特比萘芬联合伊曲康唑治疗孢子丝菌病失败1例

伊曲康唑和特比萘芬治疗孢子丝菌病（sporo-trichosis）有效安全,目前已成为孢子丝菌病治疗指南中的推荐用药[1].但少数患者单用伊曲康唑或特比萘芬不能有效控制病情,研究显示两药分别联合碘化钾溶液或两药联合治疗皮肤型孢子丝菌病显示疗效增强2-6].最近,我们诊治1例由球形孢子丝菌引起的皮肤固定型孢子丝菌病患者,采用特比萘芬联合伊曲康唑治疗失败,之后经特比萘芬联合碘化钾溶液治疗才获得痊愈.鉴于该病例治疗过程的特殊性,我们对其分离菌株进行了一些相关的实验研究,现报道如下.     

伊曲康唑联合卡泊芬净或特比萘芬对球形孢子丝菌体外抑菌作用的研究

目的探讨伊曲康唑联合卡泊芬净或特比萘芬时对球形孢子丝菌酵母相和菌丝相的体外抑菌作用。方法参照标准的微量液基稀释法及棋盘微量稀释法对33株球形孢子丝菌行药敏试验,结果使用抑菌浓度指数(FICI)判定"协同""不相关"和"拮抗"。结果伊曲康唑与卡泊芬净联合对球形孢子丝菌酵母相菌株的协同率为93.94%(31/33),与特比萘芬联合的协同率为60.61%(20/33);伊曲康唑与卡泊芬净或特比萘芬联合对菌丝相菌株协同率分别为96.97%(32/33)、84.5%(28/33)。对所有受试菌株均未观察到上述药物的拮抗作用。结论体外联合药敏试验结果显示伊曲康唑与卡泊芬净或特比萘芬联合有较好的协同作用。     

球形孢子丝菌致婴儿固定型孢子丝菌病1例及相关实验研究

报道1例由球形孢子丝菌所致的婴儿固定型孢子丝菌病。患儿女,3个月,因左眼下内侧皮损2个月就诊,皮损脓液标本进行真菌培养,对培养获得菌株进行形态学、生理学和分子生物学鉴定,并进行药物敏感性检测。真菌培养阳性,镜下可见典型的套袖样菌丝。钙调蛋白基因序列分析鉴定为球形孢子丝菌。药敏试验显示特比萘芬和伊曲康唑对该菌株的菌丝相最低抑菌浓度（minimal inhibitorycon centration,MIC）分别为0．5μg／mL和0．5μg／mL;对该菌株的酵母相的MIC值分别为0．25μg／mL和0．5μg／mL。给予患者口服特比萘芬32．5mg／d治疗10周后皮损消退呈瘢痕化修复。依据临床及实验室检查确诊该病例为球形孢子丝菌所致固定型孢子丝菌病,特比萘芬治疗本病例显示较好疗效。     

中国临床球形孢子丝菌菌丝相药物敏感性分析

目的检测我国临床球形孢子丝菌菌丝相对5种抗真菌药物的体外敏感性,同时对比我国不同地区菌株药物敏感性的差异。方法将重庆、吉林、北京地区既往基因鉴定为球形孢子丝菌的100株临床菌株接种于2%马铃薯葡萄糖琼脂培养基(PDA)上,25℃恒温培养7d获得菌丝相。依据美国临床与实验室标准化委员会(CLSI)制定的M38-A2方案,采用微量液基稀释法检测菌丝相对碘化钾、伊曲康唑、特比萘芬、氟康唑、两性霉素B的体外最低抑菌浓度(MIC)。质控菌株为近平滑念菌ATCC22019。结果碘化钾体外无抗真菌活性,特比萘芬MIC几何均值为0.14μg/mL,伊曲康唑和两性霉素B MIC几何均值分别为0.79μg/mL和0.63μg/mL,氟康唑MIC几何均值为45.89μg/mL。发现7株对伊曲康唑耐药菌株,吉林地区相对较多,但不同地区菌株的药物MIC值差异无统计学意义(P0.05)。结论碘化钾无体外抗真菌活性,我国临床球形孢子丝菌对特比萘芬最敏感,其次为伊曲康唑和两性霉素B,对氟康唑敏感性最差,不同地区菌株对抗真菌药物的敏感性没有明显差异。     

