艾滋病合并马尔尼菲篮状菌病的研究进展

马尔尼菲篮状菌病是一种由马尔尼菲篮状菌引起的深部真菌病,易发于免疫功能缺陷和免疫功能障碍的人群。随着艾滋病患者的逐渐增多,马尔尼菲篮状菌的感染率也随之上升。该文从马尔尼菲篮状菌病的流行病学、临床表现、临床诊断和治疗综述了马尔尼菲篮状菌病的研究进展。     

难辨认孢子丝菌病临床分析

探讨孢子丝菌病不典型的临床表现.孢子丝菌病是皮肤科常见的一种深部真菌病,典型的皮肤科特征是慢性肉芽肿、溃疡性损害、炎性结节等.而部分孢子丝菌病的患者由于各种各样的原因导致皮损丧失特征性临床表现,给皮肤科医生尤其是临床经验尚不丰富的年轻医师于该病的诊断带来了一定的困难.本文所讨论的8例患者均为就诊于我科门诊并已确诊为孢子丝菌病病例,皮损与典型的孢子丝菌病皮损表现不相符,希望皮肤科医师在以后的临床工作中遇到一些不典型皮损但是综合患者病史、生活环境、诊治过程等情况可考虑到此种疾病,及时给予明确的诊断,使患者能够得到及时、有效的治疗.     

申克孢子丝菌感染诊治1例

通过1例16岁女孩由申克孢子丝菌导致的皮下孢子丝菌病,口服伊曲康唑治疗有效,回顾申克孢子丝菌的实验室检验方法 ,以此来提高孢子丝菌感染的诊断水平。     

伊蒙菌病与不育大孢子菌病

伊蒙菌是一种双相真菌,可引起不育大孢子菌病和伊蒙菌病。这两种病临床较为少见,但近年来有报道伊蒙菌成为南非HIV感染人群主要的致病性双相真菌,引起高度关注。自1991年我国首报1例不育大孢子菌病后,2014年广州市新现2例皮肤播散性伊蒙菌病。故现将伊蒙菌感染的病原学、流行病学、临床表现、实验室诊断和治疗作一综述,以引起国内同行重视。     

耳鼻咽喉真菌性疾病

<正>由真菌引起的疾病统称为"真菌病"。真菌可以感染人体的不同部位,发生在耳鼻咽喉部位的真菌病并不罕见。耳鼻咽喉真菌病包括浅部和深部真菌感染,前者如各种皮肤癣菌病,部分外耳道真菌病,或可将其看作皮肤科诊治范围之疾病;后者如组织胞浆菌病、球孢子菌病、芽生菌病、念珠菌     

伊曲康唑联合特比萘芬治疗孢子丝菌病1例

孢子丝菌病（sporotrichosis）是由申克孢子丝菌引起的一种亚急性或慢性真菌感染,本病易侵犯皮肤、皮下组织及其附近的淋巴管,当存在免疫缺陷时,可能出现播散型感染。最近我们用伊曲康唑联合特比萘芬治疗1例淋巴管型孢子丝菌病患者,报告如下。     

镰刀菌感染的流行病学及其诊治进展

镰刀菌是一种腐生菌,与免疫力正常宿主的软组织感染、角膜炎、甲真菌病有关。由于应用细胞毒性药物治疗白血病以及器官移植增多,侵袭性和播散性镰刀菌感染病例近20年内逐年增多。镰刀菌可以通过皮肤黏膜、呼吸道等部位引起感染,感染可局限也可播散。播散性镰刀菌病几乎仅发生于免疫受损患者。急性髓性白血病较之急性淋巴细胞白血病更易发生镰刀菌感染。镰刀菌病的诊断主要根据宿主因素、临床表现（75%的镰刀菌病会有皮肤表现）、真菌培养、组织病理学检查。分子生物学技术的应用可以将形态学难以区分的镰刀菌鉴定到种。镰刀菌病很难治疗,尤其是播散性镰刀菌病的病死率很高。体外药敏试验结果表明氟康唑、伊曲康唑、氟胞嘧啶对镰刀菌无抗菌活性,目前主要治疗方法是联合应用伏立康唑和两性霉素B,尤其是单独应用抗真菌药无效的病例。     

伊曲康唑在中国临床应用16年回顾——广谱篇

伊曲康唑进入中国市场16年,对我们的医学真菌学研究起到巨大的推动作用,促进了我国真菌学家和皮肤科临床医生对真菌病的流行病学、菌种分布研究,提高了对各种真菌感染的临床表现的认识和诊治水平,积累了丰富的经验,使广大真菌病患者受益。     

放线菌与诺卡菌所致感染性皮肤肉芽肿的鉴别诊断及治疗

感染性肉芽肿是一类慢性增生性炎症。放线菌和诺卡菌所致感染性肉芽肿实属少见,但两者临床症状、体征相似,易误诊或漏诊。本文报道1例放线菌与1例诺卡菌所致皮肤感染性肉芽肿,通过皮肤组织病理学检查、细菌培养、生化鉴定及细菌分子生物学检测,最终明确诊断。进一步分析2种感染的病因学、流行病学、临床表现、诊断和鉴别诊断及治疗,并结合最新研究进展,可帮助临床医师更好地认识放线菌属细菌所致感染性皮肤肉芽肿,以便于及时诊断、及时治疗。这2种感染有很多相似之处,也有各自特点,需临床医师求同存异,仔细鉴别;还需与其他感染性肉芽肿如皮肤结核、孢子丝菌病或着色芽生菌病等鉴别诊断。     

