重症监护及移植病房环境真菌监测研究

目的研究重症监护及移植病房环境中真菌的浓度,菌种分布类型,并分析其与季节、温湿度、通风状况以及病房内活动人员的关系,为医院真菌感染的预防和治疗提供参考。方法2005年11月4日-2006年10月24日,对西南医院肝移植病房、脑外ICU与中心ICU空气、物体表面、水源以及外界空气等环境标本进行每月两次的分离培养。结果肝移植病房、脑外ICU、中心ICU及外界空气真菌浓度分别为123.63、139.90、7.00、214.00CFU/m3;空气和物体表面中常见的5种真菌为青霉属、枝孢霉属、链格孢霉属、曲霉菌属和酵母菌属;水源中常见真菌为酵母菌属、假丝酵母菌属、曲霉菌属、青霉属、红酵母属;肝移植病房和脑外ICU空气真菌浓度与病房温度、湿度具有相关性;而与活动人员不具有相关性。结论真菌广泛存在医院环境中,空气中真菌全年均有分布,且5-6、9-10月为2个高峰期,室内外峰期基本一致。     

用PCR法检测某化工厂患足癣工人皮损处真菌的实验研究

[目的]评价聚合酶链反应（PCR）技术直接从临床诊断为足癣的化工厂工人皮损处检测真菌的方法。[方法]采用蛋白酶K消化法和煮沸法处理标本，从中提取真菌DNA，然后用以源于医学机会性致病性真菌18srDNA保守区的一对寡核苷酸序列B2F（5′-ACTTTCGTAGGATAG-3′）和B4R（5′-TGATCGTCTTCGATAAATA-3′）为通用引物进行PCR扩增检测，并与直接镜检和培养法进行对比。[结果]在208例临床诊断为足癣的某化工厂工人皮损处皮屑中，用PCR检出真菌阳性者193例（92.79%），检出的真菌菌种为红色毛癣菌、絮状表皮癣菌和须癣毛癣菌；用培养法检测真菌阳性者186例（89.42%），检出的真菌菌种为红色毛癣菌、须癣毛癣菌、絮状表皮癣菌和犬小孢子菌；真菌直接镜检检出阳性者141例（67.79%）。[结论]用PCR法检测化工厂工人的足癣具有快速诊断的价值，并且具有较好的敏感性、特异性和准确性，可用于化工企业工人患足癣后进行真菌的常规检测和诊断。     

慢性阻塞性肺疾病合并肺部真菌感染的诊治体会

目的:探讨慢性阻塞性肺疾病(COPD)合并肺部真菌感染的诊断、临床特性及分析氟康唑治疗效果。方法:回顾性分析78例COPD合并肺部真菌感染患者的临床资料。结果:78例COPD合并肺部真菌感染患者用氟康唑治疗,痊愈56例,显效10例,总有效率为84.62%。患者年龄偏大、广泛使用抗菌药和激素、合并糖尿病等其他基础疾病都是易感因素。结论:早期诊断和及时加用氟康唑进行抗真菌治疗是防止COPD合并肺部真菌感染加重病情的重要措施。     

抗肿瘤真菌蛋白的研究进展

药用真菌具有明显的抗癌作用。以往认为多糖是真菌抗肿瘤活性的主要成分,但真菌中分离出的真菌免疫调节蛋白、凝集素、核糖核酸酶等蛋白质,具有提高机体免疫、抑制细胞增殖和诱导肿瘤细胞凋亡等抗肿瘤活性。真菌蛋白质是另一种重要的生物活性物质,对其抗肿瘤活性和机制的研究有广大的开发空间和挖掘潜力。     

Onychomycosis due to opportunistic molds

BACKGROUND:

Onychomycosis are caused by dermatophytes and Candida, but rarely by non- dermatophyte molds. These opportunistic agents are filamentous fungi found as soil and plant pathogens.

OBJECTIVES:

To determine the frequency of opportunistic molds in onychomycosis.

METHODS:

A retrospective analysis of 4,220 cases with onychomycosis, diagnosed in a 39-month period at the Institute of Dermatology and Skin surgery "Prof. Dr. Fernando A. Cordero C." in Guatemala City, and confirmed with a positive KOH test and culture.

RESULTS:

32 cases (0.76%) of onychomycosis caused by opportunistic molds were confirmed. The most affected age group ranged from 41 to 65 years (15 patients, 46.9%) and females were more commonly affected (21 cases, 65.6%) than males. Lateral and distal subungual onychomycosis (OSD-L) was detected in 20 cases (62.5%). The microscopic examination with KOH showed filaments in 19 cases (59.4%), dermatophytoma in 9 cases (28.1%), spores in 2 cases (6.25%), and filaments and spores in 2 cases (6.25%). Etiologic agents: Aspergillus sp., 11 cases (34.4%); Scopulariopsis brevicaulis, 8 cases (25.0%); Cladosporium sp., 3 cases (9.4%); Acremonium sp., 2 cases (6.25%); Paecilomyces sp., 2 cases (6.25%); Tritirachium oryzae, 2 cases (6.25%); Fusarium sp., Phialophora sp., Rhizopus sp. and Alternaria alternate, 1 case (3.1%) each.

