皮肤型孢子丝菌病316例临床分析

目的探讨孢子丝菌病的临床特征及病理特点，指导临床实践。方法分析1972～2007年间就诊于我院的孢子丝菌病447例，其中有详细资料者316例，做皮肤组织病理检查的203例中，105例做了PAS染色检查。结果春季发病者占50．34％，临床分型以固定型略多（52．53％）。儿童主要以面部发病。主要病理改变为混合细胞性肉芽肿。PAS染色阳性率为38．1％。结论孢子丝菌病常年皆可发病，近几年有增多的趋势，春季为本病高发季节。儿童皮损主要在面部，多为固定型。病理改变多为混合细胞性肉芽肿。病理切片、PAS染色诊断阳性率不高，确诊主要靠真菌培养。     

皮肤播散型孢子丝菌病1例并文献复习

目的探讨皮肤播散型孢子丝菌病发生的病因、临床特点、诊断及鉴别诊断,以提高对该病的认识,避免误诊、误治。方法对1例以声嘶为首发表现的皮肤播散型孢子丝菌病的临床资料、组织病理、真菌培养结果进行分析,并进行相关文献复习。结果患者以声嘶为首发表现,3个月后出现全身散在皮下结节。结节逐渐增多,部分破溃伴脓血。咽部组织病理示鳞状上皮黏膜急慢性炎伴上皮乳头状增生,可见多核巨细胞,抗酸染色未查出阳性菌。皮损处脓液真菌镜检及培养阴性。病理符合感染性肉芽肿。组织真菌培养见孢子丝菌生长。诊断为皮肤播散型孢子丝菌病。结论皮肤播散型孢子丝菌病在免疫正常人群发病时容易导致误诊误治;皮损表面脓液真菌镜检及培养阳性率低。病变组织真菌培养有利于得到阳性结果,早日明确诊断和治疗。     

皮肤淋巴管型孢子丝菌病1例

报道1例皮肤淋巴管型孢子丝菌病。患者女,79岁,农民。左上肢皮肤红斑结节线状分布,疼痛瘙痒不适两月余。皮损病理及PAS染色提示真菌感染,对皮损和脓液进行真菌镜检,结果为阴性。真菌培养、小培养及对培养阳性菌落进行分子生物学鉴定提示申克孢子丝菌。诊断:皮肤淋巴管型孢子丝菌病。予口服伊曲康唑胶囊0.2g/次,2次/d,治疗1个月后明显改善。     

鼻部固定型孢子丝菌病1例

报道1例猫抓后引起的固定型孢子丝菌病.患者男,16岁,皮损表现为鼻翼部位的增生物,其上覆有脓痂.临床上易与细菌感染混淆,但根据患者的病史、临床表现、病理、真菌镜检及培养诊断为申克孢子丝菌引起的孢子丝菌病.患者在应用7个月的碘化钾结合特比萘芬软膏外用治疗后,皮损完全消失.     

1例皮肤播散型孢子丝菌病的分离菌株的基因鉴定

孢子丝菌病是由申克孢子丝菌及其卢里变种感染引起的皮肤、皮下组织和附近淋巴系统的亚急性和慢性感染,偶可播散至全身引起多系统损害。该病遍布全世界,我国孢子丝菌病主要是由申克孢子丝菌引起。孢子丝菌一般生存在土壤和植物上,人的皮肤接触带菌植物或土壤后可引起感染。临床上主要表现为固定型和淋巴管型孢子丝菌病,皮肤播散型孢子丝菌病少见。现认为机体感染申克孢子丝菌引起的不同的临床型别与机体免疫状态、申克孢子丝菌的致病力及其基因差异相关[1-2]。我     

冷冻联合碘化钾治疗鼻部固定型皮肤孢子丝菌病1例

该文报道1例固定型皮肤孢子丝菌病.患者女,51岁,农民,因鼻部结节2个月就诊,皮损表现为鼻尖部增生物,其上覆有黑褐色厚痂.根据病史、临床表现、组织病理、真菌镜检及培养诊断为固定型皮肤孢子丝菌病.经过3个月冷冻联合碘化钾口服治疗后,皮损完全消失.     

