14例茄病镰刀菌所致角膜溃疡临床分析

目的探讨真菌性角膜溃疡的病原学特点、临床表现及抗真菌综合治疗的方法。方法对2004年10月-2006年10月送检的疑似感染的角膜标本进行镜检、培养及菌种鉴定。对其中14例病历资料完整的茄病镰刀菌所致角膜溃疡患者进行临床分析。结果在33例送检标本中分离出茄病镰刀菌24株（72．7％）。上述14例患者中,有3例角膜穿孔合并眼内炎行眼球内容物除去术,3例行结膜瓣或羊膜移植,1例角膜移植,7例经非手术治疗保留较好视力。结论茄病镰刀菌是我国北方真菌性角膜炎的主要致病菌,可导致视力严重受损且治愈困难。早期诊断配合以抗真菌为主的综合治疗可阻止病情进展,明显改善视力。     

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。     

3759例角膜炎患者真菌检测与耐药性分析

目的了解角膜感染真菌的分布与药敏情况,为临床诊治提供参考。方法回顾性分析2014年1月至2017年12月在本院就诊的角膜炎患者3759例。进行真菌培养及药敏实验,并汇总分析真菌分布与耐药性。结果 3759例真菌培养出阳性828例,总体阳性率为22%,患者以中老年男性为主,致病真菌以镰刀菌、链格孢霉及曲霉菌为主,其中镰刀菌最多,占比41%(340/828),且有增多趋势;其次为链格孢霉,占比30%(247/828)。真菌培养阳性率具有季节趋势,即在每年的第四季度真菌培养阳性率明显高于其他季度。抗真菌药伏立康唑、两性霉素B、伊曲康唑、酮康唑及氟康唑的耐药率分别为1.2%、1.6%、17.6%、32%及96.1%。结论本院眼角膜真菌感染以镰刀菌、链格孢霉为主且有增多趋势,时间分布呈季节性变化。氟康唑及酮康唑的耐药率较高,临床应根据真菌检验结果合理选择抗真菌药物及治疗方式。     

458例包皮龟头炎真菌感染检测及药敏试验

目的了解本地区包皮龟头炎患者中真菌感染情况及对抗生素的敏感性。方法分别采用显微镜、科玛嘉念珠菌显色培养基、法国梅里埃公司的ATB ID32C酵母菌鉴定卡和Rosco纸片扩散法对包皮龟头分泌物进行直接镜检、念珠菌培养、菌种鉴定及药敏试验。结果 458例患者中153例直接镜检阳性,培养分离出念珠菌共157株,念珠菌培养阳性率为33.4%(153/458),其中白念珠菌116株,占73.9%(116/157),非白念珠菌41株,占26.1%(41/157);120例对照组中有17例培养出念珠菌,阳性率为14.2%(17/120),其中白念珠菌6株,占35.3%(6/17),非白念珠菌11株,占64.7%(11/17)。包皮龟头炎患者组念珠菌的培养阳性率和白念珠菌的比例均高于健康对照组,差异有统计学意义(χ2=16.95,χ2=10.72,P均0.05)。157株致病菌株对制霉菌素和酮康唑的敏感率均90%,分别为97.5%和93.0%,对氟康唑敏感率为79.6%,而对特比萘芬敏感性最低,为33.8%。结论念珠菌感染是本地区包皮龟头炎发病的重要因素,感染的致病菌种以白念珠菌为主,分离的致病性念珠菌对多烯类药物敏感率较高,对唑类抗真菌药有不同程度的交叉耐药,不同菌型其药敏谱存在差异。     

47766例拟诊皮肤真菌病患者病原菌分离培养结果分析

目的了解本院门诊拟诊皮肤真菌病患者真菌感染状况,掌握近期本地区皮肤真菌感染菌种分布结构。方法采用KOH直接涂片或染色显微镜观察与分离培养相结合的方法,对分离的菌落进行形态学鉴定,对真菌镜检和培养鉴定结果进行统计分析。结果 47 766例拟诊皮肤真菌病患者中,直接镜检和(或)培养阳性25 078例,占52.50%。其中皮肤癣菌病9 310例(48.94%)、马拉色菌感染8 938例(46.99%)、念珠菌及其他酵母菌感染603例(3.17%)。除外马拉色菌镜检和(或)培养阳性,其余38 839例镜检阳性率40.33%、分离培养阳性率25.99%。分离培养与镜检阳性符合率61.41%。皮肤癣菌菌种结构方面,红色毛癣菌为优势菌种占88.19%。结论皮肤癣菌病位居皮肤真菌病之首,以红色毛癣菌为优势菌,念珠菌及其他酵母菌感染亦值得关注。     

