一例喉真菌病病例报道并文献复习

目的:探讨喉真菌病的临床特征、诊断要点和治疗方案。方法:回顾我院收治的一例喉真菌病患者的临床病例资料,并对1992年至今国内外报道的类似病例33例进行文献复习。本研究共纳入患者34例,男性16例,女性18例,年龄14-67岁,临床表现以声嘶为主,可伴有咽痛、咽干等咽喉不适感,其中有16例患者被误诊为急性喉炎,27例患者有不同程度的抗生素和(或)糖皮质激素使用史。结果:34例患者中,13例通过病理确诊为喉真菌病。所有患者均予抗真菌药物治疗,其中有1例同时行手术治疗,均治愈。结论:喉真菌病临床罕见,症状无特异性,易误诊,但病理学检查可靠,全身或局部使用抗真菌药物疗效佳,预后良好。     

红色毛癣菌和枝孢样枝孢霉混合感染导致银屑病患者甲真菌病1例

目的报道1例银屑病患者出现红色毛癣菌和枝孢样枝孢霉混合感染导致的甲真菌病。方法报告病例,对甲标本进行真菌镜检和培养,对病原菌进行形态学及分子生物学鉴定。结果该病例经临床、真菌镜检和真菌培养鉴定,确诊为红色毛癣菌和枝孢样枝孢霉导致的甲真菌病。病原菌通过菌落和显微镜下形态特征结合rRNA内转录间隔区序列分析证实。结论通过形态学及分子生物学鉴定,证实为真菌红色毛癣菌和枝孢样枝孢霉混合感染导致的甲真菌病。     

濮阳市部分浅部真菌病中癣菌和念珠菌混合感染的分析

目的了解濮阳地区部分浅部真菌病中两种及两种以上真菌混合感染的情况。方法对临床确诊为浅部真菌病的患者456例,取标本行10%KOH直接镜检、真菌培养及菌种鉴定。登记确诊患者相关临床资料,分析其中混合感染的发病特点。结果确诊皮肤癣菌和念珠菌混合感染病例36例,分离率为7.89%,多见于股部(58.33%)和足部(27.78%);分离菌株72株,皮肤癣菌中以红色毛癣菌为主(75.00%),念珠菌中以非白念珠菌为主(72.22%)。结论濮阳地区部分浅部真菌病中混合感染主要为皮肤癣菌和念珠菌的混合感染,多见于股部和足部;致病菌以红色毛癣菌和非白念珠菌为主。     

眼部浅绿色气球菌感染4例报道

目的 提高对眼部气球菌感染的认识.方法 报告4例眼部气球菌感染病例并复习文献,对其发病因素、临床症状、诊断、及治疗和预后进行分析.结果 4例眼部感染气球菌患者为中年或老年人,基础疾病为青光眼、糖尿病(2例)及甲状腺功能亢进症,均经病原菌的分离鉴定后确诊为浅绿色气球菌感染,且对左氧氟沙星、万古霉素等常用药敏感,4例患者中除1例青光眼患者用药效果不理想外,其余均经1～2周的治疗后痊愈.结论 对眼部感染患者,应加强浅绿色气球菌的分离与鉴定.     

红色毛癣菌致头癣4例临床分析及近10年文献回顾

目的通过对4例红色毛癣菌致头癣的临床分析及近10年的文献复习,探讨红色毛癣菌致头癣的临床特征。方法根据临床表现和真菌学检查确诊的头癣4例,致病菌均为红色毛癣菌。收集患者一般资料、皮损特征、病程、治疗情况,总结分析;并对近10年与红色毛癣菌相关头癣的文献进行回顾总结。结果 4例头癣,前3例为学龄前儿童,第4例为老年女性,仅1位有宠物接触史。病史显示,与儿童患者密切接触的家庭成员均患有不同程度的足癣和甲癣,且有抠脚等不良习惯;第4例患有糖尿病和甲癣多年,且头癣与其甲癣的真菌培养鉴定结果一致,均为红色毛癣菌。经口服抗真菌药物规范治疗,4位患者均在4～8周内治愈。近10年来文献回顾发现,头癣中红色毛癣菌的分离率国内文献的数据是0.6%～15.8%,英文文献的数据是0.8%～28.8%。因红色毛癣菌而发生的头癣,临床表现呈多样性,有红斑性鳞屑、脱发、渗出等病变,也有脓癣型和黑点型。结论红色毛癣菌导致头癣的报道并不少见。与患有浅部真菌病的家庭成员密切接触以及自身传播,可能是红色毛癣菌性头癣的主要传播来源。无论儿童或成人,只有提高对不同临床形式的头癣的认识和警惕性,把真菌学检查作为常规检查手段,才能有助于更多病例的确诊。     

