468例甲真菌病临床类型及病原菌分析

目的探讨本地区甲真菌病的菌种构成、临床分型和各年龄段发病情况。方法对2010年1月至2013年12月来平湖市中医院皮肤科就诊的468例甲屑培养阳性病例病原菌进行回顾性统计分析。结果甲真菌病以皮肤癣菌为主,占58.76%;酵母菌次之,占30.13%;霉菌第三,占11.11%。临床分型远端甲下型(DLSO)、全甲营养不良型(TDO)、近端甲下型(PSO)和浅表白色型(SWO)分别为50.64%、25.21%、16.03%和8.12%。发病年龄以36~50岁为主,20~35岁次之。结论甲真菌病病原菌以皮肤癣菌为主,临床分型以DLSO型为主,年龄分布以20~50岁为主。     

637例甲真菌病临床类型及致病真菌分析

目的了解637例甲真菌病患者的临床分类、致病真菌菌种构成及其分布。方法按甲真菌病诊断标准收集近3a来637例真菌培养阳性甲真菌病患者并临床分类,按真菌学分类标准诊断致病菌种类,分析各菌种在临床病种、年龄段、性别等的分布。结果临床分型以远端侧位甲下型为主(72.06%)。菌种构成为皮肤癣菌占69.39%、酵母菌占18.68%、非皮肤癣菌霉菌占11.93%。皮肤癣菌中红色毛癣菌353株(79.86%),酵母菌中白念珠菌67株(56.30%),非皮肤癣菌中以青霉和曲霉为主。致病菌种的分布在不同年龄段及性别间存在差异,但均以皮肤癣菌为主。结论甲真菌病的临床类型以远端侧位甲下型为主,红色毛癣菌为优势致病菌。     

广州地区甲真菌病致病真菌的变迁趋势研究

目的为了解广州地区甲真菌病的致病菌种分布情况.方法笔者采用真菌培养法对临床症状典型或镜检阳性的甲真菌病病甲进行培养.结果分离出致病真菌618株,其中皮肤癣菌417株,占67.5%,酵母菌149株,占23.8%,霉菌54株,占8.7%.结论广州地区的甲真菌病的致病菌除皮肤癣菌外,酵母菌,霉菌也占一定的比例,近几年酵母菌感染有上升趋势.     

国内多中心甲真菌病病原菌流行病学调查

目的了解国内甲真菌病病原菌的种类和构成情况,掌握流行病学资料。方法对真菌镜检阳性的1 428例甲真菌病患者进行真菌培养和临床分析。结果真菌培养阳性率为53.9%,分离出病原菌800株。其中皮肤癣菌占84.0%,以红色毛癣菌为主(80.9%),其次为指(趾)间毛癣菌和絮状表皮癣菌。酵母菌占11.4%,以念珠菌属为主(10.1%),尤以近平滑念珠菌为主,其次为白念珠菌和热带念珠菌。其他霉菌占4.6%,以枝顶孢霉为主(2.3%),其次曲霉属、青霉属、毛壳菌属、镰刀菌属和帚霉属等。结论本研究显示甲真菌病病原菌以皮肤癣菌为主,其次为酵母菌和霉菌。     

805例甲真菌病真菌培养结果分析

目的了解近年来我院甲真菌病病原菌的种类和构成分布情况,并研究其流行病学特点。方法收集2008年6月-2012年11月间我院皮肤科实验室甲真菌病患者病甲真菌学培养阳性的病例并进行分析。结果共收集到805例病甲真菌培养阳性的甲真菌病病例。酵母菌407株,占50．55％,皮肤癣菌385株,占47．95％,霉菌13株,占1．61％。不同年龄段的甲真菌病患者的菌属分布存在差异。结论我院近年来甲真菌病病原菌最常见为酵母菌,其次为皮肤癣菌和霉菌。年龄是影响菌属分布的重要因素。     

对石家庄地区106例甲真菌病的病原学及临床资料分析

目的 研究石家庄地区甲真菌病的临床分型、病原菌组成,对患病相关因素进行分析.方法 2011年1～12月,在河北医科大学第四医院皮肤科门诊就诊疑似甲真菌病的患者,选取患者病损最严重的1枚甲作为靶甲,对靶甲进行取材及分型,对培养阳性患者进行问卷调查,汇总所有数据,进行统计学处理.结果 106例甲真菌病患者中远端侧位甲下型50例(47.17％),全甲毁损型48例(45.28％),近端甲下型5例(4.95％),白色浅表型3例(2.97％).致病真菌111株,其中皮肤癣菌72株(64.86％),酵母菌34株(30.63％),非皮肤癣菌霉菌5株(4.50％).混合感染5例(4.72％),均为两种真菌的混合感染.106例培养阳性患者的年龄越大,病程越长;病程越长,病甲数目越多.结论 甲真菌病是一个逐渐进展的慢性疾病,临床分型复杂,病原菌组成多样,应引起重视,及早治疗.     

