误诊为头皮脓肿经抗生素及植皮治疗无效的脓癣——附2例报告

目的 报道2例误诊为头皮脓肿经长期抗生素及植皮治疗失败的须癣毛癣菌所致的脓癣病患者,分析脓肿和脓癣的鉴别要点。方法 例1为9岁男童,头皮外伤后脓肿、溃疡28d,经抗生素治疗无效,行植皮术后5d再发生脓肿溃疡。取皮损处断发行10％KOH涂片镜检、培养,发现并分离出致病真菌,沙堡弱琼脂培养基上呈白色粉状菌落,可使含尿素培养基变红,即尿素酶试验阳性,小培养见螺旋菌丝及分隔棒状大分生孢子,鉴定为须癣毛癣菌。例2为8岁女童,头顶脓肿、溃疡24d,抗感染治疗不愈而接受植皮,术后7d再发脓性丘疹。从皮损处标本中发现、分离出致病真菌,经上述方法鉴定为须癣毛癣菌。结果 2例患者结合真菌学检查和临床表现确诊为脓癣,予伊曲康唑100mg／d内服近2个月皮损均痊愈,但供皮区遗留瘢痕和色素改变。结论 真菌病原学检查是避免脓癣误诊的关键,伊曲康唑内服治疗脓癣有效、安全。     

须癣毛癣菌致成人眉区脓癣1例

报告1例由须癣毛癣菌引起的眉毛区域脓癣。患者女性,46岁,左眉部周围红斑1个月。致病菌株经真菌学鉴定为须癣毛癣菌。给予盐酸特比萘芬250mg/d口服,硝酸舍他康唑软膏外用,治疗1个月后皮损完全愈合。     

须癣毛癣菌所致面部体癣继发癣菌疹1例

报道1例由须癣毛癣菌引起面部体癣后继发的癣菌疹。患者女,10岁,因右眶周红斑、鳞屑10 d就诊。鳞屑直接镜检查见菌丝,培养生长的菌落鉴定为须癣毛癣菌。内服特比萘芬、外用萘替芬酮康唑乳膏治疗8 d后面部及颈胸部出现片状红斑,考虑为癣菌疹,加服抗过敏、抗炎药物(左西替利嗪、复方甘草酸苷片)、外用卤米松/三氯生软膏14 d后皮损消退。     

须癣毛癣菌致人兔共患体癣3例

报道须癣毛癣菌引起的人兔共患体癣3例.患者皮损均为环状红斑丘疹,上覆鳞屑,炎症明显,伴瘙痒,均与兔子有密切接触史,且兔子均有明显皮损.取患者及兔子的皮屑真菌镜检及培养,鉴定为须癣毛癣菌,经口服及外用抗真菌药物后治愈.     

须癣合并面颈部体癣1例

患者男,57岁。面部红斑、丘疹、唇部脓疱灼痛2个月余。曾口服和外用多种中药治疗无效且呈加重趋势。取皮屑、胡须镜检见大量真菌菌丝,培养见棒状分隔大分生孢子、葡萄串状小分生孢子。尿素酶实验阳性、毛发穿孔实验阳性,鉴定为须癣毛癣菌。经内服伊曲康唑胶囊和外用盐酸布替萘芬乳膏治疗10 d后病情好转,2个月后皮损消退。复查真菌阴性。     

母女共患须癣毛癣菌感染3例CSCD

病例1,女,9岁,头皮红斑、丘疹、脱屑,伴脓肿1个月,切开引流术后1 d;病例2,女,9岁,鼻背红斑2周伴脓疱3 d。病例3,女,38岁,面部红斑、脱屑,伴瘙痒1周。病例1、2为孪生姐妹,病例3为病例1、2的母亲。3例患者皮损经真菌镜检、培养及分子生物学测序均鉴定为须癣毛癣菌。病例1密切接触过流浪猫。病例1诊断为脓癣,经口服甲泼尼龙(美卓乐)片,口服伊曲康唑胶囊,外用酮康唑洗剂后病情明显好转。病例2、3诊断为面癣,外用卢立康唑4周后痊愈,未留瘢痕。以上病例目前仍在随访中。     