7例不典型肺真菌病的临床分析

目的 肺部真菌感染往往症状不典型,肺部影像学表现多样,缺乏特异性,为早期诊断和治疗带来困难。尤其足近年来无免疫缺陷人群中也出现肺部真菌感染．使临床判断更加复杂。方法 对我院于2006年上半年收治的7例无免疫缺陷的肺部真菌感染病例,从发病特点、临床表现、影像学、病原学、诊断依据以及治疗策略等方面对其进行了详细分析。结果 7例肺真菌病患者均无明显免疫缺陷,肺部影像学表现多样。通过血清学、肺活检、痰培养等方法确诊,对治疗反应均较好。结论 肺真菌病的临床表现趋向复杂多样,临床医生应予以高度重视。     

孢子丝菌病43例临床分析

目的 探讨孢子丝菌病的发病原因及特点。方法 就1991～2002年间在本院就诊的深部真菌病病例,利用沙氏真菌学检查方法筛查确诊为孢子丝菌病43例并进行临床观察。结果 1991—1993年患者5例（11．63％）,1994～1996年水灾后2年内患者34例（79．07％）,1997～2002年5年内患者4例（9．30％）。有明显外伤史及疑似蚊、蜂叮螫者占总发病人数72．09％。伴高血压者占20．93％。碘化钾治愈率100％。结论 各种原因造成的环境污染或某些自然灾害致使腐生菌大量生长繁殖是引起本病区域性流行的根本原因。外伤及昆虫叮、螫为重要致病条件。碘化钾为首选治疗药物。     

肋骨隐球菌感染2例报道并文献复习

目的探讨肋骨隐球菌感染的临床和影像特征。方法报道2例经病理确诊的肋骨隐球菌感染的临床表现,并结合国内外相关报道进行文献回顾分析。结果病例1为37岁男性,表现为咳嗽、咳血痰、右胸痛,胸部CT示右侧第5肋骨破坏伴局部软组织影,病灶穿刺活检病理确诊为肋骨隐球菌感染,经外科手术和氟康唑治疗4个月后治愈。病例2为31岁男性,表现为咳嗽、咳血痰、胸痛,胸部CT示双侧肋骨破坏伴局部软组织影,病灶穿刺活检病理确诊为肋骨隐球菌感染,经氟康唑治疗6个月后治愈。结论单纯肋骨隐球菌感染较为罕见,容易与肿瘤、结核等疾病相混淆,确诊主要依赖组织活检病理检查,经抗真菌药物和/或手术治疗预后良好。     

82株甲真菌病致病菌分布及药敏结果分析

<正>甲真菌病是甲及其周围组织的真菌感染,是皮肤科最常见的甲病,占甲病的50%。致病真菌包括皮肤癣菌、念珠菌等酵母菌及非皮肤癣菌性霉菌等。其中,红色毛癣菌是最常见的致病菌,约占90%~([1])。本文对我院2014年11月~2015年1月皮肤科门诊甲真菌病患者的菌种分布和体外药敏试验做一回顾性分析,为临床诊断治疗提供用药依据。1资料与方法     

ICU患者深部真菌感染调查

目的了解院内ICU患者深部真菌感染的临床和病原学特点。方法在2006年1月至2008年1月期间,对217例ICU患者进行前瞻性研究。结果2年期间ICU共分离出29株真菌,以白色念珠菌和热带念珠菌为主,其发生与2种以上广谱抗生素联合运用,糖皮质激素的使用,导尿管、气管插管和深静脉留置针的使用有关。结论警惕上述ICU患者深部真菌感染的相关危险因素对临床防治深部真菌病具有重要意义。     

Prevalence of fungal infections detected from biopsies and autopsies in the past 11 years at the University Hospital Joan XXIII in Tarragona, Spain

