山东"10·21"辐射事故2例放射病病人真菌感染的实验鉴定和动态观察

目的 分析引起山东"10·21"辐射事故2例放射病人真菌感染的种类和药敏试验结果.方法 用形态学方法结合VITEK2全自动微生物分析仪以及API 20C AUX生化鉴定方法对临床标本进行微生物学鉴定,真菌药敏试验采用微量稀释法.结果 在病例A的大便标本中培养出近平滑念珠菌,中段尿、血液、胸水、腹水、大便、骨髓血、两次咽拭子和脑脊液等标本中培养出申克孢子丝菌,痰液标本中培养出热带念珠菌.病例B的鼻腔、口腔、尿道口分泌物和腹腔引流液等标本中培养出阿萨丝孢酵母菌,痰标本中除阿萨丝孢酵母菌外,还培养出了土曲霉菌.随着抗真菌药物使用时间的延长,上述真菌对抗真菌药物的敏感性逐渐下降,最小抑菌浓度(MIC)逐渐增加.结论 大多数抗真菌药物的体外药敏试验敏感,但患者的一般情况很差,常用剂量乃至较大剂量的用药只能抑菌而不能杀菌,且因临床预防性抗生素和抗真菌制剂的使用,常规的微生物培养方法很难培养出细菌或真菌.     

皮肤型孢子丝菌病585例临床分析

目的 对近3年吉林地区585例皮肤型孢子丝菌病病例进行总结,分析其临床和流行病学特征。方法 对2007-2009年我院皮肤科确诊的孢子丝菌病病例进行回顾性分析。结果 585例患者中男女比1 ∶ 1.35,平均年龄40.5岁,发病年龄以51 ～ 60岁最多见（22.05%）;平均病程6.78个月;冬春季节发病者所占百分比最高;居住于农村者551例（94.19%）,有外伤史者占25.47%。临床表现以固定型最常见（56.58%）,其次为淋巴管型（39.66%）,皮肤播散型和不确定型各占1.88%。受累部位以四肢（50.94%）及面部（43.76%）最多。治疗采用10%碘化钾溶液、伊曲康唑、特比萘芬或联合治疗。失访250例,余335例已治愈289例,平均疗程2.09个月,其余46例仍在治疗随访中。结论 孢子丝菌病近年来仍然是吉林地区的多发病,其临床及流行病学特点与以往报道相似,但中老年患者所占比例及皮损不典型病例增加,碘化钾、伊曲康唑和特比萘芬是治疗孢子丝菌病安全有效的药物。     

Sporothrix schenckii type 3D (mtDNA-RFLP): report of an osteoarticular case

Sporotrichosis is a frequent subcutaneous mycosis in Mexico and lymphocutaneous cases are the most common type. Extracutaneous or disseminated forms are exceptional and are usually seen in immunosuppressed hosts. We report the case of a 74-year-old immunocompetent male with osteoarticular involvement. The isolated Sporothrix schenckii was classified as type 3D according to restriction fragment length polymorphism analysis of the mitochondrial DNA (mtDNA-RFLP).     

山苍子油抗申克孢子丝菌的动物实验研究

目的探讨山苍子油灌胃治疗实验性小鼠皮肤孢子丝菌感染的疗效。方法制备小鼠皮肤孢子丝菌(包括临床分离固定株和淋巴管株)感染的动物模型,造模成功后给予山苍子油灌胃治疗,同时设10%K I治疗组和生理盐水治疗组(空白对照组),观察治疗前后皮损的直径变化。结果山苍子油灌胃治疗4周后,小鼠皮损明显缩小,甚至消退,其皮损直径变化与空白对照组比较差异有显著性,与10%K I治疗组比较差异无显著性。结论山苍子油灌胃治疗对小鼠皮肤孢子丝菌病有一定的疗效。     

广东省珠海市金湾区孢子丝菌及暗色真菌的生态学研究

目的：了解珠海市金湾区自然环境中申克孢子丝菌及致病性暗色真菌在该地区的分布情况及生态学。方法：分别于2006年4月、7月、10月、2007年1月四季从该区三灶、南水、平沙、红旗四地区自然环境中采集土壤、腐木、树皮、沼泽淤泥、枯枝等标本160份,用含放线菌酮的马铃薯葡萄糖琼脂（PDA）培养基分离菌株,沙堡葡萄糖琼脂培养基（SDA）传代培养,通过观察菌落形态、颜色,显微镜下菌丝和孢子的生长形态等方法,鉴定申克孢子丝菌及暗色真菌。结果：分离出申克孢子丝菌24株（分离率为15%）。暗色真菌共89株（分离率为56%）,其中外瓶霉属33株（21%）,枝孢霉10株（6%）,链格孢19株（12%）,着色真菌13株（8%）,疣状瓶霉6株（4%）,待定8株（5%）。除此之外,还分离出镰刀菌、念珠菌、曲霉等多种条件致病菌。结论：在珠海金湾区自然环境中能够分离出申克孢子丝菌及暗色真菌。     

