伊曲康唑联合特比萘芬治愈着色芽生菌病1例

报告1例由卡氏枝孢瓶霉引起的着色芽生菌病。患者男性,43岁,因右上臂局限性红色斑块性皮损5 a就诊。皮损组织病理为慢性炎性肉芽肿改变,可见硬壳细胞。真菌培养鉴定为卡氏枝孢瓶霉。给予伊曲康唑(200 mg/d)和特比萘芬(250 mg/d)联合治疗12周痊愈。     

伊曲康唑治愈着色芽生菌病1例

着色芽生菌病（chromoblastomycosis）是由暗色真菌引起的皮肤及皮下组织的慢性肉芽肿性疾病。致病真菌常通过皮肤的微小外伤侵入,损害好发于四肢远端的暴露部位。临床表现为疣状增生性斑块或结节,病程持久,迁延不愈。最近我们用伊曲康唑治愈1例着色芽生菌病患者,报告如下。     

卡氏枝孢霉致着色芽生菌病2例

着色芽生菌病是一种慢性难治的皮肤及皮下组织真菌感染性疾病,其病原菌为暗色真菌属,最常见的是裴氏着色霉、卡氏枝孢霉及疣状瓶霉,常以孢子形态寄生于腐生植物或土壤中,人多通过外伤接触植入感染。其诊断依据病原学检查,治疗为以抗真菌为主的综合治疗方法。现报告2例我科诊断的由卡氏枝孢霉感染的着色芽生菌病。     

着色真菌monophora引起皮肤着色芽生菌病1例

目的报道1例由着色真菌monophora引起的皮肤着色芽生菌病。方法取皮损皮屑标本进行真菌直接镜检和培养,同时取活检进行真菌培养和组织病理学检查。对真菌培养阳性菌株进行形态学鉴定、温度试验和放线菌酮耐受试验,PCR扩增测序。结果KOH涂片检查可见较多圆形厚壁棕色硬壳细胞。组织病理学显示为慢性肉芽肿样改变;PAS和银染色可见到圆形厚壁的硬壳细胞。真菌菌落生长缓慢,呈橄榄色到黑色。小培养可见大量棕色菌丝、分支分隔,分生孢子梗主要为喙枝孢型,分生孢子棕色,椭圆形或卵圆形,单细胞。温度试验37℃生长,38℃不生长。0．01％、0．05％和0．1％放线菌酮均能耐受。扩增真菌rDNA的ITS区得到645bp的片段,经序列分析与裴氏着色真菌monophora变种ITS区比对,100％一致。结论据真菌学形态结构特征以及DNA序列分析菌种被鉴定为着色霉monophora。     

Fonsecaea monophora所致着色芽生菌病1例CSCD

患者,男,63岁,因“左手腕结节斑块半个月”为主诉就诊我科门诊。左手腕肥厚性的肉色斑块,结节,表面疣状增生,病理活检见真皮及多核巨细胞胞浆内褐色厚壁圆形硬壳小体。PAS染色(+),真菌培养见暗棕至黑色菌落生长;经测序,最终确诊为Fonsecaea monophora所致着色芽生菌病。予口服伊曲康唑治疗,但由于患者原发矽肺症状加重,后因矽肺引发并发症死亡。     

裴氏着色芽生菌病1例

1临床资料 患者男,60岁,农民。左下肢皮肤瘢痕、斑块11 a。11 a 前,不慎跌倒擦伤左膝下方皮肤,局部溃烂长期不愈。口服抗生素,外用碘伏,红霉素软膏治疗后无效,当地医院按真菌感染先后予口服伊曲康唑,氟康唑,特比萘芬不规则治疗,期间皮损大部分愈合形成瘢痕。其后瘢痕逐渐扩大并时有疼痛。后又在当地医院按“瘢痕疙瘩”予复方倍他米松注射液局部封闭治疗2次,瘢痕未缩小却在边缘渐出现红色斑块,肿胀并有浸润。遂来我院就诊。     

Fonsecaea monophora致皮肤着色芽生菌病1例

报告重庆地区1例由Fonsecaea monophora感染引起的皮肤着色芽生菌病。患者,男,81岁,因左上臂内侧皮肤被铁片划伤后出现溃疡伴疼痛1年余到我院就诊。对患者皮损组织行组织病理学检查和真菌培养,将培养出的菌落做形态学和分子生物学鉴定。真菌培养获得菌落形态,小培养乳酸酚棉兰染色得到镜下特征形态,菌落形态：可见暗棕色和黑色菌落生长;镜下形态：可见枝孢型和喙枝孢型产孢;皮损处组织病理学检查结果：可见慢性肉芽肿样改变。ITS(internal transcribed spacer)区域测序鉴定结果为Fonsecaea monophora。根据实验室培养结果和临床资料分析确定该例为Fonsecaea monophora感染引起的着色芽生菌病。口服伊曲康唑200 mg, 2次/日,联合药物涂抹和光动力学治疗有效。     