Infectious diseases caused by fungal pathogens have increased in the past 10 years. More than 300 pathogenic fungal species have been incriminated as the etiologic agents. We carried out a retrospective study (1994-2004) to evaluate the prevalence of mycoses at the University Hospital Joan XXIII (330 beds). This report found 0.24% of the studied cases (78,310 biopsies and 753 autopsies) were diagnosed as fungal infections (0.21% of the total studied biopsy and 4.25% of the whole autopsies). Skin and mucose were involved in 66% of cases, followed by other less affected anatomical areas. 61% of studied cases were caused by Candida spp (the most frequent in our environment), followed by Aspergillus spp (10%) and the Zygomycetes (5%). The most important underlying illness was obstructive chronic pulmonary disease followed by diabetes and AIDS. The incidence of mycoses increased with the patient's age, especially those patients in their 80s. Antifungal management improved the clinical outcome of the patient but predisposing factors are crucial for diagnosis. Systemic mycoses have poor prognosis with 91% of fatal outcome. Thus, it is important to perform a rapid diagnosis of the fungal infections a diagnostic area in which pathology could play a major role.     

Histopathological diagnosis of mycoses

Infectious diseases emerge as a cause of pathology in our patients. Among the possible etiologies, mycoses have shown a considerable increase in the two last decades. In general, the clinical features of fungal diseases are not very distinctive. The morphology and the clinical aspects of the fungi serve as a protocol for their correct identification. Clinicians, microbiologists and pathologists are essential for the diagnosis. The pathologist using a simple and fast methodology can diagnose some types of mycosis, but they do not only identify the causal agent, but also the kind of injury that produces, the inflammatory response and the affected organ or organs. Moreover, they can classify the mycosis as superficial, cutaneous, subcutaneous, deep and systemic depending on the location. The present review paper describes study guidelines for the pathologist faced with a fungal infection and new technical advances that are established in pathology laboratories for a more precise identification of the mycoses.     

重要深部真菌病研究进展

近20年来,由于接受肿瘤化学治疗、细胞毒药物治疗的患者不断增多,器官移植和骨髓移植术广泛开展,深部真菌病的发病率和病死率急剧上升.而生物技术的进步和人们对真菌研究的深入,为临床提供了早期、特异的诊断方法和新型抗真菌药物.本文归纳了深部真菌病流行病学调查、真菌与宿主相互作用、深部真菌病诊断和治疗等方面的最新内容,这些研究...     

肺隐球菌病12例临床分析

目的 提高对隐球菌病的认识.方法 对确诊为肺隐球菌病的12例病例的临床资料进行回顾性分析.结果 12例病例中,男性8例,女性4例,年龄31～68岁,平均年龄(51.8±12.6)岁,6例伴有基础疾病,但无1例有鸟类接触史;有临床症状者10例,其中咳嗽8例,咯痰3例,胸痛4例,发热2例,有体征者仅2例;胸部影像表现为:1...     

Las micosis en Venezuela: casuística de los Grupos de Trabajo en Micología (1984-2010)

BackgroundIn 1984 the Venezuelan Work Groups in Mycology (VWGM) were created introducing an innovative approach to the study of the mycoses in Venezuela.AimTo study the occurrence of the mycoses in Venezuela.MethodsReview the reported cases of mycoses by the newsletter Boletín Informativo Las Micosis en Venezuela (VWGM) from 1984 to 2010.ResultsThe data collected showed 36,968 reported cases of superficial mycoses, 1,989 of deep systemic cases, and 822 of localized mycoses. Pityriasis dermatophytosis was the most common superficial infection, and paracoccidioidomycosis and histoplasmosis the most frequent deep systemic infection. Chromoblastomycosis was the most frequently diagnosed subcutaneous infection. The data provided showed the distribution by geographical area for each of the fungal infections studied, which may help to establish the endemic areas.DiscussionSuperficial mycosis is a public health problem due to its high morbidity and is probably responsible for some of the outbreaks in high-risk groups. Paracoccidioidomycosis and histoplasmosis were reported more often, which agrees with earlier reports prior to the formation of the VWGM. Cases of sporotrichosis and chromoblastomycosis in Venezuela can be considered unique due to the high number of cases. This study highlights the contribution of the VWGM to the behavior of the mycoses in Venezuela, its incidence, prevalence, and the recognition of these infections as a problem of public health importance. The VWGM should keep working in this endeavor, not only reporting new cases, but also unifying the clinical and epidemiological criteria, in order to properly monitor the evolving epidemiological changes reported in these types of infections.     