CONCLUSIONS:

We found onychomycosis by opportunistic molds in 0.76% of the cases and DLSO was present in 62.5%. The most frequent isolated etiological agents were: Aspergillus sp. and Scopulariopsis brevicaulis.     

重症急性胰腺炎合并深部真菌感染32例临床分析

目的 探讨重症急性胰腺炎(severe acute pancreatitis,SAP)并发深部真菌感染(deep fungal infection,DFI)的特点及防治. 方法回顾性分析1998年10月至2009年10月我科收治的135例SAP患者的临床资料,其中并发DFI的32例,男19例,女13例,平均年龄(56±5)岁.结果 本组死亡7例(占21.9%),32例平均住重症监护室时间(21±6)d、住院时间(78±14)d、治疗费用(13.5±0.7)万元.SAP合并DFI患者具有以下特点:病情重、病程长、需住重症监护室治疗、多需手术清除感染灶、需长期留置各种导管、接受气管插管机械通气、肠外营养及长期使用广谱抗菌素治疗等特点.结论 SAP合并DFI具有较高发生率及病死率.应采取防治结合的措施,如:恰当处理原发病,严格无菌操作,合理应用抗生素和预防性应用抗真菌药等,可降低SAP合并DFI的发生率、病死率.     

改良复方KOH在真菌镜检中应用效果分析

目的探讨改良复方KOH载浮液在皮肤真菌检验中阳性检出率和阳性标本保存时间,为临床快速诊断真菌感染和标本保存提供依据。方法用复方KOH和改良复方KOH两种载浮液检查皮肤真菌,比较两者阳性检出率和阳性标本室温放置不同时间保持率。结果复方KOH真菌阳性检出率68.66%,改良复方KOH真菌阳性检出率73.73%,经统计学处理,两者阳性检出率差异无统计学意义,实验组查出真菌阳性室温放置2h(χ2=8.26,P<0.01),3h(χ2=27.04,P<0.01)和5h(χ2=34.32,P<0.01)阳性保持率均大于对照组。结论改良复方KOH载浮液检验皮肤真菌阳性率和室温放置阳性保持率高,适宜大批量皮肤真菌检验和教学示教片保存。     

Human antimicrobial peptides in ocular surface defense

Sight depends on the passage of light through the transparent cornea and being focused on the fovea. Its exposed position renders it vulnerable to microbial infection. The cornea has developed a wide array of defense mechanisms against infection, of which endogenous antimicrobial peptides (AMPs) are key. AMPs are essentially small molecular weight cationic peptides with a wide range of activity against virus, bacteria, fungi and parasites. Some proteins such as RNases and S100As are also included in this group. Several AMPs act synergistically allowing low expression of multiple AMPs to act efficiently. AMPs also have a range of non-microbicidal functions and serve as signaling molecules, immunomodulators; show anti-tumour activity, and influence vascularization and wound healing. Different toll-like receptors (TLR) have been implicated in the preferential induction of specific AMPs. A range of bacteria, including mycobacteria tuberculosis, viruses including herpes virus, fungi and parasites including acanthamoeba, that cause ocular infections have been shown to induce specific AMPs via TLR activation. Non-TLR mediated induction of AMP expression can occur and several molecules such as L-isoleucine, sodium butyrate, vitamin D3, phenylbutyrate, vasoactive intestinal peptide, and etinostat have been identified in this regard. Given the rising microbe resistance to antibiotics, the slow rate of development of new antibiotics and the limited access to effective antibiotics by patients living in the developing world, an ideal solution would be to find AMPs that are effective singly or in combination with each other or other antimicrobial proteins to reduce, if possible eliminate reliance on antibiotics alone.     

真菌性鼻-鼻窦炎研究进展

近年来真菌性鼻-鼻窦炎在临床上日益多见,其病原菌、临床表现、诊断以及治疗均与传统的鼻-鼻窦炎有所不同。不同类型的真菌性鼻-鼻窦炎由于致病的病原菌不同,在临床表现、诊断、治疗以及预后方面有各自的特点,如非侵袭性真菌性鼻-鼻窦炎的治疗以手术为主,而侵袭性真菌性鼻-鼻窦炎除手术外,还需在治疗全身原发疾病基础上全身使用抗真菌药物。本文就各类真菌性鼻-鼻窦炎的病因、临床表现、诊断、治疗及预后等方面做一综述。     

常见致病真菌唑类耐药基因研究进展

随着唑类抗真菌药物在临床的广泛应用,耐药现象日益突出.真菌耐药基因突变或表达水平的改变是对唑类耐药的主要原因之一,也一直是国内外关注的热点.参与真菌唑类耐药的基因主要涉及影响麦角甾醇合成途径的相关基因,如ERG11、ERG3;药物外排蛋白相关基因,如编码ABC蛋白的CDR基因、编码MFS泵的MDR基因、钙调神经磷酸酶通路的靶基因RTA2基因.然而,一些基因是否介导真菌唑类耐药仍存在争议或证据不足,如白念珠菌的FLU1基因、光滑念珠菌的ERG11基因.不同类型真菌唑类耐药的主导基因也有差异.