参照CLSIM38-A方案测定皮肤癣菌临床株对4种抗真菌药物的敏感性

目的测定并比较临床分离的皮肤癣菌对4种常用抗真菌药物的敏感性,探讨CLSIM38-A方案用于皮肤癣菌药敏试验的可行性。方法实验菌株为31株临床近期分离的皮肤癣菌。其中红色毛癣菌14株,须癣毛癣菌14株,犬小孢子菌1株,铁锈色小孢子菌1株,絮状表皮癣菌1株。4种抗真菌药物为益康唑、伊曲康唑、特比萘芬、伏立康唑。采用M38-A方案微量稀释法,并适当调整试验参数进行体外抗真菌药物敏感性试验。结果红色毛癣菌和须癣毛癣菌对以上4种药物的敏感性无明显差异。犬小孢子菌、铁锈色小孢子菌、絮状表皮癣菌对所有4种抗真菌药物的敏感性都低于红色毛癣菌和须癣毛癣菌。结论M38-A方案经过调整适用于皮肤癣菌药敏试验。     

卡泊芬净、米卡芬净对8种皮肤癣菌体外抑菌活性的研究

目的评价棘白菌素类抗真菌药物卡泊芬净（caspofungin）、米卡芬净（micafungin）针对常见致病性皮肤癣菌的体外抗菌活性。方法参考CLSI制定的M38-A2方案。测定82株常见皮肤癣菌的最低有效浓度（minimal effective concentrations,MECs）。结果按照MEC90浓度从高到低,米卡芬净对紫色毛癣菌和断发毛癣菌的MEC90是0.25μg/mL;对犬小孢子菌、疣状毛癣菌的MEC90为0.06μg/mL;对红色毛癣菌、须癣毛癣菌、石膏小孢子菌、絮状表皮癣菌的MEC90均在0.03μg/mL。②卡泊芬净对红色毛癣菌、紫色毛癣菌和断发毛癣菌的MEC90为1μg/mL;对须癣毛癣菌、犬小孢子菌、石膏小孢子菌、絮状表皮癣菌和疣状毛癣菌的MEC90为0.5μg/mL。③根据中位数检验,米卡芬净对几种皮肤癣菌的MEC值均低于卡泊芬净的MEC值,统计学比较有显著性差异（P〈0.05）。结论米卡芬净和卡泊芬净对皮肤癣菌有较强的抑菌作用,米卡芬净的MEC值低于卡泊芬净。     

常见皮肤癣菌体外药物敏感试验的研究

目的比较液基稀释法和纸片扩散法对临床常见皮肤癣菌的体外药物敏感性。方法应用Rosco纸片扩散法和微量液基法（参考美国国家实验室标准委员会NCCLS推荐的M38-P方案修改方案）测定临床分离的40株皮肤癣菌（包括红色毛癣菌、须癣毛癣菌、犬小孢子菌及絮状表皮癣菌）对两性霉素B、伊曲康唑、氟康唑和特比萘芬的体外药物敏感性。结果应用Rosco纸片扩散法,大部分菌株在7—9d时可读到清晰的结果。Rosco纸片扩散法和微量液基法结果中,特比萘芬、伊曲康唑和两性霉素B一致性较好,氟康唑较差。结论Rosco纸片扩散法操作简单,可选择用于皮肤癣菌对某些抗真菌药的药敏试验。     

126例面癣临床因素及病原菌分析

目的探讨面癣的致病菌种、临床特点及发病相关因素。方法对126例面癣患者进行真菌分离培养鉴定及流行病学分析。结果面癣见于各年龄段,以11～30岁最多见。患病动物接触史、合并其他部位浅部真菌病史及糖皮质类固醇激素类药物外用史是面癣发病的重要危险因素。分离出皮肤癣菌108株,包括红色毛癣菌63株（58．3％）、犬小孢子菌25株（23．1％）、须癣毛癣菌18株（16．7％）和石膏样小孢子菌2株（1．9％）。结论面癣的发病没有年龄差异,患者可见于各个年龄阶段;面癣的常见致病真菌绝大多数为红色毛癣菌和犬小孢子菌,其发病可能与患者自体接种或接触患病动物相关。面癣容易被误诊,及时进行真菌镜检和培养是降低面癣误诊率的关键。     

阴囊皮肤癣菌病患者临床及 真菌学分析

目的探讨阴囊皮肤癣菌病患者的致病菌、临床特征、易感因素及治疗转归等相关因素。方法回顾性分析2007-2017年广州市中山大学附属第三医院经真菌学检查确诊的24例阴囊癣病例,分析患者一般资料、临床特征、发病相关因素、合并其他部位浅部真菌病情况、病原菌及治疗转归等情况。结果 24例阴囊癣患者均为青少年,平均年龄19.6岁,平均病程2.9个月。患者分离皮肤癣菌24株,其中石膏样小孢子菌15株(62.50%)、红色毛癣菌7株(29.17%)和絮状表皮癣菌2株(8.33%)。石膏样小孢子菌主要引起阴囊单纯性感染,临床表现为特征性的白色伪膜样斑片,而红色毛癣菌多引起阴囊及其他部位皮肤癣菌病。结论阴囊癣多见于青少年,石膏样小孢子菌为主要病原菌,其临床表现具有一定特征性。     

