Onychomycosis due to Achaetomium strumarium

Onychomycosis is the most common infection of the toe-nails or finger-nails and it may be caused by a large variety of fungal species. Achaetomium species which belong to the phylum Ascomycota (Family Chaetomiaceae), are usually soil saprophytes or endophytic fungi which have been rarely reported as human or animal pathogens. Here, we report a case of onychomycosis caused by Achaetomium strumarium in a healthy person who showed involvement of all fingers of both hands with yellowish brown discoloration. The causative agent isolated was identified as Achaetomium species by morphology, colony morphometry and growth at high temperature and as A. strumarium from DNA sequence of ITS region. Onychomycosis from this case responded satisfactorily with per os (P. O.; oral) and topical application of Terbinafine.     

特比萘酚联合氟康唑对念珠菌及新生隐球菌的体外药敏试验

目的研究特比萘酚（FCZ）和氟康唑（TBNF）对念珠菌及新生隐球菌体外联合药敏试验中的相互作用，为临床用药提供实验室依据。方法参照美国国家临床实验室标准化委员会（NCCLS）提出的标准（M27-A方案）采用棋盘微量稀释法对10株念珠菌和18株新生隐球菌进行了特比萘酚和氟康唑的体外联合药敏试验。结果联合用药时FCZ的最低抑菌浓度（MIC）几何均值从单用药时的5.124降至0.672，差异有显著性（t=5.558，P〈0.001）;TBNF从2.26降至0.291，差异有显著性（t=6.552，P〈0.001）。两种药物联用有协同或相加作用，联合抑菌指数（FICI）的平均值为0.629。结论特比萘酚和氟康唑对致病酵母菌主要表现为协同相加作用。     

乳酸杆菌活菌联合特比萘芬治疗念珠菌性阴道炎的疗效观察

目的观察乳酸杆菌活菌联合特比萘芬治疗念珠菌性阴道炎的临床疗效。方法选取2016年1月—2016年12月在中国人民解放军第四五七医院就诊的念珠菌性阴道炎患者106例,随机分为对照组和治疗组,每组各53例。对照组口服盐酸特比萘芬片,0.25 mg/次,1次/d;治疗组在对照组基础上阴道深部放入阴道用乳杆菌活菌胶囊,1粒/次,1次/晚。两组患者均治疗12周。观察两组患者临床疗效,比较治疗前后两组患者临床症状评分和临床症状体征改善时间。结果治疗后,对照组临床总有效率为79.25%,显著低于治疗组的92.45%。两组比较差异具有统计学意义(P0.05)。治疗后,两组患者外阴瘙痒和灼痛感评分均明显降低(P0.05);且治疗组上述临床症状评分比对照组更低(P0.05)。治疗组患者临床症状体征开始改善时间明显短于对照组,两组比较差异具有统计学意义(P0.05)。结论乳酸杆菌活菌联合特比萘芬治疗念珠菌性阴道炎疗效显著,可明显改善患者临床症状,不良反应较少,具有一定的临床推广应用价值。     

特比萘芬治疗儿童头癣59例疗效和安全性评价

目的探讨特比萘芬治疗儿童头癣的疗效及安全性。方法将59例患儿随机分为两组,治疗组口服特比萘芬,同时采用剃发、洗头、搽药、用具消毒、日晒等方法治疗;对照组仅口服特比萘芬。两组的疗程均为12周。结果治疗组临床治愈率为79.31%,真菌学治愈率为72.41%,完全治愈率为68.97%;对照组依次为50.00%,46.67%和36.67%。未达真菌学治愈的真菌菌种以犬小孢子菌居多,共19(32.20%)例。结论剃发、洗头、擦药、用具消毒、日晒同时口服特比萘芬可明显提高头癣的完全治愈率。     

伊曲康唑、特比萘芬和他克莫司单用及联合对皮炎外瓶霉的体外抗真菌作用

目的 探讨他克莫司与伊曲康唑、特比萘芬联合对皮炎外瓶霉的体外抗真菌效果.方法 参考美国临床实验室标准化研究所M38-A2方案,测定特比萘芬和伊曲康唑对12株皮炎外瓶霉的最低抑菌浓度;利用棋盘法,测定他克莫司和伊曲康唑或特比萘芬的联合抗皮炎外瓶霉效果.结果 特比萘芬和伊曲康唑对皮炎外瓶霉最低抑菌浓度范围分别为(0.06 ～0.125) mg/L和(0.5 ～1) mg/L.他克莫司和特比萘芬联合对5株皮炎外瓶霉、他克莫司和伊曲康唑联合对10株皮炎外瓶霉有协同作用.两组均无拮抗作用.结论 他克莫司在体外与伊曲康唑或特比萘芬联合应用时,能够增加皮炎外瓶霉对伊曲康唑和特比萘芬的敏感性.     

