3例着色芽生菌病的临床分析及病原菌鉴定

目的对着色芽生菌病进行临床分析及病原菌鉴定。方法分析3例患者的临床特点。取患者皮损及分泌物行组织病理及真菌学检查。提取病原菌DNA,利用引物ITS4和ITS5进行rDNA ITS区序列的PCR扩增,扩增产物测序后在Genbank核酸数据库中进行同源性比对。按照CLSI制定的M38-A方案对菌株进行体外药敏实验。结果结合3例患者组织病理、真菌学特征及rDNA ITS区序列分析将病原菌鉴定为Fonsecaea monophora,其引起的着色芽生菌病病程迁延。体外药敏试验显示该菌对伊曲康唑、特比萘芬、伏立康唑、硝酸异康唑均敏感。临床上伊曲康唑和（或）特比萘芬治疗有效。结论 Fonsecaea monophora与裴氏着色霉相似,可通过分子生物学方法鉴别,其引起的着色芽生菌病需长期治疗。

Clinical analysis of chromoblastomycosis and identification of Fonsecaea monophora

Aim To analyze the clinical features and identify the fungal pathogen of chromoblastomycosis Fonsecaea monophora.Methods The clinical features,pathogen identification,treatment and prognosis of three chromoblastomycosis cases were analyzed.PCR was used to amplify the DNA of the pathoden with primers ITS4 and ITS5.The amplified products were sequenced and blasted in Genbank for homology comparison.The antifungals susceptibility of the strains was tested according to the reference method of approved standard M38-A published by CLSI.Results The pathogenic fungi of three patients were identified as Fonsecaea monophora by histopathology.The three isolates were sensitive to itraconazole,terbinafine,voriconazole,and econazole in vitro.Itraconazole and（or） terbinafine were effective on patients infected with Fonsecaea monophora.Conclusions Fonsecaea monophora was very similar to Fonsecaea monophora,and rDNA ITS sequence analysis is capable of idification of the pathogen.The chromoblastomycosis caused by Fonsecaea monophora need a long course of treatment.