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。     

白内障PHACO术后感染性眼内炎的病原菌分布特征及耐药性分析

目的探讨白内障超声乳化手术(PHACO)术后感染性眼内炎的病原菌分布特征及耐药性分析。方法选择2006年11月至2013年12月来青田县人民医院就诊住院实施白内障PHACO术的患者共4 132例(6 734眼),其中9例(9眼)患者术后发生眼内炎。对其进行细菌、真菌及阿米巴等的培养与鉴定,病原菌的种类分布及体外药敏试验。结果 PHACO术后眼内炎的发生率为0.13%(9/6 734),其中有8眼细菌培养阳性(房水培养2眼,玻璃体培养6眼),阳性率为88.9%:表皮葡萄球菌4眼,粪肠球菌2眼,金黄色葡萄球菌1眼,醋酸不动杆菌1眼。所有标本均未发现真菌感染。8眼细菌培养阳性的标本行药敏试验,表皮葡萄球菌及粪肠球菌等均对万古霉素、利福平、利奈唑胺敏感,对其他抗生素耐药情况则不同。进行术后6个月随访,9例患者术后1~6个月最佳矫正视(BCVA)与术前比较,差异均有统计学意义(P0.05),提示患者术后的BCVA较术前有提高,6个月较1个月有提高。所有患者末次随访时炎症均得到有效控制,无复发眼内炎。结论白内障PHACO术后的感染性眼内炎以表皮葡萄球菌及粪肠球菌为主的条件致病菌为主要致病的菌株,其中万古霉素对这两种菌属以及其他菌属均有良好的药敏性,可以作为临床眼科预防和治疗的参考用药。     

真菌性外耳道炎患者耳道环境菌群结构及多样性

本研究针对广东地区真菌性外耳道炎患者,采集健康对照组以及患病组外耳道分泌物,提取其总DNA,分析其微生物群落结构、多样性变化以及真菌与细菌之间的相关关系。结果显示,对于细菌而言,致病细菌不仅存在于患病组耳道,也存在于健康人群的耳道当中;对于真菌而言,虽然健康组也检出了真菌,但与细菌不同的是,患病组与健康组的真菌群落差异显著。健康组耳道真菌以担子菌门Basidiomycota为主,该类真菌并不是真菌性外耳道炎的致病菌,而在患病组中,子囊菌门Ascomycota的曲霉属Aspergillus占据绝对优势地位。曲霉是重要的致病菌,在10个患病组样本中,8个样本的曲霉属占比超过90%。此外,真菌与细菌之间,仅有极少数菌种的丰度变化存在正相关关系,多数细菌与真菌的丰度变化并不相关,这意味着在耳道环境中,真菌与细菌群落变化的依存关系不明显。总的来说,健康人群与患病人群的耳道环境均存在致病菌,致病菌的存在并不必然导致耳道炎症的发生,菌群变化只是炎症产生的前提。而曲霉在耳道的大量繁殖是真菌性外耳道炎发病的重要原因,维持一种不利于该菌繁殖的耳道环境,可能是预防真菌性外耳道炎发病的有效措施。     

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     

糖尿病真菌性角膜炎患者临床特征及病原学分析CSCD

目的调查与探讨糖尿病真菌性角膜炎患者临床特征及病原学状况,发现影响糖尿病真菌性角膜炎患者预后的主要危险因素。方法采用回顾性研究方法,选择2013年2月~2016年5月在我院眼科确诊的,具有完整病例资料和随访资料的真菌性角膜炎患者120例作为研究对象,包括合并糖尿病的真菌性角膜炎60例(糖尿病组)和无糖尿病的真菌性角膜炎60例(非糖尿病组),调查所有患者的人口学特征、临床症状、病原学检查结果,同时记录患者的预后情况并进行危险因素分析。结果两组患者的性别、体重指数、病程等对比,差异无统计学意义(P>0.05),糖尿病组糖尿病病史平均为(8.14±2.11)a,糖尿病组的年龄和角膜感染程度评分与非糖尿病组相比,差异有统计学意义(P<0.05)。在糖尿病组中,镰刀菌属10例(16.7%),曲霉菌属40例(66.7%),念珠菌属10例(16.7%);在非糖尿病组中,镰刀菌属25例(41.7%),曲霉菌属30例(50.0%),念珠菌属5例(8.3%),两两比较差异都有统计学意义(P<0.05)。糖尿病组与非糖尿病组的治疗总有效率分别为86.7%和98.3%,糖尿病组的治疗总有效率明显差于非糖尿病组(P<0.05)。多分变量Logistic回归显示浸润病灶、前房积脓、曲霉菌为影响糖尿病真菌性角膜炎预后的主要危险因素(P<0.05)。结论糖尿病真菌性角膜炎患者相对于非糖尿病患者而言主要表现为发病年龄偏大、角膜感染较重、预后差的特点,曲霉属为其主要病原菌。浸润病灶、前房积脓和曲霉菌为影响糖尿病真菌性角膜炎预后的主要危险因素。     