Efficacy and safety of itraconazole pulses vs. continuous regimen in cutaneous sporotrichosis

Background Primary observation of using itraconazole pulse regimen (commonly used for onychomycosis) in five sporotrichosis patients produced satisfactory effect, but there are no randomized controlled trials to assess this regimen and to compare with routine continuous regimen. Objectives The aim of this study was to compare the efficacy and safety of itraconazole pulse regimen, as a new treatment option for cutaneous sporotrichosis, with continuous regimen. Methods A prospective, randomized, evaluator‐blind, controlled study was performed. A total of 50 cutaneous sporotrichosis patients were divided randomly into two groups: Pulsed Rx (n_pulse = 25), treated with itraconazole 200 mg b.i.d. for 1 week and off for 3 weeks; Daily Rx (n_cont = 25), treated with itraconazole 100 mg bid continuously. In total, 46 patients (n_pulse = 22, n_cont = 24) were assessable at the end of the study. Cure rates at weeks 12, 24 and 48 along with the course of treatment and the rate of side effects were evaluated. Results In Pulsed Rx, the cure rates at weeks 12, 24 and 48 were 77.3%, 81.8%, 81.8% respectively. The mean course of treatment was 2.65 ± 0.81 pulses and the rate of side effects was 4.5%; In Daily Rx, the corresponding cure rates were 79.2%, 91.7% and 95.8% respectively. The mean course of treatment was 2.80 ± 2.33 months and the rate of side effects was 16.7%. These parameters had no significant difference between the two groups (P > 0.05). Conclusion The efficacy and safety of Itraconazole pulse regimen for cutaneous sporotrichosis were similar to the continuous regimen. It is an effective and safe alternative treatment for cutaneous sporotrichosis, which can also lower the cost by decreasing the number of capsules.     

Detection of 2 immunoreactive antigens in the cell wall of Sporothrix brasiliensis and Sporothrix globosa

The cell wall of members of the Sporothrix schenckii complex contains highly antigenic molecules which are potentially useful for the diagnosis and treatment of sporotrichosis. In this study, 2 immunoreactive antigens of 60 (Gp60) and 70 kDa (Gp70) were detected in the cell wall of the yeast morphotypes of Sporothrix brasiliensis and Sporothrix globosa.     

Sporothrix brasiliensis outbreaks and the rapid emergence of feline sporotrichosis

Sporotrichosis is the main subcutaneous mycosis in Brazil, and is caused by Sporothrix schenckii and allied species. Sporothrix propagules present on soil and plant debris may be traumatically inoculated into the cutaneous/ subcutaneous tissues of the warm‐blooded host. An alternative route involves direct animal – animal and animal – human transmissions through deep scratches and bites of diseased cats. Sporotrichosis is much more common than previously appreciated with several cases emerging over the years especially in South and Southeast Brazil. We conducted an epidemiological surveillance in endemic areas of feline sporotrichosis in the southern region of Rio Grande do Sul state, Brazil. Over the last 5‐year period the number of feline sporotrichosis in Rio Grande increased from 0.75 new cases per month in 2010 to 3.33 cases per month in 2014. The wide geographic distribution of diagnosed cases highlights the dynamics of Sporothrix transmission across urban areas with high population density. Molecular identification down to species level by PCR‐RFLP of cat‐transmitted Sporothrix revealed the emergence of the clonal offshoot S. brasiliensis during feline outbreaks; this scenario is similar to the epidemics taking place in the metropolitan areas of Rio de Janeiro and São Paulo. Controlling and preventing sporotrichosis outbreaks are essential steps to managing the disease among humans and animals.     

Molecular identification and susceptibility profile of Sporothrix schenckii sensu lato isolated in Argentina

We studied 23 clinical and environmental strains of Sporothrix schenckii sensu lato collected from 1984 to 2017 in Argentina. The molecular identification (partial sequencing of a fragment of the calmodulin gene) of the strains was performed. For the yeast and mycelial phases, the in vitro susceptibility testing by a microdilution reference method was determined against eight antifungal drugs. Strains studied were identified as S. schenckii sensu stricto 13 (56.5%), S. brasiliensis 8 (34.7%) and S. globosa 2 (8.7%). The most active antifungal drugs tested for the yeast and mycelial phases expressed as geometric mean (GM ) value of the minimal inhibitory concentration (MIC ) (μg mL^?1) were terbinafine (0.07 and 0.24), posaconazole (0.13 and 0.58), itraconazole (0.38 and 1.10) and ketoconazole (0.22 and 0.89), while fluconazole (110.10 and 131.92) and flucytosine (2.96 and 79.03) were the less active. For voriconazole and amphotericin B the GM ‐MIC values were acceptably low for the yeast phase (0.39 and 0.72 μg mL^?1), while the mycelial phase showed values ≥2‐fold higher (8.76 and 1.88 μg mL^?1), P  < .05. Here, we described S. schenckii sensu stricto, S. brasiliensis and S. globosa, these species were isolated from humans, animals and soil and are circulating in Argentina since at least 1984.