南京地区734例甲真菌病临床及致病菌分析CSCD

甲真菌病是由皮肤癣菌、酵母菌和非皮肤癣菌性霉菌,侵犯甲板和/或甲床所致的病变。其中由皮肤癣菌引起的甲真菌病又称为甲癣。甲真菌病的发病率占自然人群的2%~18%[1]。在真菌镜检的基础上再做真菌培养,明确病原菌的种类,将为药物选择带来较明确的方向。     

特殊人群甲真菌病的流行病学研究现状

甲真菌病在特殊人群中发病特点各不相同.在年长人群中,发病率随年龄增大而增高.老年人中,指、趾甲同时受累多、TDO型多、混和性真菌感染多;中青年中,常见是DLSO和WSO,WSO随年龄增大而增多,皮肤癣菌感染多见,但年龄越大念珠菌、霉菌感染越多;在穿高跟鞋女性人群中,年穿高跟鞋时间与甲真菌病发病机会、严重程度呈正相关,以DLSO多见,小趾、拇趾多发;在糖尿病人群中,发病率是17%,以Ⅱ型糖尿病为甚,常见类型是DLSO,指甲念珠菌分离率极高,患病时间是严重程度的影响预后因素;在银屑病人群中,甲改变患者培养阳性率是18%,常见类型是TDO,分离真菌最多的是霉菌,以关节病型银屑病真菌感染最多;在肾移植人群中,发病率是12.7%,常见类型是PWSO,分离真菌常见是红色毛癣菌和须癣毛癣菌;HIV人群中,发病率是23.2%,PWSO是HIV感染的早期临床征象,甲真菌病出现概率和CD4细胞计数呈负相关;慢性病毒性肝炎人群的流行特点未有报道.     

中药浸泡联合甲开窗疗法治疗甲真菌病50例临床疗效观察

应用中药浸泡联合甲开窗疗法治疗50例病甲面积《50%的远端侧位甲下型甲真菌病(DLSO)单个指甲感染的患者,总有效率为76%.     

国内甲真菌病病原学的流行病学调查

甲真菌病是最常见的甲病,通常认为甲真菌病在人群中的发病率在3%～5%之间,在某些特定人群中的发病率可能会更高一些.甲真菌病的致病真菌可以分为三类,皮肤癣菌、酵母菌和非皮肤癣菌霉菌.通常认为在这三类致病真菌中,皮肤癣菌最为常见.但是,随着对甲真菌病认识的加深,实验室检查方法的改进以及研究资料的日益丰富,我们发现甲真菌病的流行情况十分复杂,受到多种因素的影响.不同地区,气候条件差异、患者职业、感染部位不同均会对引起甲真菌病的致病真菌种类产生影响.……     

汕头地区甲真菌病病原菌流行病学研究

目的了解近年来汕头地区甲真菌病病原菌的种类和构成情况,掌握流行病学资料。方法对2005年12月～2008年12月间来我院皮肤科就诊的214例甲真菌病患者进行病甲标本真菌学检查和分析。结果214例患者分离出163株致病菌。酵母菌居首位,占53．99％,其中自念珠菌占22．09％,近平滑念珠菌占17．18％,热带念珠菌占6．75％,其他酵母菌占7．97％;皮肤癣菌居第2位,占37．42％,其中红色毛癣菌占23．93％,须癣毛癣菌占12．27％,断发毛癣菌占1．23％;霉菌居第3位,占8．59％,以曲霉和青霉为主,分别占3．07％和2．45％。结论汕头地区近年来甲真菌病病原菌为酵母菌、皮肤癣菌和霉菌,其中以红色毛癣菌、白念珠菌、近平滑念珠菌和须癣毛癣菌最常见。     

Study of onychomycosis in Córdoba,Spain: Prevailing fungi and pattern of infection