原位肝移植病人术后真菌感染的病原学特点

探讨原位肝移植术后真菌感染的病原学特征及耐药特性,为临床治疗提供依据。分析了2003年1月至2006年6月间,我院原位肝移植患者术后感染真菌的种类、分布及耐药特性。61例原位肝移植患者有19例术后并发真菌感染,感染率为31.1%;共检出52株真菌,以酵母菌感染为主,主要真菌的检出率分别是近平滑假丝酵母菌51.9%(27/52)、白假丝酵母菌23.1%(12/52)、热带假丝酵母菌9.6%(5/52)、季也蒙假丝酵母菌9.6%(5/52)、克柔假丝酵母菌3.8%(2/52)、曲霉菌感染1.9%(1/52)。常见的感染部位依次为呼吸道、肠道、尿道、血液、胆汁。药敏试验显示,51株真菌对常用抗真菌药物两性霉素B(AMB)、制霉菌素(MYS)、5-氟胞嘧啶(5-FC)、酮康唑(KTC)、咪康唑(M IC)、益康唑(ECO)的平均耐药率分别是2.0%、7.8%、9.8%、29.4%、35.3%和41.2%。原位肝移植术后真菌感染是影响患者预后的重要因素之一,临床应该加强肝移植术后真菌感染耐药性的监测。     

Identification and incidence of fungal strains in chronic rhinosinusitis patients

The fungal revolution taking place in otorhinology inspired us to study the frequency of occurrence of fungi in the nasal mucus of chronic rhinosinusitis (CRS) patients (with or without polyposis) in order to evaluate the incidence of eosinophilic fungal sinusitis in CRS patients. Ninety-six samples were examined from patients with CRS. In 74 cases mucus was collected non-invasively, and in 22 cases during operation. The Gram-stained direct smears of all samples were also evaluated. Bacteria and fungi colonizing in the mucus were detected by culturing method. The control group consisted of 50 healthy volunteers. Typical aerobic pathogenic bacteria could be isolated from 34 patients. Fifty-seven aerobic bacteria were isolated, i.e. 1.6 bacteria/positive patient with a maximum of 3 different bacteria/sample. The most frequently isolated bacteria were Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae, and Haemophilus influenzae. Yeasts and moulds could be detected from 79 patients (83%): Candida albicans, Candida spp., Aspergillus spp., Cladosporium spp, and Penicillium spp. were isolated most frequently. Altogether 237 yeasts and moulds were isolated, i.e. 3.0 different fungi/positive patient, with a maximum of 5 different fungi/sample. In the control group aerobic pathogens were not isolated, only apathogenic species. Fungi were isolated from 22 healthy patients (44%). These data indicate that fungi are frequently involved in the aetiology of CRS. IgE-medicated hypersensitivity to fungal allergens could not be proven in our patients.     

297例浅部真菌病临床及病原菌菌种分析

目的 探讨皮肤浅部真菌病致病真菌菌种的构成.方法 对297例真菌涂片阳性和培养阳性的浅部真菌病患者,取标本进行分离培养及菌种鉴定,培养阳性标本在形态学上不能准确鉴定的,进行梅里埃API 20C AUX酵母菌鉴定试剂盒或核糖体DNA （rDNA） ITS区序列测定,确切鉴定菌种.使用SPSS 17.0统计软件对于结果进行统计分析.结果 共分离培养出致病菌13种,其中红色毛癣菌86株（29.0％）,须癣毛癣菌68株（22.9％）,念珠菌属59株（19.9％）,暗色真菌属13株（4.4％）,曲霉菌属13株（4.4％）,红酵母菌12株（4.0％）,青霉菌属9株（3.0％）,毛霉菌9株（3.0％）,犬小孢子菌5株（1.7％）,浅白隐球菌3株（1.0％）,毛孢子菌属2株（0.7％）,絮状表皮癣菌1株（0.3％）,混合感染17株（5.7％）.结论 本地区浅部真菌病以甲癣为主,主要致病真菌是红色毛癣菌,但其他种类真菌感染尤其是念珠菌属有明显上升趋势.     