申克氏孢子丝菌实验研究

孢子丝菌病(Sporotrichosis)国内外已多有报告,对其致病菌—申克氏孢子丝菌(Sporothrix schenckii)似乎早有定论。但从真菌学方面研究,在国外日渐增多。我们也注意到所检出的菌株中,有的与从国外引进的典型菌株对照,不大一样。为了进一步探明,我们作了如下试验与菌种鉴定。今将试验结果及初步分析报告如下。试验菌种:按我们门诊条件,无选择的抽样10例。经真菌学培养,证实其致病菌—申克氏孢子丝菌,经病理组织学检查及 PAS染色找出“组织型”者为确诊病例。其致病菌作为本文试验菌株,如表1。对照菌株:     

不同方法治疗皮肤型孢子丝菌病

皮肤型孢子丝菌病首选口服抗真菌药物治疗,如碘化钾、伊曲康唑、特比萘芬和氟康唑等[1].由于个体差异及疾病情况的复杂性,患者对每种抗真菌药物治疗的反应不同,最近我们应用不同的方法治愈了4例皮肤型孢子丝菌病患者,报道如下.1临床资料1.1病例1患者男,68岁,北京市延庆县农民.因右侧面部皮损8个月于2008年12月8日就诊.8个月前患者右侧面部出现米粒大小皮损,之后皮损破溃、增多,伴疼痛.否认外伤史.皮肤科情况:右面颊部可见8个1 ～1.5 cm大小皮损,基底红肿,其上有厚的结痂,无脓液渗出,可触及多数皮下结节(见图1a).皮损痂屑KOH湿片真菌镜检阴性,皮损组织真菌培养为申克孢子丝菌.皮损组织病理显示表皮角化不全,有脓痂,表皮呈假上皮瘤样增生;真皮全层弥漫淋巴细胞、组织细胞、多核巨细胞、浆细胞、嗜中性粒细胞浸润,伴少许嗜酸粒细胞;PAS染色未见真菌成分.诊断:皮肤淋巴管型孢子丝菌病.     

沈阳地区孢子丝菌病48例临床分析

目的探讨孢子丝菌病的发病原因、特点、诊断及治疗。方法对48例孢子丝菌病病例进行调查分析,全部行真菌学检查,部分行病理检查,采用碘化钾、特比萘芬或以碘化钾为基础的联合治疗。结果48例患者有明确外伤史,蚊虫叮咬病史者占总发病人数66.67%。单纯应用碘化钾或以碘化钾为基础的联合治疗8~12周,治愈率均达100%。结论外伤及昆虫叮咬、动物抓伤为本病的重要致病诱因,单纯应用碘化钾或特比萘芬均可治愈,但联合用药起效更快,效果更好。     

孢子丝菌病的治疗及护理

目的探讨孢子丝菌病患者的治疗与各项护理方法的临床效果。方法对88例孢子丝菌病患者给予抗真菌药物治疗,同时给予预防感染及皮肤、心理、饮食等护理措施。结果痊愈29例(占32.9%),显效38例(占43.2%),好转16例(占18.2%),无效5例(占5.68%),总有效率76.1%。结论采用综合疗法治疗孢子丝菌病,获得疗程短、疗效佳的效果。     

Diagnostic performance of mycologic and serologic methods in a cohort of patients with suspected sporotrichosis

BackgroundThe gold standard for the sporotrichosis diagnosis is culture; however, serologic approaches have been recently implemented to aid in the sporotrichosis diagnosis. Nevertheless, the clinical consequences of the introduction of serologic tests are poorly addressed.AimsTo correlate the results of culture and serology of patients with suspected sporotrichosis.MethodsA retrospective study of 198 patients with suspected sporotrichosis was conducted. Information about culture isolation of Sporothrix from clinical samples and antibody detection by an enzyme-linked immunosorbent assay (ELISA) were obtained from the medical records of the patients.ResultsPositive culture and antibody detection was observed in the samples of 84 patients (42.4%). Forty-one samples (20.7%) showed negative results with both techniques and divergent results were obtained in the samples of 73 patients (36.9%). False negative results in the ELISA were observed with 23 patients (31.5%), 78.3% of them with less than 30 days of infection (p = 0.0045). Among the initial false positive ELISA in the sera of 50 patients, four samples in culture yielded the growth of Sporothrix, and 27 improved with itraconazole. At the end of follow-up, a diagnosis of proven or probable sporotrichosis was established in 139 patients, and possible sporotrichosis in 11 patients. The treatment of the patients with probable sporotrichosis with antifungal drugs resulted in clinical cure for these individuals.ConclusionsThese two techniques are complementary in the diagnosis of sporotrichosis, making diagnosis and clinical decision more precise.     