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。     

1株多重耐药申克孢子丝菌感染的治疗

报道1例由多重耐药申克孢子丝菌引起的面部孢子丝菌病。患者61岁男性,面部皮疹2 a余,先后口服伊曲康唑、特比萘芬和氟康唑治疗16个月无效。患者皮损经真菌镜检和培养确诊为孢子丝菌病,分离的申克孢子丝菌体外药敏试验显示其菌丝相和酵母相对上述三种药物均不敏感。给予患者口服10%碘化钾溶液治疗3个月获得痊愈。     

特比萘芬治愈儿童鼻翼孢子丝菌病1例

目的报道1例发生在4岁儿童鼻翼的孢子丝菌病。方法刮取病变组织接种到沙堡弱培养基培养,并对培养出的病原菌进行形态学鉴定和ITS区序列分析。结果病变组织在沙堡弱培养基25℃培养长出黑褐色菌落,25℃小培养后光镜及扫描电镜下见菌丝细长,分枝分隔,合轴式产孢形成的成簇和沿菌丝两侧排列,分生孢子卵圆形。提取真菌总DNA用PCR方法扩增ITS序列,测序后登录GeneBank进行比对,该菌与申克孢子丝菌菌株KMU3360ITS区碱基序列一致性达99%,鉴定为申克孢子丝菌。内服联合局部应用特比萘芬治疗6个月后皮损完全消退。结论确诊1例儿童鼻翼的孢子丝菌病,内服联合局部应用特比萘芬治疗儿童孢子丝菌病疗效良好。     

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。     

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.     

外用和口服抗真菌药治疗足癣疗效评价

目的分别评价外用和口服抗真菌药治疗足癣的疗效,为足癣治疗提供参考。方法收集国内外已公开发表的有关外用和口服抗真菌药治疗足癣的临床随机对照试验进行分析评价。结果共有24篇文献入选,总病例数为3059例。外用联苯苄唑乳膏的疗效优于咪康唑和克霉唑乳膏;特比萘芬的疗效明显优于克霉唑乳膏;缺乏特比萘芬和联苯苄唑乳膏疗效比较的相关文献。口服特比萘芬(250mg/d,治疗2周)或伊曲康唑(100mg/d,治疗4周)均明显优于安慰剂和灰黄霉素(500mg/d,治疗4周或6周)。结论外用特比萘芬和联苯苄唑乳膏疗效均较理想;口服特比萘芬和伊曲康唑均有较好的临床疗效。     

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。     

Lymphocutaneous Sporotrichosis in an Immunocompetent Patient: A Case Report from Extreme Southern Italy

Sporotrichosis is a mycotic infection rarely encountered in European countries, including Italy. We describe lymphocutaneous sporotrichosis in an immunocompetent 64-year-old male Italian mason. The patient had linear nodules along the right upper arm with severe lymphadenopathy in the same arm. Sporothrix schenckii was identified by phenotypic and molecular methods. Treatment with itraconazole and methylprednisolone followed by administration of itraconazole alone successfully cured the infection. To our knowledge, this is the first documented report of sporotrichosis from Calabria and Sicily, extreme southern Italy.     