Trichophyton Spp. fungal keratitis in 22 years old female contact lenses wearer

Fungal keratitis represents one of the most difficult forms of microbial keratitis to diagnose and treat successfully. It is difficult to obtain correct diagnosis and topical antifungal preparations. Fungi can cause severe stromal necrosis and enter the anterior chamber by penetrating an intact Descemet membrane. The most common pathogens are filamentous fungi (Aspergillus and Fusarium spp.) and Candida albicans. The incidence of Trichophyton spp. keratitis is 5%. A 22 years old female contact lenses wearer after keratitis developed corneal melting syndrome, spontaneous perforation of the cornea and complicated cataract of the left eye. Conjunctival swab was sterile as well as first sample of corneal tissue and sample from the anterior chamber. Urgent therapeutic perforating keratoplasty (PK), was performed together with extracapsular cataract extraction and the implantation of the intraocular lens in the posterior chamber. The patient was treated with ciprofloxacin and diflucan (systemic therapy); with dexamethason and atropin (subconjunctivaly) and chlorhexidine, brolene, levofloxacin, polimyxin B, and dexamethason/neomycin (topically). Microbiology evaluation was performed once again following excisional biopsy of the intracameral portion of the lesion. The presence of Trichophyton spp. was finally confirmed. Itraconazole and garamycin were included in the systemic therapy. Corneal graft was clear for 17 days but decompensated 28 days after the PK. After two weeks microorganisms invaded the vitreous and caused endophthalmitis. Despite urgent pars plana vitrectomy patient developed endophthalmitis, lost light sensation and developed phthysis. Evisceration and the implantation of silicon prosthesis was done. Perforating keratoplasty is a method of choice in treating severe infectious keratitis unresponsive to conservative treatment but without the eradication of microorganisms it cannot restore the vision or save the eye. Trichophyton spp. may cause a severe disease of the anterior and posterior part of the eye which may finish with the lost of vision/eye. Prompt diagnosis and treatment of Trichophyton spp. keratitis are essential for a good visual outcome.     

白内障术后感染性眼内炎的致病菌分析及影响因素研究

目的:分析白内障术后感染性眼内炎的致病菌分布情况,并对其影响因素进行分析。方法:选取2016年8月~2019年3月期间于我院行白内障手术的患者2936例,统计白内障术后感染性眼内炎的发生情况。分析术后感染性眼内炎患者的病原菌分布情况及病原菌耐药情况。单因素及多因素Logistic回归分析术后感染性眼内炎发生的影响因素。结果:本研究中,共发放2936份调查问卷,回收2931份,回收率为99.83%(2931/2936)。其中53例患者患有感染性眼内炎,发生率为1.81%(53/2931),根据患者是否患有感染性眼内炎分为感染组(n=53)和未感染组(n=2878)。感染性眼内炎的病原菌检出41株,其中革兰阳性菌37株,占90.24%;共检出4株真菌,为白色假丝酵母菌,占比9.76%。37株革兰阳性菌中,头状葡萄球菌、表皮葡萄球菌以及腐生葡萄球菌对利福平、利奈唑胺以及万古霉素的敏感度达100.00%。感染组和未感染组在性别、住院时间、玻璃体溢出方面比较差异均无统计学意义(P>0.05);两组在麻醉药时间、年龄、手术切口、手术时间、高血压、糖尿病方面比较差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:年龄≥66岁、手术切口为透明角膜、手术时间≥15 min、合并糖尿病均是发生感染性眼内炎的危险因素(OR=2.759、2.676、1.601、1.261,P<0.05)。结论:白内障术后感染性眼内炎的致病菌较多,以革兰阳性菌为主,革兰阳性菌对利福平、利奈唑胺、万古霉素的敏感度较高,年龄≥66岁、手术切口为透明角膜、手术时间≥15 min、合并糖尿病均会增加术后感染性眼内炎发生的风险。     

Synthesis of pseudopeptides based L-tryptophan as a potential antimicrobial agent