Micosis pulmonares en pacientes con diabetes mellitus. Características clínicas y factores de riesgo

BackgroundDiabetes mellitus is a public health problem in Mexico, and the trend of the disease is increasing. From 2000 to 2017, 7.32 million new cases were diagnosed, with pulmonary mycoses being one of the most serious complications.AimsTo describe the frequency and the clinical characteristics of patients diagnosed with pulmonary mycoses, and to identify the risk factors associated with this entity.MethodsCase–control study, paired by gender (1:1-3) and age (± 5 years), that analyzed patients with pulmonary mycosis (mucormycosis, histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis, cryptococcosis, paracoccidioidomycosis) and studied the risk factors present in each patient.ResultsFrom the 162 patients studied, 56 suffered pulmonary mycosis and 106 were controls. The median of the age was 51 and 50 years for the cases and for the controls, respectively. Multiple logistic regression analysis showed that patients with diabetes mellitus had an odds ratio of 8,3 (p < 0.001), and patients with a history of tuberculosis had an odds ratio of 8,8 (p < 0.001).ConclusionsOur results show that 52% of the patients with pulmonary mycoses had a history of diabetes mellitus. Diabetes mellitus is a relevant risk factor for pulmonary mycoses, which are usually diagnosed in advanced stages and have a high mortality.     

Infiltración perineural por células fúngicas. Presentación de un caso y revisión de la literatura

The perineural spread by fungal cells during the progression of the infection could be an important prognostic factor, especially in mycoses localized in the rhino-orbito-cerebral and pulmonary areas. We present a clinical case of a 73-year-old male, with diabetes and acute myelomonocytic leukaemia that began with tumefaction on the left side of his face, spreading to the sinus with invasion of the soft tissues and fistulae in the oral cavity. Clinical examination showed cerebral involvement. The histopathological sections and the histochemical techniques showed perineural involvement by fungal cells. Although the patient was diagnosed and treated in a short period of time, he died due to the infection. We would like to alert that perineural spread could be a retrograde way of mycoses dissemination, particularly in infections located in areas rich in neural cells.     

Aspectos actuales de las enfermedades invasivas por hongos filamentosos

Invasive fungal infections have become a major cause of morbimortality in intensive care patients, persons suffering from cancer or immune deficiencies, and other diseases with impaired immunity. Candida albicans remains the most frequent fungal pathogen, but advances in the diagnosis, prevention and treatment of invasive candidiasis are leading to important etiological changes. Among the emerging invasive mycoses, are those caused by filamentous fungi, such as Aspergillus, Lomentospora/Scedosporium, Fusarium or the Mucorales. Invasive aspergillosis is difficult to diagnose, and although there are diagnostic tools available, their use is not widespread, and their effectiveness vary depending on the group of patients. Clinical suspicion in high-risk patients, radiological diagnosis and the use of biomarkers, such as 1,3-β-D-glucan and galactomannan, can be of great help. However, diagnostic resources are limited in other mycoses, but radiology, pathological studies and the microbiological diagnosis can be useful. The high mortality of these mycoses requires early empirical antifungal treatment in many cases. Voriconazole is the first choice for treatment of the majority of aspergillosis, scedosporiasis, fusariosis and other hyalohyphomycoses. The treatment of mucormycoses, Lomentospora prolificans infections or mycoses by dematiaceous fungi are more complicated. Amphotericin B is active against many mucoralean fungi, but the combination of two or more antifungal agents could be a therapeutic alternative in many amphotericin B-refractory mycoses. Current clinical challenges include improving the diagnosis and the treatment of these mycoses, along with improving the adequate prevention in patients at high risk of suffering from them.     

Immunology of fungal infections: lessons learned from animal models

The continuing AIDS epidemic coupled with increased usage of immunosuppressive drugs to prevent organ rejection or treat autoimmune diseases has resulted in an increase in individuals at risk for acquiring fungal diseases. These concerns highlight the need to elucidate mechanisms of inducing protective immune responses against fungal pathogens. Consequently, several experimental models of human mycoses have been developed to study these diseases. The availability of transgenic animal models allows for in-depth analysis of specific components, receptors, and signaling pathways that elicit protection against fungal diseases. This review focuses on recent advances in our understanding of immune responses to fungal infections gained using animal models.