30％,显效率97．83％;对照组痊愈率52．22％,显效率75．56％。结论两种方法均有效,治疗组疗效明显高于对照组（Х^2=35．566,P〈0．01）。     

Therapeutic efficacy of topically applied KP-103 against experimental tinea unguium in guinea pigs in comparison with amorolfine and terbinafine

The therapeutic efficacy of KP-103, a novel topical triazole, in a guinea pig tinea unguium model was investigated. Experimental tinea unguium and tinea pedis were produced by inoculation of Trichophyton mentagrophytes SM-110 between the toes of the hind paw of guinea pigs. One percent solution (0.1 ml) of KP-103, amorolfine, or terbinafine was topically applied to the nails and whole sole of an infected foot once daily for 30 consecutive days, and terbinafine was also orally administered at a daily dose of 40 mg/kg of body weight for 30 consecutive days, starting on day 60 postinfection. The fungal burdens of nails and plantar skin were assessed using a new method, which makes it possible to recover infecting fungi by removing a carryover of the drug remaining in the treated tissues into the culture medium. Topically applied KP-103 inhibited the development of nail collapse, significantly reduced the fungal burden of the nails, and sterilized the infected plantar skin. On the other hand, topical amorolfine and topical or oral terbinafine were ineffective for tinea unguium, although these drugs eradicated or reduced the fungal burden of plantar skin. The in vitro activities of amorolfine and terbinafine against T. mentagrophytes SM-110 were 8- and 32-fold, respectively, decreased by the addition of 5% keratin to Sabouraud dextrose broth medium. In contrast, the activity of KP-103 was not affected by keratin because its keratin affinity is lower than those of the reference drugs, suggesting that KP-103 largely exists in the nails as an active form that was not bound to keratin and diffuses in the nail without being trapped by keratin. The effectiveness of KP-103 against tinea unguium is probably due to its favorable pharmacokinetic properties in the nails together with its potent antifungal activity.