From a total of 20 004 patients seen during two years, we carried out a mycologic nail investigation (direct microscopy and repeated cultures). Ninety-three (43.2%) of the nails were judged to be infected by their clinical appearance. They fulfilled the laboratory criteria required to start antifungal treatment (isolation of the same fungus in culture on two consecutive occasions), but only in 64 cases (29.7%) was there a clinical and mycological recovery once antifungal treatment and follow up were completed.Yeasts were isolated in two thirds of the cases of onychomycosis, mainly from fingernails. Candida albicans, C. parapsilosis or both were the most prevalent species. Dermatophytes were found in 18.8% of the samples, especially from toenails. Trichophyton rubrum was the predominant species. Non-dermatophytic filamentous fungi were cultured in 17.2%, Scopulariopsis brevicaulis being the most prevalent species.The highest prevalence of onychomycosis was found in patients between 50 and 70 years of age. Females were affected more frequently than males. Fingernails were affected more frequently than toenails. Proximal subungual onychomycosis, secondary to paronychia (PSOp), was the most prevalent clinical type, although primary distal and lateral subungual onychomycosis (DLSO) and total dystrophic onychomycosis (TDO) were also frequent. PSOp was only observed in fingernails, while DLSO was almost only seen in toenails and TDO in both fingernails and toenails. All the clinical types were more frequent in women except TDO, which showed a similar prevalence in both sexes.This revised version was published online in October 2005 with corrections to the Cover Date.     

Onychomycosis in Malaysia

The common etiological agents of onychomycosis are dermatophytes, molds and yeasts. A mycological nail investigation of onychomycosis using direct microscopy and culture was conducted by the Mycology Unit, Department of Medical Microbiology, University of Malaya from March 1996 to November 1998. The study involved 878 nail clippings or subungal scrapings from subjects with onychomycosis. On direct microcopy examination, 50% of the specimens were negative for fungal elements. On culture, 373 specimens had no growth; bacteria were isolated from 15 nail specimens. Among the 490 specimens with positive fungal cultures, 177 (36.1%) were dermatophytes, 173 (35.5%) were molds and 130 (26.5%) were Candida. There were 2% (10/490) mixed infections of molds, yeasts and dermatophytes. Trichophyton rubrum (115/177) and Trichophyton mentagrophytes (59/177) were the main dermatophytes isolated. The molds isolated were predominantly Aspergillus niger (61/173), Aspergillus nidulans (30/173), Hendersonula toruloidea (26/173) and Fusarium species (16/173). 96.9% of the Candida species identified were Candida albicans.This revised version was published online in October 2005 with corrections to the Cover Date.     

Antifungal Activity of Sodium Bicarbonate Against Fungal Agents Causing Superficial Infections

Although sodium bicarbonate—NaHCO₃ (SB) has many domestic and medical, traditional and empirical uses, only little scientific documentation of its activity is available. The aims of this study were to investigate the antifungal activity of SB on the three fungal groups (yeasts, dermatophytes and molds) responsible for human skin and nail infections. We first evaluated the in vitro antifungal activity of SB on 70 fungal strains isolated from skin and nail infections: 40 dermatophytes, 18 yeasts and 12 molds. A concentration of 10 g/L SB inhibited the growth of 80 % of all the fungal isolates tested on Sabouraud dextrose agar. The minimal inhibitory concentration 90 (MIC90) of SB measured on Sabouraud dextrose agar, Sabouraud dextrose broth and potato dextrose broth was 5 g/L for the yeasts, 20 g/L for the dermatophytes and 40 g/L for the molds. In a second step, we prospectively evaluated the ex vivo antifungal activity of SB on 24 infected (15 dermatophytes, 7 yeasts and 2 molds) clinical specimens (15 nails and 9 skin scrapings). The fungal growth was completely inhibited for 19 (79 %) specimens and reduced for 4 (17 %) specimens after 7 days of incubation on Sabouraud dextrose–chloramphenicol agar supplemented with 10 g/L of SB as compared to Sabouraud dextrose–chloramphenicol agar without SB. In conclusion, we documented the antifungal activity of SB on the most common agents of cutaneous fungal infection and onychomycosis, and we specified the effective concentrations for the different groups of pathogenic fungi. The mechanism of action of SB has yet to be explored.     

Onychomycosis in Children with Down Syndrome

Purpose of Review

Fungal infection of the nail, known as onychomycosis, occurs more frequently in older age, showing a higher prevalence in pediatric age in recent years. A high rate of dermatological infections befalls in patients with Down syndrome, including onychomycosis, due to a decrease in T and B lymphocytes in number and function, resulting in a disarrangement of cellular and humoral immunity. This has led to several investigations on onychomycosis in children with Down syndrome, so the purpose of this review is to show the available evidence.

Recent Findings

The etiological agents of onychomycosis can be dermatophytes, non-dermatophyte molds, and yeasts. Most cases are related with dermatophytes; Trichophyton rubrum being the most common cause. In children with Down syndrome, T. rubrum has been reported as the main cause, followed by T. mentagrophytes. Distal lateral subungual onychomycosis is the most common variety of onychomycosis in children. The importance of identifying the fungus lies in selecting the appropriate treatment, since not all antifungals have the same spectrum of action against molds and Candida. Terbinafine has showed to be safe and effective for the treatment of onychomycosis in patients from special populations, including children with Down syndrome. In patients with Down syndrome, treatment for onychomycosis has not been completely studied; so far, terbinafine has shown the best results.