红色毛癣菌致儿童脓癣1例

报道儿童脓癣1例。患儿男,5岁,头部左后侧圆形脓肿破溃结痂伴瘙痒疼痛半个月余。取断发及脓液直接镜检及真菌培养均阳性,做小培养确定菌种为红色毛癣菌,经综合治疗后痊愈。     

难辨认癣1例

36岁女性患者,右小腿丘疹红斑、脓疱、渗液伴瘙痒5个月。查体见:右小腿可见大小不等的丘疹红斑,伴有糜烂渗液。真菌荧光镜检:阳性,真菌培养:须癣毛癣菌,诊断:难辨认癣。口服伊曲康唑分散片0.1 g,2次/日,外用酮康唑乳膏2次/日,治疗2周后,皮损明显好转,治疗1个月后,右小腿皮肤基本恢复正常,目前随访中。     

须癣毛癣菌所致脓癣病发的扫描和透射电镜观察及菌体外酶活性分析：2例报告

目的报道2例由须癣毛癣菌引起的脓癣,并对病发做扫描和透射电镜观察及菌体外分泌酶活性测定。方法例1为6岁女孩,表现为头顶部炎性肿块、脓血伴脱发;例2为1岁8个月男孩,表现为头部红斑,无脓肿及脱发。家中分别饲养宠物狗和兔。病发真菌镜检均阳性后做真菌培养、生化鉴定及分子生物学鉴定。对2例患儿病发用扫描和透射电镜进行超微结构观察。对2株分离的菌株分别进行细胞外分泌酶测定。结果2株菌均鉴定为万博节皮菌（须癣毛癣菌的有性期）。扫描电镜见例1的病发受累毛干表面大量炎性组织碎屑、红细胞、脓细胞及上皮细胞;透射电镜在毛皮质内发现菌体。扫描电镜见例2的受累毛干表面真菌孢子及炎性渗出物;透射电镜见毛发内外菌体。2株菌的外分泌酶主要为碱性磷酸酶、白氨酸芳胺酶、β-葡萄糖甙酶、N-乙酰-葡萄糖胺酶、α-甘露糖甙酶。经口服伊曲康唑胶囊等综合治疗后2例均痊愈,未见不良反应。结论确诊2例须癣毛癣菌所致脓癣,伊曲康唑胶囊等药物联合治疗有效。     

麻类织物对须癣毛癣菌生长抑制作用的研究

目的通过分析汉麻、亚麻和苎麻对须癣毛癣菌生长的影响,探讨麻类织物对浅部真菌的抑制作用。方法实验采用振荡法。将3种麻类织物分别与须癣毛癣菌混合培养,对照组为棉布组,3d后分别取培养液稀释5倍后涂布培养皿,计算各自的菌落数和抑菌率并进行统计分析。结果麻类织物组菌落数明显少于对照组棉布组(P<0.01),3种麻类织物对须癣毛癣菌的抑菌率均高于60%,但3种麻类织物的抑菌率之间无明显差异(P<0.01)。结论3种麻类织物均可显著抑制须癣毛癣菌的生长,麻类织物有可能用来预防由须癣毛癣菌引起的足癣、股癣等浅部真菌病。     

误诊2年的左上臂难辨认体癣1例

报道1例由须癣毛癣菌引起的难辨认体癣。患者女,45岁,左臂伸侧多处红斑、丘疹伴脱屑、瘙痒2a余。曾多次就医诊断不明,患处皮损取活检做病理检查倾向于＂银屑病＂但疗效不佳。刮取皮屑镜检见真菌菌丝,小培养见葡萄串状小分生孢子及螺旋菌丝,尿素酶试验阳性,毛发穿孔试验阳性,鉴定为须癣毛癣菌。经内服特比萘芬和外用萘替芬酮康唑乳膏治疗28d后皮损消退,复查真菌阴性。     

