人类免疫缺陷病毒与深部真菌感染

人类免疫缺陷病毒（HIV）感染的发病率与致死率很高,已成为人类健康的一大威胁,其中约50％的HIV感染者最终因侵袭性真菌病而死亡。高效抗反转录病毒治疗（HAART）的应用大大降低了 HIV感染者深部真菌病的发生率。因此,深入研究HIV与深部真菌病的关系,对预防、诊断和治疗HIV感染者深部真菌病具有十分重要的意义。本文归纳了HIV感染者深部真菌病的流行病学调查、诊断与治疗进展,有助于临床医师预防和诊治HIV感染者深部真菌病,也为将来新型抗真菌药物的研发提供了思路和方向。     

医学真菌学研究现状与对策

真菌病尤其是深部真菌感染病例数日益增多,真菌病已成为影响人类生活质量、威胁生命健康的重要疾病之一.尽管医学真菌学研究这些年获得了显著进步,但仍有许多亟待解决的问题.深入研究病原真菌的特性,切实提高真菌病的诊断和防治水平,是每个医学真菌学工作者面临的严峻挑战.     

肺部真菌病的实验室诊断——组织病理学诊断和其他实验室诊断方法

肺部真菌病为深部真菌病,无论从“深部”还是“病”来理解,都需要从组织学上证明真菌侵犯及其形成的炎症损害,而不能仅仅以支气管分泌物中分离到真菌,特别是可以在呼吸道定居的条件致病性真菌,就简单地作出诊断。     

2009全国深部真菌病研究进展学习班

一、主办单位：第二军医大学附属长征医院皮肤科 二、办班宗旨：通过讲授有关深部真菌病的基础知识、最新研究进展及目前国内外研究的热点及难点，了解真菌的分类、常见真菌病的诊断和处理、真菌病理、抗真菌药的研究进展等内容；通过演示真菌标本的取材及检验方法等，了解真菌标本的取材和检验方法及注意事项。     

2009全国深部真菌病研究进展学习班

一、主办单位：第二军医大学附属长征医院皮肤科 二、办班宗旨：通过讲授有关深部真菌病的基础知识、最新研究进展及目前国内外研究的热点及难点,了解真菌的分类、常见真菌病的诊断和处理、真菌病理、抗真菌药的研究进展等内容;通过演示真菌标本的取材及检验方法等,了解真菌标本的取材和检验方法及注意事项。学习班还将特别邀请美国的Bulmer教授和Richard教授就真菌病的难点问题做精辟、深入的讲解。学习班注重实用性,通过此次学习,     

329株深部真菌感染菌种分布及药敏试验分析

近年来临床上随着广谱抗生素、化疗药物和免疫抑制剂大量应用、艾滋病的流行以及放射治疗和器官移植的广泛进行,深部真菌病发病率大幅上升;唑类药物作为当前临床抗真菌治疗的主要药物,其使用量的增加导致临床深部真菌分离株耐药性增强、感染菌种发生变化^[1]。为了解近年来临床深部真菌感染的分布与耐药状况、分析真菌感染的流行趋势,对我院2004～2008年5年间临床深部真菌感染的病原学资料进行回顾性分析。     

β—1,3—葡聚糖合成酶的提取及在抗真菌抗生素筛选中的应用

真菌病,尤其是有致命危险的深部感染真菌病随着易感染患者的增加而越来越多。一些条件致病菌,在机体免疫能力下降时,也成为重要的病原,但是,治疗真菌病至今没有理想的药物。真菌细胞壁结构和组成的特点,为筛选抗真菌药物提供了理想的靶位。真菌细胞壁主要由多糖构成,约占干重的80％,蛋白约占3％～20％,还有少量的脂、色素和无机盐。多糖是骨架,主要包括几丁质、葡聚糖和甘露聚糖,其含量和比例因菌不同而异。临床上的重要条件致病菌白色念珠菌(C.albicans)的细胞壁主要由葡聚糖和甘露聚糖构成,兼有少量几丁质,葡聚糖又以β—1,3—葡聚糖为主,这为以葡聚糖合成酶作为筛选真菌细胞壁合成抑制剂的靶酶提供了理论依据。     

病理确诊深部真菌病45例分析

目的 探讨深部真菌病病理诊断的价值。方法 回顾性分析我院1995年1月-2004年12月期间,经病理确诊为深部真菌病45例患者的临床及病理资料,其中副鼻窦真菌感染14例;肺部真菌病19例;胃肠道真菌病4例;口腔真菌病2例,脑部真菌病2例,其他真菌病4例。结果 我院近5年来真菌病的确诊病例明显增多,且内脏及器官真菌病患者多合并基础性疾病,如血液病、肿瘤等。部分病例的致病菌根据病理确定有曲霉、念珠菌及隐球菌等。临床上主要采用手术结合氟康唑静滴的治疗方法。结论 我院经病理确诊的真菌病例呈上升趋势,病理组织学特点结合特殊染色可将大部分致病菌鉴定至属,治疗前最好进行培养鉴定至种。     