裴氏着色霉致着色芽生菌病1例并文献复习

报道1例裴氏着色霉致左手背及腕部着色芽生菌病,通过文献复习统计并分析该病在我国的流行病学及临床特点.患者男,48岁,左手背部红斑、疣状增生伴瘙痒10 a.皮损组织病理检查示真皮中下层有炎细胞及多核巨细胞,PAS染色见硬壳小体.经真菌培养和分子鉴定为裴氏着色霉.经伊曲康唑600 mg每日口服,治疗3个月后好转.     

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.     

首次报道中国北方Fonsecaea monophora所致着色芽生菌病1例及其相关实验研究

目的首次报道中国北方1例由Fonsecaea monophora所致着色芽生菌病。方法患者男性,58岁,主因"右腕部皮损伴瘙痒8~9a"就诊。对皮损脓液直接镜检,皮损组织病理检查,真菌培养,并对培养获得菌株进行形态学,分子生物学鉴定等实验室研究。结果脓液直接镜检可见多个圆形、厚壁、棕色硬壳细胞,皮损组织病理表现为慢性肉芽肿样改变,并可见硬壳小体。真菌培养可见暗棕色,橄榄色至黑色菌落生长,生长速度较慢,镜下可见枝孢型和喙枝孢型产孢。ITS区序列分析鉴定为Fonsecaea monophora。依据临床及实验室检查确诊该例为Fonsecaea monophora所致的着色芽生菌病。口服伊曲康唑200mg,1次/d;特比萘芬250mg,1次/d。治疗3个月后,皮损消退痊愈。结论 Fonsecaea monophora感染也可见于我国北方地区的着色芽生菌病患者,而ITS区序列分析是该菌种鉴定的重要手段,伊曲康唑联合特比萘芬治疗本例患者显示较好疗效。     

Treatment of deep mycoses with itraconazole

Four patients with deep mycoses were treated with itraconazole. Two patients had chromoblastomycosis, one patient each had aspergillosis and Rhinofacial zygomycosis. These patients were either resistant to or showed poor response to Amphotericin B and/or ketoconazole. After the initial clinical and mycological evaluation, itraconazole was given in a daily dose of 200 mg orally. All patients responded to the drug very well. No adverse effects attributable to itraconazole were detected.     

Histopathology of chromoblastomycosis

Summary A study aimed at determining the histopathologic appearance of chromoblastomycotic lesions was undertaken. Biopsies from 26 patients with the disease were examined. It was found that 23 cases (88.46%) exhibited the organized mixed mycotic granuloma — OMMA —, a granuloma modified by the presence polymorphonuclear neutrophils — PMN's. An equal proportion of cases exhibited pseudoepitheliomatous hyperplasia, with the epithelium playing an important role in the transepidermic elimination of the fungus. Healing of the lesions took place by fibrosis which was observed in 21 (80.77%) patients; this type of reaction was more common in the deeper areas of the dermis.     

Cellular immune response of patients with chromoblastomycosis undergoing antifungal therapy

One of the most characteristic features of the chromoblastomycosis is its unresponsiveness to treatment. In order to analyzed whether during therapy could be observed a change of cellular immune response pattern, we evaluated the production of IL-10, TNF-α and IFN-γ, as well as proliferation of peripheral blood mononuclear cell (PBMC) from patients in different periods of chemotherapy treatment. Our results showed that after 6 months of treatment cells from patients proliferated to fungal antigens and produced a significant level of IFN-γ. However, after 1 year of treatment a low proliferation of T cells and production of IFN-γ accompanied by an increase of IL-10 were observed when compared with 6 months of treatment.     