面癣误诊1例

报道由须癣毛癣菌感染引起并被长期误诊的面癣1例。患者女,37岁,因"面部反复红斑、丘疹、水疱伴瘙痒半年"就诊。多次被误诊为单纯疱疹、脓疱疮、湿疹、皮肤感染、脂溢性皮炎及玫瑰痤疮等,先后应用抗病毒、抗感染和抗过敏治疗,皮损未能完全消退并逐渐扩大。再次就诊,真菌学直接镜检阳性,真菌培养为须癣毛癣菌。给予口服特比萘芬片、外用联苯苄唑乳膏治疗后痊愈。     

密切接触宠物兔后幼儿鼻孔周围体癣1例

报道1例密切接触宠物兔后发生在幼儿双侧鼻孔周围及上唇部的体癣。患儿4岁,因“鼻唇部红斑、鳞屑、伴瘙痒10余日”就诊。取皮屑镜检见真菌菌丝及毳毛内孢子,培养见棒形分隔大分生孢子、葡萄串状小分生孢子及螺旋菌丝。尿素酶试验阳性、毛发穿孔试验阳性,鉴定为须癣毛癣菌。经内服伊曲康唑胶囊和外用萘替芬酮康唑乳膏治疗6d后红斑瘙痒明显减轻,34d后皮损消退。复查真菌阴性。     

Cytoplasmic fungal lipases release fungicides from ultra-deformable vesicular drug carriers

The Transfersome? is a lipid vesicle that contains membrane softeners, such as Tween 80, to make it ultra-deformable. This feature makes the Transfersome? an efficient carrier for delivery of therapeutic drugs across the skin barrier. It was reported that TDT 067 (a topical formulation of 15 mg/ml terbinafine in Transfersome? vesicles) has a much more potent antifungal activity in vitro compared with conventional terbinafine, which is a water-insoluble fungicide. Here we use ultra-structural studies and live imaging in a model fungus to describe the underlying mode of action. We show that terbinafine causes local collapse of the fungal endoplasmic reticulum, which was more efficient when terbinafine was delivered in Transfersome? vesicles (TFVs). When applied in liquid culture, fluorescently labeled TFVs rapidly entered the fungal cells (T(1/2)~2 min). Entry was F-actin- and ATP-independent, indicating that it is a passive process. Ultra-structural studies showed that passage through the cell wall involves significant deformation of the vesicles, and depends on a high concentration of the surfactant Tween 80 in their membrane. Surprisingly, the TFVs collapsed into lipid droplets after entry into the cell and the terbinafine was released from their interior. With time, the lipid bodies were metabolized in an ATP-dependent fashion, suggesting that cytosolic lipases attack and degrade intruding TFVs. Indeed, the specific monoacylglycerol lipase inhibitor URB602 prevented Transfersome? degradation and neutralized the cytotoxic effect of Transfersome?-delivered terbinafine. These data suggest that (a) Transfersomes deliver the lipophilic fungicide Terbinafine to the fungal cell wall, (b) the membrane softener Tween 80 allows the passage of the Transfersomes into the fungal cell, and (c) fungal lipases digest the invading Transfersome? vesicles thereby releasing their cytotoxic content. As this mode of action of Transfersomes is independent of the drug cargo, these results demonstrate the potential of Transfersomes in the treatment of all fungal diseases.     

Characterization of the cyclophilin of Trichophyton mentagrophytes

A genetic approach to cyclophilins in a dermatophyte, Trichophyton mentagrophytes, was carried out. The nucleotide and deduced amino acid sequences of the cyclophilin of T. mentagrophytes shared about 70% sequence similarity with those of Schizosaccharomyces pombe, Saccharomyces cerevisiae and Candida albicans. However, the first 21 amino acid and the C-terminal amino acid regions of 188 to 226 of the T. mentagrophytes cyclophilin were distinct from those of the other fungal cyclophilins. The recombinant glutathione S-transferase (GST)-T. mentagrophytes cyclophilin fusion protein produced by Escherichia coli was purified. The protease digest of the fusion protein had a molecular weight of about 13 kDa and peptidyl-prolyl cis-trans isomerase (PPI) activity. This digest protein from T. mentagrophytes was confirmed to be cyclophilin by proving PPI activity.     