转化医学真菌学和精准皮肤医学融合创新——记第16期国家级继续医学教育项目“皮肤真菌病基础和临床研究进展讲习班”

<正>由四川大学华西医院冉玉平教授负责的第16期国家级继续医学教育项目[编号:2015-04-12-063(国)](简称"真菌班")于2015年3月27~31日在蓉成功举行。真菌班分理论授课与实验操作实习两部分,从真菌形态及分类、真菌特征及鉴定,到抗真菌药物、真菌检查,再到各种浅部、深部真菌病的概述、诊断与治疗,涵盖真菌学基础知识和科研前沿,贯穿临床经验与诊治思维。冉玉平教授以《开班致辞:欢迎加入真菌世界》开篇,继而讲授《真菌的分类与命名》《实验室操     

β-1,3-葡聚糖合成酶的提取及在抗真菌抗生素筛选中的应用

真菌病,尤其是有致命危险的深部感染真菌病随着易感染患者的增加而越来越多。一些条件致病菌,在机体免疫能力下降时,也成为重要的病原,但是,治疗真菌病至今没有理想的药物。真菌细胞壁结构和组成的特点,为筛选抗真菌药物提供了理想的靶位。真菌细胞壁主要由多糖构成,约占干重的80％,蛋白约占3％～20％,还有少量的脂、色素和无机盐。多糖是骨架,主要包括几丁质、葡聚糖和甘露聚糖,其含量和比例因菌不同而异。临床上的重要条件致病菌白色念珠菌(C.albicans)的细胞壁主要由葡聚糖和甘露聚糖构成,兼有少量几丁质,葡聚糖又以β—1,3—葡聚糖为主,这为以葡聚糖合成酶作为筛选真菌细胞壁合成抑制剂的靶酶提供了理论依据。     

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.     

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.     

Coccidioidomycosis and other endemic mycoses in Mexico

The endemic mycoses traditionally include coccidioidomycosis, histoplasmosis, blastomycosis and paracoccidioidomycosis. Although sporotrichosis and chromomycosis are technically not included among the endemic mycoses, they are frequently diagnosed in Mexico. Most systemic endemic mycoses are a consequence of inhaling the fungi, while subcutaneous mycoses are acquired through the inoculation of vegetable matter or soil containing the organism. Coccidioidomycosis is caused by Coccidioides spp., a dimorphic pathogenic fungus. Approximately 60% of exposures result in asymptomatic infection; in the rest there are protean manifestations that range from a benign syndrome also known as "Valley Fever" to progressive pulmonary or extrapulmonary disease. Histoplasmosis, caused by the dimorphic fungus Histoplasma capsulatum, is endemic to the Americas. Pulmonary histoplasmosis manifestations are protean, ranging from a brief period of malaise to a severe, prolonged illness. The spectrum of illness in disseminated histoplasmosis ranges from a chronic, intermittent course to an acute and rapidly fatal infection. Paracoccidioidomycosis is a chronic, granulomatous systemic disease caused by Paracoccidioides brasiliensis that characteristically produces a primary pulmonary infection, often asymptomatic, and then disseminates to form ulcerative granulomata of the oral, nasal and occasionally the gastrointestinal mucosa. Sporotrichosis, caused by Sporothrix schenckii, has diverse clinical manifestations; the most frequent is the lymphocutaneous form. Generally, infection results from inoculation of the fungus through thorns, splinters, scratches and small traumas. Chromomycosis (Chromoblastomycosis) is a slowly progressive cutaneous and subcutaneous mycosis attributed to various saprophyte Hypomycetes fungi. The primary lesion is also thought to develop as a result of percutaneous traumatic inoculation.     

Opportunistic invasive mycoses in AIDS. An autopsy study of 211 cases.

The opportunistic mycoses are an important cause of morbidity-mortality among patients with severe immunosuppression provoked by HIV. We present a study of 211 serial autopsies of patients with HIV/AIDS infection carried out by our service in a period of 10 years, observing frequency of invasive mycoses of the 44.1%. Pneumocystis carinii infection was the most frequent (32%) with a prevalence of lung affection. Candidiasis follows it in order of frequency with 31.1%, predominantly the oropharyngeal manifestation. Systemic or cerebromeningeal cryptococcosis were serious and common disorder (29%). Diseminated histoplasmosis occurred in 9.6% and in three cases (3.2%) pulmonary aspergillosis was diagnosed as a postmortem discovery in cavity lesions. In our series, other less common HIV-associated were not identified.     

