免疫荧光技术在皮肤活检组织真菌染色中的应用

目的：评价免疫荧光染色法在皮肤活检组织真菌染色中的应用价值。方法：经组织病理和组织培养确诊的43例皮肤真菌病患者对其石蜡包埋切片分别进行免疫荧光染色、PAS染色。结果：43例皮肤真菌病中PAS染色阳性27例（62.8%）,免疫荧光染色阳性30例（69.7%）,免疫荧光染色法较PAS染色阳性率有所提高,两者差异无统计学意义（P>0.05）。同时两种方法均阴性患者5例,两种方法联合真菌检出阳性率为88.4%。结论：免疫荧光染色是提高皮肤活检组织中真菌检出的重要补充。     

Efficacy testing of antimycotic prophylactics in an animal model

Trichophyton mentagrophytes is both zoophilic and a common causative organism in human dermatomycosis. Therefore this dermatophyte is widely used for experimental efficacy testing of antimycotic agents and their active ingredients. The use of the guinea pig as an animal model for dermatomycosis is based on the predisposition of this species to spontaneous dermal fungal infections. A previously described guinea pig model was modified according to the results of pilot experiments. The modification consists of 1) evaluation of the infectious activity of the primary mycotic tissue cultures obtained from patients and 2) the efficacy testing itself with treatment of the infected skin area including the continuous clinical observation for 28 days. At first the required duration of cultivation and the number of spores for a reproducible infection of all animals were determined. The following efficacy test consisted of four groups with ten animals each. Group I (control of infection) remained without further treatment after experimental infections, groups II-IV received a single treatment by spraying at the day of infection with isopropanol (70%) (negative control), water (mechanic control) and the antimycotic agent (treated group), respectively. After 28 days under continuous examination, clinical symptoms (scabs; reddening, scaliness) were statistically analyzed. The model takes into account the duration and severity of infection in order to evaluate the differences between the four groups. The experimental protocol presented allows the efficacy of antimycotic agents to be demonstrated by means of statistical analyses. As an example the results of a successful prophylactic treatment against T. mentagrophytes with the antimycotic prophylactic Laudamonium (1%) are presented.     

酒醋溶液与吡佛拉唑溶液治疗兔皮肤真菌病的实验观察

本文报告酒醋溶液与１％吡佛拉唑溶液治疗兔皮肤真菌病的效果。实验结果表明，酒醋溶液对红色毛癣菌和石膏样毛癣菌均有效，与吡佛拉唑溶液疗效相似，与对照区有明显差别。无副作用。     

Recalcitrant cutaneous fungal infections—A growing problem

The incidence and prevalence of recalcitrant cutaneous fungal infections is on the rise. Terbinafine-resistant Trichophyton has not only been widespread in India, but has also been reported in countries spread throughout the globe. Strains of yeasts such as Malassezia and Candida, which exist both as commensals and as pathogens to the human skin, have also been found to develop resistance to antifungals. Non-dermatophyte moulds which can colonize and infect damaged nails are especially difficult to treat, not only due to resistance, but also because of poor drug penetration of hard keratin. Psychosocial factors such as the indiscriminate broad-spectrum antifungal use in agriculture and in medicine, and poor adherence to hygienic measures to break the chain of infection contribute to the development of antifungal resistance. Such environments encourage fungi to develop various resistance mechanisms to withstand antifungal treatment. These include: (a) alteration of the drug target, (b) increasing efflux of drug/metabolites, (c) inactivation of drug, (d) bypass mechanisms or substitution of the pathway affected by the drug, (e) stress adaptation mechanisms and (f) biofilm formation. Understanding of such mechanisms and how they arise are crucial for development of new ways to prevent or overcome resistance. Novel antifungal treatments have recently been approved in the United States of America for treatment of vulvovaginal candidiasis. Ibrexafungerp (enfumafungin derivative) and oteseconazole (tetrazole) differ from their respective related drug classes of echinocandins and triazoles by having different structures, which lend these medicines advantage compared to traditional treatment by having a different binding site and more selectivity for fungi respectively. Other drugs designed to circumvent the known mechanisms of antifungal resistance are also at various phases of development. Concurrent measures at an institutional and individual level to address and limit inappropriate antifungal use to reduce development of antifungal resistance should be undertaken in a concerted effort to address this epidemic.     