石膏样小孢子菌所致面部难辨认癣1例

报道1例由石膏样小孢子菌引起的面部难辨认癣。患者为青年女性,因右眼上眼睑及周围出现浸润性斑块2个月就诊。2个月前发疹部位有烫伤史。经真菌培养和病理检查确诊为“石膏样小孢子菌感染”。予伊曲康唑胶囊口服、外用特比萘芬乳膏1周后痊愈。     

Fonsecaea monophora所致着色芽生菌病1例及其相关实验研究

目的 报道1例由Fonsecaea monophora所致的着色芽生菌病.方法 患者女,60岁,主因左手背皮损1 a余就诊,取皮损痂屑进行真菌直接镜检和培养,取皮损组织进行组织病理学检查和真菌培养.对培养获得菌株进行形态学和分子生物学鉴定,并进行药物敏感性检测.结果 真菌直接镜检阳性,可见较多圆形、厚壁、棕色的硬壳细胞.组织病理学显示为慢性肉芽肿样改变;HE和PAS染色均可见到圆形、厚壁、棕色的硬壳细胞.真菌培养阳性,菌落生长缓慢,呈橄榄色到黑色.小培养及扫描电镜检查可见枝孢型和喙枝孢型产孢,分生孢子单细胞性,呈椭圆形或卵圆形.ITS区序列分析鉴定为Fonsecaea monophora.药敏试验显示伊曲康唑对F.monophora的最低抑菌浓度（minimal inhibitory concentration,MIC）为1.0 μg/mL,特比萘芬的MIC为0.015 6μg/mL.给予患者口服特比萘芬250 mg/d治疗,皮损缓慢好转;6周后加服伊曲康唑200 mg/d治疗,14周后皮损消退呈瘢痕化修复.结论 依据临床及实验室检查确诊该病例为Fonsecaeamonophora所致着色芽生菌病,伊曲康唑联合特比萘芬治疗本病例显示较好疗效.     

蒺藜TTS-12对须癣毛癣菌的体内外抗菌活性研究

为考察天然产物蒺藜TTS-12对须癣毛癣菌的体外和体内抗菌活性,本研究采用CLSI的M38-A2方案对须癣毛癣菌进行最小抑菌和杀菌浓度的检测,选取多重指标考察TTS-12对须癣毛癣菌的抑菌作用;建立豚鼠感染须癣毛癣菌豚鼠体癣模型,分组给药观察低、中、高剂量蒺藜TTS-12凝胶剂对豚鼠体癣模型在背部病变程度评分,病灶皮肤真菌培养阴性率,病灶皮肤病理变化的影响。结果发现,TTS-12对须癣毛癣菌的标株菌株的MIC值为1μg/mL,MFC为8μg/mL,其还能够显著抑制须癣毛癣菌的菌丝生长,浓度为4μg/mL的TTS-12作用15天时,菌丝生长抑制率已经高于60%,且对须癣毛癣菌的孢子萌发抑制作用呈时间和浓度依赖性。动物实验中,低、中、高剂量蒺藜TTS-12凝胶剂均能显著降低背部病变程度评分(P<0.01),中、高剂量能增高病灶皮肤真菌培养阴性率(P<0.05),病灶皮肤HE染色切片表明高剂量组棘层肥厚降低,背部炎症减弱,使角质层恢复正常。以上结果表明蒺藜TTS-12在体外抗须癣毛癣菌和豚鼠体癣模型中均有较好的活性。     

Visual micromethod for assay of fungal growth

A visual micromethod for measuring antifungal effects on germination and growth is described. The antifungal agent griseofulvin and the fungus Trichophyton mentagrophytes were used as materials to compare the micromethod with a standard assay based on dry mycelial weight. The micromethod was more sensitive than the weight method in detecting the minimum inhibitory concentration of griseofulvin (0.18 and 35 microgram/ml, respectively). At higher concentrations of griseofulvin (22.5 microgram/ml), the micromethod measured minimal fungal growth that was undetectable on a weight basis. The micromethod showed that griseofulvin does not change the number of spores forming germ tubes. Progressively severe alterations in fungal morphology occured as the concentration of griseofulvin was increased from 0.09 to 22.5 microgram/ml.