耳内镜下抗真菌药局部注入治疗真菌性外耳道炎

目的总结南方地区真菌性外耳道炎患者的临床表现、病原学特点和治疗转归,探讨耳内镜清理+曲安奈德克霉唑乳膏局部注入法治疗真菌性外耳道炎的临床疗效。方法选取2014年1月至2015年12月就诊的来自南方地区、资料完整的256例真菌性外耳道炎患者,随机分为两组,注药组(152例)采用耳内镜下先清理外耳道内真菌病变,再外耳道内注入曲安奈德克霉唑乳膏,每周复诊同上治疗1次,共3~4次;涂药组(104例)采用耳内镜下清除真菌病变,嘱患者自行外耳道内涂曲安奈德克霉唑乳膏,每天1次,每周复诊治疗1次,共3~4次。随访6个月,以症状和耳内镜检查结果评价效果。非随机法连续选择部分患者取外耳道分泌物行真菌病原学培养。结果两组共256例真菌性外耳道炎患者,主要症状是耳痒(89. 8%)、耳内阻塞感(80. 9%)、流脓(69. 1%)、听力下降(51. 2%)、耳痛(42. 2%)、耳内臭味(18. 0%)等。96例外耳道分泌物行真菌病原学检测,89例阳性,7例阴性,培养阳性率92. 7%;89例中曲霉菌属75例,念珠菌属8例,6例未能鉴别出真菌种属。随访6个月以上,注药组152例,治愈141例,复发11例;涂药组104例,治愈86例,复发18例;注药组治愈率(92. 8%)高于涂药组(82. 7%),差异有统计学意义(χ~2=6. 235,P=0. 013)。结论真菌性外耳道炎南方地区常见,早期多无特殊症状,以耳痒、耳内流液和耳内阻塞感较常见,耳内镜的临床应用能提高其早期诊断率。曲霉菌属感染最常见,连续多次耳内镜下彻底清除局部病变、同期抗真菌药物局部注药能显著提高治愈率。     

Fingernail Onychomycosis Due to Aspergillus niger

Onychomycosis is usually caused by dermatophytes, but some species of nondermatophytic molds and yeasts are also associated with nail invasion. Aspergillus niger is a nondermatophytic mold which exists as an opportunistic filamentous fungus in all environments. Here, we report a case of onychomycosis caused by A. niger in a 66-year-old female. The patient presented with a black discoloration and a milky white base and onycholysis on the proximal portion of the right thumb nail. Direct microscopic examination of scrapings after potassium hydroxide (KOH) preparation revealed dichotomous septate hyphae. Repeated cultures on Sabouraud''s dextrose agar (SDA) without cycloheximide produced the same black velvety colonies. No colony growth occurred on SDA with cycloheximide slants. Biseriate phialides covering the entire vesicle with radiate conidial heads were observed on the slide culture. The DNA sequence of the internal transcribed spacer region of the clinical sample was a 100% match to that of A. niger strain ATCC 16888 (GenBank accession number {"type":"entrez-nucleotide","attrs":{"text":"AY373852","term_id":"34809332","term_text":"AY373852"}}AY373852). A. niger was confirmed by KOH mount, colony identification, light microscopic morphology, and DNA sequence analysis. The patient was treated orally with 250 mg terbinafine daily and topical amorolfine 5% nail lacquer for 3 months. As a result, the patient was completely cured clinically and mycologically.     

Ecophysiology of Aspergillus section nigri species potential ochratoxin a producers

After aflatoxins, ochratoxin A (OTA) is the most studied mycotoxin due to the toxicological significance in human and animal diets. OTA presence has been extensively reported worldwide in the last decade in several agricultural products. The main OTA producer in tropical and temperate climates is Aspergillus carbonarius followed by species belonging to A. niger aggregate. Currently, many scientists worldwide have studied the influence of water activity and temperature for growth and biosynthesis of OTA by these species on synthetic media. This article reviews ecophysiological studies of Aspergillus section Nigri strains on synthetic media and natural substrates. The results of these investigations suggest that significant amounts of OTA can be produced in only five days and that the use of different storage practices, such as a(W) and temperature levels below 0.930 and 15 °C, respectively, allow controlling fungal contamination and minimizing the OTA production in several products as peanuts, corn, dried grapes and derived products for human consumption.