Esporotricosis: prevalencia,perfil clínico y epidemiológico en un centro de referencia en Colombia

BackgroundSporotrichosis is a subacute and chronic infection caused by Sporothrix schenckii, which affects humans and other mammals. Clinical and epidemiological information in Colombia is scarce.ObjectiveTo describe clinical and socio-demographic findings and diagnostic tests in patients with sporotrichosis from 1996 to 2005 in a national reference center in Colombia, and to determine the institutional prevalence from 2002 to 2005.Material and methodsThis was a prevalence study, including patients with clinical diagnosis of sporotrichosis and at least one of the following criteria: positive culture with S. schenckii, pathologic diagnosis suggestive of sporotrichosis, or response to treatment with potassium iodide.ResultsSixty cases were included, 67% were male, and 25% of them were farmers. The most affected anatomical areas were the forearms and hands (32.5% and 22.8% respectively). Most cases came from the Cundinamarca and Boyacá areas. The cases presented as fixed cutaneous sporotrichosis and lymphangitic sporotrichosis. Differential diagnoses with: leishmaniasis and chromoblastomycosis were performed in most of the cases. All patients were treated with potassium iodide. The prevalence for our center from 2002 to 2005 was 8 cases per 100,000 patients.ConclusionsThe characteristics of our patients are similar to those described in other populations, with some differences. The culture continues to be the gold standard for diagnosis purposes. Potassium iodide is the treatment of choice in our center.     

Bone sporotrichosis: 41 cases from a reference hospital in Rio de Janeiro,Brazil

BackgroundBone sporotrichosis is rare. The metropolitan region of Rio de Janeiro is hyperendemic for zoonotic sporotrichosis and the bone presentations are increasing.MethodsWe studied a retrospective cohort of 41 cases of bone sporotrichosis, diagnosed from 1999–2016. The inclusion criteria was fungal culture isolation from any clinical specimen associated to bone involvement (radiography and/or computed tomography) compatible with fungal osteomyelitis or histopathological findings of bone material compatible with sporotrichosis. Molecular identification was performed when possible.ResultsMale patients represented 58.5% of the cases, with a cohort median age of 43 years. Immunosuppressive conditions were present in 68.3% of the patients, mostly HIV coinfection (51.2%). Multifocal bone involvement (more than one anatomical segment) was diagnosed in 61% of the patients, while 39% presented unifocal involvement. The bones of the hands were the most affected (58.5%), followed by the feet (41.5%) and tibia (26.8%). Multifocal group was characterized by a higher proportion of males (p = 0.0045) with immunosuppressive conditions (p = 0.0014). Amphotericin B followed by oral itraconazole was the main treatment, with a median time of 16.7 months (1.5 to 99.2 months), and cure of 53.7% of the patients (84.6% of immunocompetent and 39.3% of immunocompromised patients). Sequelae occurred in 12.2% of the patients—amputations (7.3%) and ankylosis (4.9%), while 22% died in the course of the disease. Sporothrix brasiliensis was the causative agent in all the 9 (22%) performed cases.ConclusionsBone sporotrichosis is a chronic, challenging condition with prolonged treatment, often with poor results and sequelae.     

Sporothrix schenckii isolated fromdomestic cats with and without sporotrichosis in Rio de Janeiro,Brazil

A total of 148 cats with a clinical and mycologic diagnosis of sporotrichosis and 84 apparently healthy cats with domiciliary contact with the affected animals were studied. Sporothrix schenckii was isolated from 148 (n = 148; 100%) clinical samples of cutaneous lesion (biopsy, swab or aspiration of purulent secretion), 47(n = 71; 66.2%) nasal cavities, 33 (n = 79; 41.8%) oral cavities, and 15 (n = 38; 39.5%) nails of cats with sporotrichosis. Histopathological examination revealed yeast-like structures in 50 (n = 70; 71.4%) of the biopsies studied. S. schenckii was isolated from the blood culture of one cat (n = 5, 20%) with the disseminated cutaneous form of the disease. On another occasion, the fungus was isolated from the testis of one (n = 7; 14.3%) of the animals submitted to sterilization. In the group of cats with domiciliary contacts, 3(n = 84; 3.57%) oral swabs showed positive cultures. Isolation of S. schenckii from different clinical specimens during both the clinical and preclinical phase reinforces the zoonotic potential of feline sporotrichosis. This revised version was published online in June 2006 with corrections to the Cover Date.     