Summary

The clinical presentations of children with Down syndrome and the rest of the general pediatric population are similar. However, there are few studies about onychomycosis in children with Down syndrome. It is necessary to perform new onychomycosis research in this study population, in order to establish recommendations.

     

Onychomycosis in Cali,Colombia

This study presents the epidemiological and mycological aspects of 299 patients with nail lesions who were referred to three diagnostic laboratories in the city of Cali. The diagnosis of mycoses was established through visualization of mycotic structures in a direct microscopic examination of skin scrapings and by isolation. Onychomycosis was found in 183 cases (61.2%), of which 141 were in toenails (44 in males and 97 in females), 38 in fingernails (9 males and 29 females), and 4 cases in toenails and fingernails simultaneously (all females). No statistically significant relation was found between sex and onychomycosis. Yeasts accounted for 40.7% of the mycoses, dermatophytes for 38%, nondermatophyte molds for 14% and the etiology was mixed in the remaining cases (7.3%). Candida albicans was the most commonly isolated yeast species; the most common dermatophyte was Trichophyton rubrum and Fusarium spp. and Scytalidium dimidiatum were the most common nondermatophytic molds. Them common fungi found in fingernails were yeasts; in toenails dermatophytes were more prevalent (chi2 with Yates' correction = 19.75, P= 0.000088). Yeasts were observed more frequently in females while dermatophytes were more common in males. The difference between these two etiologic groups was statistically significant (chi2 with Yates' correction = 7.43, P = 0.0064); no relation was observed according to age.     

Onychomycosis in São Paulo,Brazil

Onychomycosis is a fungal infection of the nails with broad aetiological scope, and it represents 18–40% of all onychopathies and 39% of all superficial mycotic infections. From July 1996 to December 1999, samples of nails were collected from 588 patients with presumptive diagnosis of onychomycosis at the Dermatology and Mycology Divisions EPM\UNIFESP, Brazil, and the diagnosis was confirmed in 247 of these cases. The most common pathogens isolated in this study were yeasts in 52% of positive cultures (Candida albicans 18.3%, Candida parapsilosis 13.8%, other species of Candida 15.4% and other yeasts 4.6%), followed by dermatophytes in 40.6% of positive cultures (the most commonly isolated organisms were Trichophyton rubrum in 33.2%, followed by Trichophyton mentagrophytes in 6.3% and others 1.2%). Non-dermatophyte moulds were isolated in 7.4% of positive cultures (Fusarium spp. 4.5%, Nattrassia mangiferae 2.3% and Aspergillus spp. 0.6%). Distal and lateral subungual onychomycosis (DLSO) was the commonest clinical pattern 44.6% followed by free edge onycholysis (FEO) 38.8% and others. In conclusion, this study demonstrated that T. rubrum is the main agent causing onychomycosis in toenails, and species of genus Candida were the main agents isolated in fingernail onychomycosis in our region.     

Onychomycosis Incidence in Type 2 Diabetes Mellitus Patients

The onychomycosis incidence was determined in 250 type 2 diabetes mellitus (T2DM) patients who were registered at the Internal Medicine Service from a Mexico city General Hospital throughout a year (January-December 2006). Out of the total of studied T2DM patients, 93 (37.2%) showed ungual dystrophy and from these, in 75.3% a fungal etiology was corroborated. Out of 70 patients, 34 were men and 36 women, with an average of 63.5 years. Correlation between T2DM evolution time and onychomycosis was significant (P < 0.01). Distal-lateral subungual and total dystrophic onychomycosis were the most frequent clinical types (55.1% and 33.7%, respectively). Fifty-eight fungal isolates were obtained; 48.6% corresponded to dermatophytes, Trichophyton rubrum being the first species (37.1%). All these strains corresponded to two morphological varieties: "yellow" and typical downy. From the yeast-like isolates, 12 corresponded to Candida spp., firstly C. albicans and C. parapsilosis; three to Cryptococcus spp. (C. albidus, C. uniguttulatus and C. laurentii); two Trichosporon asahii; and only one to Pichia ohmeri. Six non-dermatophytic molds were isolated: two Chrysosporium keratinophylus, two Scopulariopsis brevicaulis, one Aspergillus fumigatus, and one Acremonium sp. The fungal mixture corresponded to T. mentagrophytes with C. guilliermondii; T. mentagrophytes with C. glabrata; T. rubrum with C. glabrata; T. rubrum with P. ohmeri.