Allergic contact dermatitis from naftifine in a child without cross-reaction to terbinafine

Allergic contact dermatitis from naftifine has been scarcely described in the English literature, all of them in adults. We report a case of a 12-year-old girl who developed an acute eczema on her neck after application of a naftifine cream. This fact was confirmed by a patch-test study. We did not find a cross-reaction to terbinafine, a structurally linked allylamine.     

Intricate isavuconazole therapy of a subcutaneous nodule caused by Alternaria infectoria in a heart transplant recipient

Invasive fungal infections have appeared to be increasingly emergent in immunocompromised patients, especially in solid organ transplant (SOT) recipients. The Alternaria genus encompasses more than 80 dematiaceus species. Among them, Alternaria alternata and Alternaria infectoria are the most frequent isolated as responsible for infection in humans.To our knowledge, we report the first case of a heart transplant recipient suffering from subcutaneous nodule caused by Alternaria infectoria and who was treated with isavuconazole. Despite all the promises of this new azole drug, one should keep in mind the potential great variability of the inter-individual responses for such complex patients. We demonstrate herein how it can be challenging to manage Alternaria infection in SOT recipients. More comprehensive studies and recommendations are expected in the context of Alternaria infections.     

特比萘芬联合10%浓碘酊治疗甲真菌病疗效观察

目的观察特比萘芬联合10%浓碘酊外用治疗甲真菌病的疗效及安全性。方法将112例甲真菌病患者随机分为2组,治疗组60例给予特比萘芬片250mg口服,每天1次,连服7d后,改为隔日服用1次,指甲真菌感染患者连用7周,趾甲真菌感染患者连用9周;同时加用10%浓碘酊外涂,每天2次,指(趾)甲真菌感染患者连用时间分别为8周和10周。对照组52例给予特比萘芬片250mg口服,每天1次,指甲真菌感染患者连服8周,趾甲真菌感染患者连服10周。结果治疗组停药时、停药后6个月总有效率比较差异无统计学意义(P>0.05)。治疗组不良反应发生率为3.3%低于对照组的17.3%,差异均有统计学意义(P<0.05)。在疗效相当的情况下,治疗组所需药品费用低于对照组(P<0.05)。结论特比萘芬联合10%浓碘酊外用治疗甲真菌病临床疗效好,不良反应少,安全有效,节省治疗费用,值得临床推广应用。     

对1例左胫腓骨骨折术后指甲隐球菌感染患者的药学监护

1例47岁男性患者,左胫腓骨骨折术后伤口流脓并不愈合,经过脓液真菌培养及皮肤组织病理检查均找到指甲隐球菌,诊断为术后伤口组织真菌感染。临床药师参与治疗方案的评估,结合指甲隐球菌的病理结果,先后给予抗真菌药氟康唑和特比萘芬单独治疗,鉴于在用药过程中患者出现对氟康唑耐药以及特比萘芬致过敏性水疱等症状,立即调整用药方案,交替隔日使用2种抗真菌药物。患者接受抗真菌药物治疗1个多月后,症状得到较大改善。     

特比萘芬与咪康唑软膏治疗手、足癣的临床疗效比较

目的比较特比萘芬软膏与咪康唑软膏用于手、足癣的疗效。方法将81例手、足癣患者随机分为观察组44例和对照组37例。观察组外用特比萘芬软膏,对照组外用咪康唑软膏,比较2组停药时及停药4周后临床疗效及真菌培养情况。结果观察组停药时和停药4周后总有效率和真菌清除率均高于对照组,差异有统计学意义(P<0.05)。结论特比萘芬软膏治疗手、足癣的疗效更好、疗程更短。