自身免疫性肝炎合并慢性布鲁菌病1例并文献复习

目的探讨自身免疫性肝炎合并布鲁菌感染时的临床特征、诊断及其治疗等特点。方法回顾性分析我院确诊的1例自身免疫性肝炎合并慢性布鲁菌感染患者的临床特点、相关指标的检测结果并结合文献报道进行总结。结果患者临床表现缺乏特异性。血培养和血清抗体检测呈阳性,C-反应蛋白(CRP)可见升高而降钙素原(PCT)变化不明显。结论布鲁菌病不能仅从临床表现来鉴别和诊断,更不能因为缺少流行病学资料而否定。自身免疫性肝炎患者的CRP水平对急性炎症的敏感性会降低,但仍可以作为疗效判断的参考指标。应适度增加疗程,定期复查,以更好的控制慢性布鲁菌感染。     

Advances in the serodiagnosis of blastomycosis

Blastomyces dermatitidis, the etiologic agent of blastomycosis, is endemic to certain areas of North America and other continents and can cause a variety of clinical manifestations that range from subclinical to life-threatening infections. Delineation of its ecology and epidemiology has been difficult because of the lack of rapid, sensitive, and specific noninvasive diagnostic tests. Despite efforts to develop such tests for clinical use, diagnosis of infection is still based on direct visualization of the organism in histopathologic or cytologic specimens and growth in the microbiologic laboratory. Serologic tests and skin testing have been hampered by low sensitivity and specificity caused by cross-reactivity with other endemic mycoses and are not commercially available. An antigen assay is now commercially available, but it also has significant cross-reactivity with other mycoses, especially histoplasmosis. The keys to diagnosis remain a high index of suspicion and knowledge of the disease’s varied clinical manifestations.     

A global view on fungal infections in humans and animals: opportunistic infections and microsporidioses

After cardiovascular diseases, infectious diseases are the second most common cause of death worldwide. Although these infections are caused mainly by viruses or bacteria, a systematically growing prevalence of human and animal opportunistic fungal infections is noticeable worldwide. More attention is being paid to this problem, especially due to the growing frequency of recalcitrant and recurrent mycoses. The latter are classically divided into superficial, which are the most common type, subcutaneous, and systemic. This work discusses opportunistic fungal pathogens without proven horizontal transmission between different animal species including humans and microsporidia as spore-forming unicellular parasites related to fungi; however, with a yet undetermined taxonomic position. The review also mentions aetiological agents, risk factors, epidemiology, geographical distribution, and finally symptoms characteristic for individual disease entities. This paper provides insight into fungal infections from a global perspective and simultaneously draws attention to emerging pathogens, whose prevalence is continuously increasing. Finally, this work also takes into consideration the correct nomenclature of fungal disease entities and the importance of secondary metabolites in the pathogenesis of fungal infections.     

Dermatophytoses in Mexico

The dermatophytic infections are superficial mycoses common in Mexico, they have an estimated frequency of 5% in dermatological outpatients. In this review we present a global view of these mycoses as well as their etiological agents in tinea capitis, tinea pedis, tinea corporis, tinea cruris and onychomycosis and also uncommon infections such as tinea imbricata and epidermophytosis of the diaper area. We also analyze these infections in diabetic patients, healthy carriers and dermatophytic infections in pets and laboratory animals. The most important publications about dermatophytosis in Mexico in the dermatological, epidemiological or mycological area are reviewed, specially those published in the last ten years.     

The mycoses of Oceania

A review of the mycoses of Oceania, defined as the Pacific islands of Melanesia, Micronesia and Polynesia, has revealed the occurrence of cutaneous, subcutaneous and systemic mycoses.Tinea versicolor is the most prevalent of the cutaneous mycotic infections. Dermatophyte infections are also common. The etiologic agents incriminated have beenEpidermophyton floccosum, Microsporum canis, members of theMicrosporum fulvum-gypseum complex,Trichophyton concentricum, T. mentagrophytes, T. rubrum, T. tonsurans andT. verrucosum. Only one case of tinea nigra has been reported and that was in Hawaii. Among the fungi that cause subcutaneous mycoses onlyAllescheria boydii, Nocardia brasiliensis, Madurella mycetomi andSporothrix schenckii have been encountered to date. Among the systemic mycoses, actinomycosis, cryptococcosis and histoplasmosis have been found to be present. The geographic distribution of these actinomycotic and mycotic infections is provided along with data on soil isolation records and histoplasmin sensitivity surveys.Paper presented at the Symposium on Microbiology, Canadian Medical Expedition to Easter Island, Montreal, April 26–28, 1971     