Sporotrichosis in sub-himalayan India

Sporotrichosis is endemic in the Sub-Himalayan belt, which ranges from the northern to the north-eastern Indian subcontinent. Similar to many parts of the developing world, sporotrichosis is commonly recognized clinically in this region however consolidated epidemiological data is lacking. We report epidemiological, clinical and microbiological data from a hundred culture positive cases of sporotrichosis. Out of 305 clinically suspicious cases of sporotrichosis, a total of 100 isolates were identified as Sporothrix schenckii species complex (S. schenckii) on culture. Out of the culture proven cases 71% of the cases presented with lymphocutaneous type of lesions while 28% had fixed localized type and 1% had disseminated sporotrichosis. Presentation with lesions on hands was most frequently seen in 32% with arm (23%) and face (21%) in that sequence. The male to female ratio was 1∶1.27. Age ranged from 1 ½ years to 88 years. Mean age was 43.25 years. Disease was predominantly seen in the fourth to sixth decade of life with 58% cases between 31 and 60 years of age. Since the first report from the region there has been a steady rise in the number of cases of sporotrichosis. Seasonal trends reveal that most of the patients visited for consultation in the beginning of the year between March and April. This is the first study, from the most endemic region of the Sub-Himalayan belt, to delve into epidemiological and clinical details of such a large number of culture proven cases over a period of more than eighteen years which would help in the understanding of the local disease pattern of sporotrichosis.     

Comparative Evaluation of Five Serological Methods for the Diagnosis of Sporotrichosis

The diagnosis of sporotrichosis can be time consuming. Serological procedures could facilitate the rapid and accurate diagnosis of this disease. A slide latex agglutination (SLA) test for sporotrichosis was developed and compared with the tube agglutination (TA), complement fixation (CF), and immunodiffusion (ID) tests in the serological study of 80 proven human cases of sporotrichosis representing the cutaneous, subcutaneous, and extracutaneous forms of the disease. In addition, the indirect fluorescent antibody (IFA) technique was applied to 61 case sera. In the SLA test, latex particles sensitized with culture filtrate antigens from the yeast form of Sporothrix schenckii (B 959) detected 94% of the cases, as compared to 96% of the cases detected by the TA test, 68% by the CF test, and 56% by the ID test. The IFA test detected 90% of the 61 cases. The SLA and ID tests were specific, showing no reactions with sera from 86 persons with no disease or with diseases other than sporotrichosis. Because of its sensitivity, specificity, ease of performance, and ability to provide results in 5 min, the SLA test is highly recommended for routine use in the clinical laboratory.     

An endemic area of sporotrichosis in Guatemala]

An endemic area of sporotrichosis is described in the Lake of Ayarza District, South Guatemala, where 53 patients have been observed within 3 years. In 45.3% of the cases, the infection appeared after handling fish. The disease was more frequently observed in man (83%) and in patients less than 30 years of age. The most frequent clinical type was the ascending lymphocutaneous sporotrichosis of the limbs. Some cases of ulcerative or verrucous lesions were seen. Almost all the patients cured rapidly either by potassium iodide (46 patients) or spontaneously, or after application of local heat (4 patients). Intradermal tests were performed in healthy population in the endemic area and, for comparison, in Guatemala City. Whole yeast cell antigens of Sporothrix schenckii and Ceratocystis stenoceras were used in these tests. Skin tests to both antigens were more frequently positive in the endemic area; the highest frequency was obtained with the antigen of C. stenoceras. A serological study was performed in 26 patients. The fluorescent antibody staining technique was more sensitive than yeast cell and latex particles agglutinations. C. stenoceras was isolated from bark of some trees, especially Eucalyptus, in the environment, but not S. schenckii.     

难治性孢子丝菌病1例

报道1例因非医嘱习惯性口服激素导致的难愈性孢子丝菌病。患者右腕木屑刺伤后,出现局限性红斑伴破溃,曾多次外院就诊,诊断为“孢子丝菌病”,给予抗真菌治疗半年后病情仍不断恶化,遂来我院就诊。皮损经真菌镜检、培养及分子生物学测序均鉴定为孢子丝菌病,病理示感染性肉芽肿。询问病史时发现患者有日常口服激素的习惯,嘱患者停用激素并口服伊曲康唑4个月后治愈。     

利用小鼠模型筛选孢子丝菌病快速诊断的特异性引物

目的通过感染孢子丝菌的动物模型筛选文献报道的4对申克孢子丝菌特异性引物，以确定引物的敏感性和特异性。方法12只小鼠随机分成实验及对照组，实验组皮内注射申克孢子丝菌菌悬液，不同时间留取皮损组织，分别进行真菌培养和皮损组织DNA提取，PCR扩增。结果4对引物s2-R2，SSHF31-SSHR97，ITS3-SSP，SS3-SSd在感染申克孢子丝菌的小鼠皮损中均可扩增出目的条带，但引物SSHF31-SSHR97所需浓度较高，引物s2-R2的敏感性和特异性最好，与在体外培养条件下筛试的结果相同。结论针对几丁质合成酶基因I的引物s2-R2对申克孢子丝菌的敏感性和特异性最好。