Four compounds named L-BTrpPA, L-Trp-o-PA, L-Trp-m-PA and L-Trp-p-PA, pseudopeptides constructed from pyridine and tryptophan units, were synthesized and tested against the Gram-positive, Gram-negative strains of bacteria and human pathogenic fungi. L-Trp-o-PA proved to be a broad-spectrum antimicrobial agent, showing a significant inhibition of the growth of Gram-positive bacteria (Staphylococcus aureus, methicillin-resistant S. aureus, Bacillus subtilis, Micrococcus luteus), and pathogenic fungi (Candida spp., Cryptococcus neoformans, Rhodotorula glutinis, Saccharomyces cerevisiae, Aspergillus spp., Rhizopus nigricans) tested and activity against Gram-negative bacteria (Escherichia coli, Pseudomonas aeruginosa and Proteus vulgaris, Enterobacter aerogenes) tested. The in vitro cell cytotoxicity of L-Trp-o-PA was evaluated using haemolytic assay, in which the compound was found to have low lytic property, even up to the concentration of 4000 microg/mL, it only lysed 6-7% of erythrocytes, which was 100-fold greater than the MICs (minimum inhibitory concentration).     

Synthesis, structure and biological activity of cobalt(II) and copper(II) complexes of valine-derived schiff bases

We have synthesized two cobalt(II) 2 and copper(II) 3 complexes of valine-derived Schiff bases. The obtained complexes were characterized by elemental analysis, FT-IR and X-ray diffraction. Biological studies of complexes 2 and 3 had been carried out in vitro for antimicrobial activity against Gram-positive, Gram-negative bacteria and human pathogenic fungi. Compound 3 was proven to be a broad spectrum agent, showed a significant inhibition of the growth of Gram-positive bacteria (Staphylococcus aureus, methicillin-resistant S. aureus, Bacillus subtilis, Micrococcus luteus), and pathogenic fungi (Candida spp., Cryptococcus neoformans, Rhodothece glutinis, Saccharomyces cerevisia, Aspergillus spp., Rhizopus nigricans) tested and a moderate activity against Gram-negative bacteria (Escherichia coli, Pseudomonas aeruginosa, Proteus vulgaris and Enterobacter aerogenes) tested. The in vitro cytotoxicity of compound 3 was evaluated using hemolytic assay, in which the compound 3 was found to be non-toxic to human erythrocytes even at a concentration of 500mug/mL.     

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。     

Antifungal activity in vitro of Ro 14-4767/002, a phenylpropyl-morpholine

Minimal inhibitory concentrations (MICs) of Ro 14-4767/002 for pathogenic yeasts, Aspergillus spp., dermatophytes and other filamentous fungi were determined in dilution tests under a variety of experimental conditions and, for the most of the species and a number of different isolates. Ro 14-4767/002 showed the highest effect against dermatophytes and Cryptococcus neoformans, followed by Candida spp., whereas its activity against Aspergillus spp. was weak. Its activity against most pathogens compared favourably with antifungals of the imidazole class. The activity of Ro 14-4767/002 not only differed between the species but there was also a significant intra-species variation. The MICs were influenced by the inoculum size, the incubation time, and by the composition of the medium. The activity of the compound was significantly higher on Casitone agar than on a chemically defined medium (Yeast Nitrogen Base + glucose). Ro 14-4767/002 was also found to exert fungicidal activity which was time- and concentration-dependent.     

Identification of medically significant fungal genera by polymerase chain reaction followed by restriction enzyme analysis

Rapid non-culture-dependent assays for identification of fungi quicken diagnosis and prompt treatment of invasive fungal disease. Fungal DNA extracts from pure cultures of the most frequently isolated fungal pathogens belonging to the Genera Aspergillus, Candida and Cryptococcus along with less common pathogenic Genera were amplified with the general fungal primer pair internal transcribed spacer-1/4. Subsequently, the amplicon was digested with the restriction endonucleases MspI, HaeIII, HinfI and EcoRI in order to generate genus- or species-specific patterns for identification of the fungus. HinfI produced indistinguishable fingerprints for all Aspergillus species tested. MspI produced species-specific patterns for: Cryptococcus neoformans, Cryptococcus non-neoformans, Candida albicans and Candida tropicalis. EcoRI succeeded in differentiating penicillia from aspergilli and cryptococci from Candida spp. It is concluded that this procedure can differentiate genera and occasionally species of medically important fungi and that following the necessary validation experiments, it can be used directly on clinical samples to assist prompt diagnosis of systemic fungal infections.