Review of animal mycoses in Australia

This review covers the available literature on the mycoses of animals in Australia since the last review published in 1967. Of the cutaneous infections, dermatophytoses have been recorded in a wide range of animals: cattle, horses, goats, pigs, sheep, cats, dogs, mice, guinea-pigs, rabbits, a lion, kangaroos, a camel, koalas and wallabies. These infections were caused by several species and varieties of the genera,Microsporum andTrichophyton. Eight agents of ringworms have been recorded in the horse. Two subcutaneous mycoses, phaeohyphomycosis and sporotrichosis have been reported. Phaeohyphomycosis is becoming more common but sporotrichosis is rare having been recorded only once in a cat.The following systemic mycoses have been recorded: adiaspiromycosis, aspergillosis, candidiasis, cryptococcosis, dactylariosis, fusariomycosis, histoplasmosis, miscellaneous mycoses, mycotic abortion and related conditions, zygomycosis, pythiosis, protothecosis and green algal infections. Cryptococcosis has affected 11 different animal species. Mycotic abortion is a serious disease in Victoria. Pythiosis of horses has been extensively studied in northern Australia.     

Histopathological diagnosis of mycoses in veterinary pathology

Histopathological analysis demonstrates the morphology of the fungi and shows their relationship with tissue lesions, which is a valuable information in the diagnosis of veterinary mycoses, especially in superficial infections where reservoirs make difficult the diagnosis using other techniques. On the other hand, histopathological analysis should be complementary to other methods such as culture, immunohistochemistry, serology, PCR, etc. In this work, the most relevant histopathological features of some of the most common mycoses of domestic animals, some of which have zoonotic potential, are described and their differential diagnosis is discussed. To facilitate the discussion of the differential diagnoses, mycoses have been grouped by the sites of the infections and by the nature of the fungi (dimorphic and filamentous). Mycoses included in the study were 1) Superficial and deep infections: dermatophytosis, dermatophytic pseudomycetoma, eumycotic mycetoma, phaeohyphomycosis and malasezziasis. 2) Systemic mycoses: aspergillosis and zygomycosis. 3) Mycoses due to dimorphic fungi: candidiasis, cryptococcosis, blastomycosis, sporotrichosis, coccidioidomycosis and histoplasmosis. 4) Infections by algae and other fungi: protothecosis and pneumocystosis.     

Update on Amphotericin B Pharmacology and Dosing for Common Systemic Mycoses

Amphotericin B (AMB) has been used for nearly five decades in the treatment of life-threatening mycoses. While triazoles and echinocandins have largely supplanted the routine use of AMB for common Candida and Aspergillus infections, this prototypical broad-spectrum agent or its lipid formulations are still preferred by many clinicians as the initial empiric antifungal therapy for severely immunosuppressed patients, and remain the preferred treatment in combination with 5-fluorocytosine for cryptococcal meningioencephalitis. This article reviews progress over the last decade in understanding the pharmacology and clinical dosing of AMB formulations for common systemic mycoses, including invasive candidiasis, cryptococcosis, aspergillosis and mucormycosis.     

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.     

Photodynamic Therapy in the Treatment of Superficial Mycoses: An Evidence-based Evaluation

Photodynamic therapy (PDT) is effective in the destruction of fungi. In order to evaluate the efficacy and safety of PDT for superficial mycoses, we performed an evidence-based review of published literature. Database of MEDLINE, EMBASE, and Cochrane Library was searched until March 2010. English-language articles evaluating the efficacy and safety of PDT for superficial mycoses were included. No randomized clinical trials were found. Seven reports described the antifungal effect of PDT against 63 superficial mycoses patients. Eight of 10 (80%) tinea cruris patients and 6 of 10 (60%) tinea pedis were led to mycological cure after 1–3 treatments. Unfortunately, only 4 (40%) tinea cruris patients and 3 (30%) tinea pedis had a persist healing at the 8-week follow-up. Six of the 9 (66.7%) foot-interdigital mycoses patients recovered clinically and microbiologically after 1 or 4 treatments. Only 2 patients (22.2%) had a persist healing at the 8-week follow-up. Eleven of 30 (36.6%) onychomycosis patients were cure for 18 months after treatment, and 3 onychomycosis patients were all cure in other 2 reports. The therapeutic effect of PDT for one pityriasis versicolor patients was well. Overall tolerability of PDT was good. Therefore, it is unclear what PDT’s place for superficial mycoses will be. Further clinical trials are needed to evaluate the efficacy of PDT to treat superficial mycoses. It is also important to optimize treatment protocols in order to cope with recurrence.     

Penicillium marneffei Infection: Knowledge, Gaps, and Future Directions

Penicilliosis is a disease caused by Penicillium marneffei, a fungus endemic to Southeast Asia. Prior to the HIV/AIDS epidemic, infection was exceedingly rare, but penicilliosis is currently one of the most common opportunistic infections in persons with HIV/AIDS in some Asian countries. This paper describes the clinical manifestations, diagnosis, and epidemiology of this emerging opportunistic infection and will focus on some gaps in our knowledge and directions for future research.