伊曲康唑联合外用药物治疗花斑糠疹临床研究

目的探讨伊曲康唑胶囊联合1%盐酸布替萘芬乳膏和2%酮康唑洗剂治疗花斑糠疹的疗效及不良反应。方法入选患者按单双日分为两组,两组均口服伊曲康唑0.2g,1次/d,连续7d,同时外用1%盐酸布替萘芬乳膏,1次/d,连续14d,对照组停药观察,试验组同时使用2%酮康唑洗剂洗浴,每周2次,连用3个月。分别于治疗前、治疗后1、3、6、12个月评价疗效。结果试验组114例患者3个月时痊愈率78.1%,6个月时痊愈率90.4%,对照组125例患者3个月时痊愈率72.8%,6个月时痊愈率75.2%,12个月后试验组复发率1.8%,对照组为18.4%。结论伊曲康唑胶囊短时口服联合外用布替萘芬和酮康唑洗剂洗浴疗效较好,安全性高,使用方便,可大大降低花斑糠疹的复发率。     

Biology and pathogenesis of Fonsecaea pedrosoi, the major etiologic agent of chromoblastomycosis

Fonsecaea pedrosoi is the principal etiologic agent of chromoblastomycosis, a fungal disease whose pathogenic events are poorly understood. Treatment of the disease presents poor effectiveness and serious side effects. The disease is epidemiologically important in several regions, which has stimulated studies focused on the biology and pathogenic potential of its major causative agent. In this review, we summarize the current knowledge on the biological aspects of F. pedrosoi, including cell differentiation and pathogenic mechanisms during the interaction of fungi with different hosts' elements.     

小鼠烟曲霉角膜炎的实验研究

目的 比较伊曲康唑和氟康唑对烟曲霉的体外抗菌活性,观察伊曲康唑对小鼠烟曲霉角膜炎的治疗作用.方法 通过角膜基质注射法建立烟曲霉角膜炎小鼠模型.造模后观察角膜病变,取角膜病变处分泌物做真菌镜检、真菌培养以证实造模成功.用药基法检测伊曲康唑和氟康唑对烟曲霉的最低抑菌浓度( MIC)和最低杀菌浓度(MFC).对烟曲霉角膜炎小鼠给予伊曲康唑治疗,治疗结束行临床评分、炎性评分、菌落形成单位测定以评价疗效.结果 伊曲康唑对烟曲霉的MIC和MFC分别为6.25 μg/mL、12.5 μg/mL;氟康唑对烟曲霉的MIC和MFC分别为500 μg/mL、1 000 μg/mL.伊曲康唑治疗组临床评分、炎性评分和测定的菌落数较对照组均明显减少(P＜0.05).结论 伊曲康唑对烟曲霉的体外抗菌活性优于氟康唑,并且对烟曲霉性角膜炎有明显疗效.     

Onychomycosis in Tehran,Iran: Prevailing fungi and treatment with itraconazole

A total of 187 Patients with suspected onychomycosis were examined for causative fungal agents between 1996 and 1997. Laboratory examination confirmed onychomycosis in 115 patients, of which 97 cases were presented with positive microscopic and cultural examinations, and they were selected for itraconazole pulse therapy. From an etiological point of view, 48.4% of the nail infections, mainly toenail infections, were caused by dermatophytes, 43.3% were infected with Candida spp, specially infected fingernails, and 8.2% by non-dermatophytic molds. Trichophyton mentagrophytes var. interdigital and T. violaceum were the most prevalent species. Candida albicans and C. parapsilosis were the predominant species of the Genus Candida. Scopolariopsis brevicaulis was the most common non-dermatophyte molds observed. Female affected more frequently than male and in both sexes, those who were 30–49 years old, more infected. Toenails were affected more frequently than fingernails. In this study, itraconazole pulse therapy (400 mg daily) gave during the first week of per month for 3 months. The study included 51 patients with toenail onychomychosis (group 1) and 46 patients with fingernail infections (group 2). Patients were followed up for 9 months after the last treatment. Clinical response rates were 83% in the group 1, 95% in the group 2 at month 12; the corresponding mycological cure rates were 71 and 87%, respectively. This revised version was published online in June 2006 with corrections to the Cover Date.     

伊曲康唑治疗复发性外阴阴道念珠菌病38例临床观察

目的了解国产伊曲康唑（商品名“美扶”）治疗复发性外阴阴道念珠菌病的疗效。方法收集38例复发性外阴阴道念珠菌病为治疗组,口服伊曲康唑200mg,1次／d,连续7d,以后每次月经第1天口服伊曲康唑200mg,1次／d,连续6个月经周期停药,而对照组20例则单子硝酸咪康唑栓200mg阴道外用,方法同前。两组完成冲击治疗后1周、3个月、6个月评价疗效。结果1周后治疗组总有效率为92．1％,对照组为90％,两组相比无统计学差异。3个月、6个月后治疗组的复发率分别为3．2％、6．7％,对照组为28．6％、38．5％,两组相比有统计学意义。结论伊曲康唑短程冲击治疗加长期间断给药对复发性外阴阴道念珠菌病的治疗和预防复发效果满意。