Comparison of diagnostic methods in the diagnosis of dermatomycoses and onychomycoses

Direct microscopic examination of potassium hydroxide (KOH)-prepared specimens is the simplest, cheapest method used for the diagnosis of mycotic infections of the skin. However, KOH preparations have been reported to have 5-15% of false-negative results, possibly because of the low visibility of scant, scattered fungal material of the nail scrapings and because the detection of fungal elements depends on the skill of the observer [Arch Dermatol133 (1997) 1317; Clin Microbiol Rev8 (1995) 240]. We compared two different KOH-based staining methods in order to obtain reliable results in shorter time than expected for cultures. A total of 124 patients with suspect diagnosis of dermatomycosis or onychomycosis were enrolled. Two scrapings from the same lesion of each patient were stained with KOH-Chlorazole and KOH-Acridine Orange (AO), respectively; cultural examination of the same specimen was considered as diagnostic gold standard. The two methods showed neither significantly different sensitivity nor specificity; however, for onychomycoses, we observed a slightly higher sensitivity for KOH-Chlorazole and a higher specificity for KOH-AO. We suggest the use of both techniques in order to improve detection of fungal infection, especially for onychomycoses.     

Skin infection due to Geomyces pannorum var. pannorum

Geomyces pannorum var. pannorum is an ubiquitous saprophytic fungus frequently isolated from the soil and from air samples. It has rarely been reported as an animal or plant pathogen and it is an occasional aetiological agent of superficial infection of skin and nails in humans. Here, we report a case of superficial infection of the skin due to this fungus in a healthy man. The patient was treated orally with terbinafine 250 mg daily and topic bifonazole with complete resolution in 2 months.     

Effectiveness of an encecalin standardized extract of Ageratina pichinchensis on the treatment of onychomycosis in patients with diabetes mellitus

Ageratina pichinchensis is utilized in traditional medicine for the treatment of dermatomycosis and inflammation. The aim of this study was to evaluate the clinical and mycological effectiveness of the topical administration of an enecalin standardized extract of A. pichinchensis for treating onychomycosis in patients with type 2 diabetes mellitus (DM2). A double blind, randomized, and controlled clinical trial was carried out that included patients with DM2 and who had mild or moderate onychomycosis. Participants were administered topically, for 6 months, a lacquer containing the encecalin standardized extract of A. pichinchensis (experimental group) or 8% ciclopirox (control group). In a large percentage of both, the control group (77.2%) and the experimental group (78.5%), clinical efficacy was detected as a decrease in the number of affected nails and a reduction in the severity of nail involvement. Without exhibiting statistically significant differences between groups, the encecalin standardized extract of A. pichinchensis was clinically and mycologically effective in the treatment of mild and moderate onychomycosis in patients with DM2. The treatment of onychomycosis in patients with DM2 implies a greater challenge, while control of blood glucose levels in these patients, played a very important role in the response of patients to treatment.     

某些个体因素在浅部真菌病感染中的作用探讨

为探讨某些个体因素在浅部真菌病感染中的作用，对６７６例门诊浅部真菌病患者作了性别、年龄、职业性质、病损部位、病种分布、感染情况、解剖等差异及其他发病诱因等的统计学分析研究。结果表明：发病率无性别差异：青壮年人对癣病易感，婴幼儿和老年人发病率较低，工人和干部好发癣病，农民和渔民患癣病者较少；足部是最易好发的病损部位；最多见的病种是足癣；癣病的感染和复发还与个体易感性、遗传素质、多汗、局部皮肤毗邻间隙、个人生活习惯和社会公共卫生环境密切相关。文章还对浅部真菌病的病因病机和某些个体因素在浅部真菌病中的作用分别作了扼要地阐述，提出癣病防治的主要病种是足癣，预防重点是个人和社会公共卫生。