Melanins Protect Sporothrix brasiliensis and Sporothrix schenckii from the Antifungal Effects of Terbinafine

Terbinafine is a recommended therapeutic alternative for patients with sporotrichosis who cannot use itraconazole due to drug interactions or side effects. Melanins are involved in resistance to antifungal drugs and Sporothrix species produce three different types of melanin. Therefore, in this study we evaluated whether Sporothrix melanins impact the efficacy of antifungal drugs. Minimal inhibitory concentrations (MIC) and minimal fungicidal concentrations (MFC) of two Sporothrix brasiliensis and four Sporothrix schenckii strains grown in the presence of the melanin precursors L-DOPA and L-tyrosine were similar to the MIC determined by the CLSI standard protocol for S. schenckii susceptibility to amphotericin B, ketoconazole, itraconazole or terbinafine. When MICs were determined in the presence of inhibitors to three pathways of melanin synthesis, we observed, in four strains, an increase in terbinafine susceptibility in the presence of tricyclazole, a DHN-melanin inhibitor. In addition, one S. schenckii strain grown in the presence of L-DOPA had a higher MFC value when compared to the control. Growth curves in presence of 2×MIC concentrations of terbinafine showed that pyomelanin and, to a lesser extent, eumelanin were able to protect the fungi against the fungicidal effect of this antifungal drug. Our results suggest that melanin protects the major pathogenic species of the Sporothrix complex from the effects of terbinafine and that the development of new antifungal drugs targeting melanin synthesis may improve sporotrichosis therapies.     

Interaction with Pantoea agglomerans Modulates Growth and Melanization of Sporothrix brasiliensis and Sporothrix schenckii

Mycopathologia - Sporothrix brasiliensis and Sporothrix schenckii stand as the most virulent agents of sporotrichosis, a worldwide-distributed subcutaneous mycosis. The origin of Sporothrix...     

Sporotrichosis Successfully Treated with Terbinafine and Potassium Iodide: Case Report and Review of the Literature

Sporotrichosis is rare in Turkey. We report a 40-year-old woman who had subcutaneous sporotrichosis caused by sporothrix schenckii that was successfully treated with terbinafine (250 mg, twice a day) for a period of 6 months. She received a saturated solution of potassium iodide orally for two months. Terbinafine and potassium iodide are suggested to be the agents of choice for treatment of subcutaneous sporotrichosis.     

Interference of melanin in the susceptibility profile of Sporothrix species to amphotericin B

BackgroundThe presence of melanin in the fungal cell is a major virulence factor of the genus Sporothrix since it protects the fungal cells against the defense systems.AimsThe present study aimed to investigate the interference of melanin in the susceptibility of Sporothrix brasiliensis and Sporothrix schenckii sensu stricto to amphotericin B and itraconazole, drugs recommended as therapy for disseminated and subcutaneous sporotrichosis, respectively.MethodsYeast cells were cultivated in minimal medium with or without l-DOPA in order to induce the production of melanin. Microdilution and killing assay methods were used to determine the antifungal activity against yeast cells with different amounts of melanin.ResultsThe killing assay showed that melanization protected isolates within the S. schenckii complex from amphotericin B, particularly in the lower concentrations tested.ConclusionsStudies combining amphotericin B and inhibitors of melanin are required in order to avoid this effect.     

Evaluation of the Origin of a Sample of <Emphasis Type="Italic">Sporothrix Schenckii</Emphasis> that Caused Contamination of a Researcher in Southern Brazil

We report a case of a researcher from a laboratory of Mycology in Rio Grande do Sul, Brazil that presented a clinical evidence of sporotrichosis. The researcher had an accident while manipulating the microculture slides of chromoblastomycosis agents and presented a clinical evidence of sporotrichosis. As the laboratory has some cultures of Sporothrix schenckii, it was suggested that it might be a laboratory contamination. In order to test this hypothesis, the genotypic characterization of the samples was performed by means of the random amplified polymorphic DNA (RAPD) analysis method. In addition, we evaluated the in vitro antifungal activity of four antifungal agents against the isolated fungus. The sample obtained from the researcher was not genetically similar to any of the samples kept in the laboratory and showed the minimum inhibitory concentrations of 0.5 μg/mL for itraconazole and ketoconazole, >64 μg/mL for fluconazole and 0.125 μg/mL for terbinafine. It is suggested that the contamination had an environmental origin.