A study of 3891 cases of mycoses in the tropics.

4103 cases suspected of mycoses were analysed as to sex, age and site of disease and 3891 were proved cases. This group formed 50% of total mycoses or 13-93% of all dermatoses recorded in the Government General Hospital, Madras, during the period of study. There were 66-26% adult female, 27-6% adult male and 6-14% were below 13 years. Dermatophytoses were found in 73-5%; the other common diseases were tinea versicolor (17-68%) and candidiasis (12-43%). Multiple sites of involvement or more than 1 disease in the same individual were mostly observed. The incidence of piedra (0-1%) and deep mycoses (0-156%) was very low. Mycetoma was the common disease (5/6) in deep mycoses. In dermatophytoses, tinea corporis (49-71%) and tinea cruris (47-85%) commonest; tinea axillaris (3-42%), tinea capitis (1-72%) and tinea barbae (1-29%) were less common. The incidence of tinea manuum, tinea pedis and tinea unguium was similar (4-97%-6-38%). High temperature and humidity were related to the higher incidence of tinea corporis, tinea cruris and tinea versicolor. Mainly children suffered from tinea capitis. All other mycoses were commonly found in adults between 2nd and 3rd decades. In all mycoses but candidiasis, female predominated. Cutaneous candidiasis was mainly a problem of housewives. Among the dermatophytes Trichophyton violaceum was predominant (33-7%) followed by T. rubrum (32-6%). Trichophyton schoenleinii and M. gypseum were rarely isolated. From mycetoma, Madurella mycetomii, Nocardia braziliensis, N. asteroides and Actinomadura spp. were isolated. Demonstration of Cryptococcus laurentii in 1 case is reported in this area for the first time.     

Some deep mycoses diagnosed by histopathology in South Eastern Nigeria

Twenty-three cases of deep mycoses were histologically diagnosed in 6500 surgical biopsy specimens examined during a three year period (1985-1988) in the Department of Pathology, University of Calabar Teaching Hospital, Calabar, Nigeria. These included 12 cases of African histoplasmosis, four of mycetoma, four of actinomycetoma, two of paranasal aspergilloma, and one of zygomycosis due to Conidiobolus coronatus (rhinoentomophthoromycosis). Involvement of tooth gum and colon in one case each of African histoplasmosis, and of maxillary sinus in two cases of paranasal aspergilloma were unusual clinical manifestations. The need for greater awareness of deep mycoses and for provision of adequate laboratory facilities in Nigeria is emphasized.     

Pulmonary mycotic infections; allergic and immunologic factors

The mechanisms of immunity and allergy, at play in every infectious disease, must be comprehended before the pathogenesis of an infection can be appreciated.Immunity, allergy and serology are concerned with specific antigen-antibody reactions. In immunity the principal concern is with the final disposition of antigen (agglutination, lysis, and phagocytosis). In allergy attention is focused upon tissue damage resulting from antigen-antibody union. In serology interest is devoted to the presence of antibody as evaluated by certain visible in vitro reactions-precipitin, agglutination, opsonization and complement fixation tests. There are two types of allergic reaction-the immediate or anaphylactic type and the delayed type or the allergic disease of infection. Neither kind takes part in the mechanism of immunity. At this time the allergic antibody and the immune antibody must be considered as two different and distinct antibodies. Skin and serologic tests are important diagnostic aids in certain pulmonary mycotic infections-for example, coccidioidomycosis, blastomycosis, histoplasmosis and moniliasis. Clinical expressions of allergy may appear in coccidioidomycosis, histoplasmosis and moniliasis. Pulmonary mycoses are divided into three groups, that is, the endogenous mycoses (actinomycosis, moniliasis, geotrichosis), the endogenous-exogenous mycoses (cryptococcosis, aspergillosis, mucormycosis) and the exogenous mycoses (nocardiosis, coccidioidomycosis, histoplasmosis, North American blastomycosis). The diagnosis and treatment of the important mycotic infections that invade lung tissue are discussed.     

Histopathology,Molecular Identification and Antifungal Susceptibility Testing of Nannizziopsis arthrosporioides from a Captive Cuban Rock Iguana (Cyclura nubila)

Mycopathologia - Chrysosporium-related fungi, the cause of superficial and deep mycoses, are an emerging infectious disease affecting not only reptiles but also immunocompromized humans. However,...     

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.