85株皮肤癣菌感染的病原菌分析及标准化体外药物敏感性研究

目的分析深圳地区教学医院门诊皮肤癣菌感染的病原菌特点,测定7种抗真菌药物对85株皮肤癣菌的体外抗真菌活性。方法收集疑诊为皮肤癣菌感染的患者的皮屑(或甲板刮屑、毛发)进行KOH直接镜检和培养。并通过测定皮肤癣菌临床分离菌株的核糖体DNA内转录间隔区(ITS)区序列鉴定菌种。参考CLSI M38-A2方案,测定7种抗真菌药物对85株鉴定为皮肤癣菌的临床分离菌株的体外抗真菌活性。结果 161例疑诊为皮肤癣菌感染的患者中KOH直接镜检皮肤癣菌的阳性率为67.7%,真菌培养皮肤癣菌的阳性率为52.8%。菌种鉴定结果为红色毛癣菌68例、犬小孢子菌7例、石膏样小孢子菌3例、趾间毛癣菌5例、紫色毛癣菌1例、断发毛癣菌1例。体外药敏试验显示特比萘芬(GM MIC,0.032μg·mL~(-1), MIC范围, 0.001～0.125μg·mL~(-1))对6种皮肤癣菌表现出良好的体外抗真菌活性,而伏立康唑(GM MIC, 0.041μg·mL~(-1), MIC范围, 0.032～0.125μg·mL~(-1))在唑类药物中的体外MIC值相对较低。结论本研究中皮肤癣菌感染的致病菌以红色毛癣菌为主。标准化药敏试验证实特比萘芬和伏立康唑对分离的皮肤癣菌具有较强体外抗菌活力,适用于本地区皮肤癣菌感染的治疗。     

不同地区浅部真菌病病原菌流行状况比较

目的了解近半年来华东、华南、华北地区浅部真菌病病原菌的种类、构成情况以及菌种变迁。方法以近半年来在上海、广州、北京3家教学医院皮肤科就诊的浅部真菌病患者为3个地区的代表,对具有典型浅部真菌病临床表现且真菌镜检阳性的患者进行致病真菌的分离培养。结果共分离出致病真菌926株,其中红色毛癣菌544株（58.7%）,念珠菌132株（14.3%）,犬小孢子菌119株（12.9%）,须癣毛癣菌23株（2.5%）,石膏小孢子菌16株（1.7%）。华东地区浅部真菌构成比复杂,华南及华北地区相对简单。结论不同地区浅部致病真菌菌种及构成比存在差异;三地红色毛癣菌均仍占优势;而念珠菌和犬小孢子菌所占比例有上升趋势。     

聚六亚甲基双胍体外抗真菌作用研究

目的探讨聚六亚甲基双胍(PHMB)对浅部真菌病常见致病菌的杀灭作用。方法参照标准的微量液基稀释法和琼脂稀释法检测PHMB粉剂和溶液对红色毛癣菌、须癣毛癣菌、犬小孢子菌及白念珠菌临床分离株的体外最低抑菌浓度(MIC)和最低杀菌浓度(MFC)。结果 PHMB对红色毛癣菌、须癣毛癣菌、犬小孢子菌和白念珠菌临床分离株的MIC范围分别为1.0～4.0μg/mL、2.0～4.0μg/mL、2.0～4.0μg/mL和0.3～5.0μg/mL;MFC范围分别为2.0～8.0μg/mL、 4.0μg/mL、2.0～4.0μg/mL和5.0～10.0μg/mL。琼脂稀释法结果表明PHMB溶液浓度为1.25%时,红色毛癣菌、犬小孢子菌和须癣毛癣菌无菌落生长;PHMB溶液浓度为0.32%时,白念珠菌无菌落生长。加入透皮剂氮酮后,杀菌效果并无改变。结论 PHMB对浅部真菌病常见的致病真菌皮肤癣菌及白念珠菌具有较好的抑制和杀灭作用。     

1031例皮肤癣菌病及致病菌分析

目的了解本院皮肤癣菌病患者的临床特点、易感因素、病原菌种的构成及分布等。方法对2013年1月～2017年12月收集在本院皮肤科门诊就诊、培养结果为阳性的1031例皮肤癣菌感染病例进行病种及致病菌种分析。使用SPSS 23.0软件对结果进行统计处理分析。结果 1031例皮肤癣菌病中,男性535例,女性496例,共分离出1033株皮肤癣菌,其中皮肤癣菌病的发病高峰为21～30岁、 31～40岁年龄段。皮肤癣菌病患者分离出1种或1种以上其他真菌(非皮肤癣菌真菌)有71例(6.89%),分离出两种皮肤癣菌的有2例(0.19%),分离出最多的其他真菌是红酵母。最常见的皮肤癣菌病为甲癣(n=344,33.37%),其次为股癣(n=200,19.40%),体癣(n=162,15.71%),足癣(n=138,13.39%),手癣(n=108,10.48%),面癣(n=45,4.36%)和头癣(n=34,3.30%),其中股癣、甲癣等存在统计学意义上的性别差异。在菌种分布上,构成比前三依次为须癣毛癣菌(n=542,52.47%)、红色毛癣菌(n=397,38.43%)和犬小孢子菌(n=66,6.39%),其中红色毛癣菌和犬小孢子菌感染患者的性别差异有统计学意义。结论本院皮肤癣菌病以甲癣为主,主要致病菌为须癣毛癣菌,皮肤癣菌病及皮肤癣菌的分布特点和流行趋势与近年我国多数地区类似,但具备自身特点。     

家庭内红色毛癣菌病患者间菌株差异性分析

目的用PCR技术比较分离自同一家庭红色毛癣菌病患者的菌株差异性,分析家庭内多发的红色毛癣菌病的致病菌株是家内相互感染,还是家外感染。方法以家庭内多发的皮肤癣菌病患者为研究对象,分离致病菌株并以传统方法鉴定菌种。再分别用随机扩增多态性DNA(RAPD)和巢式PCR特异扩增红色毛癣菌的串联重复亚元件(TRSS:TRS-1/TRS-2)产生的指纹图谱分析种内株间有无差异性。结果纳入实验的16株菌分离自8个家庭,用形态学等方法及种特异引物均鉴定为红色毛癣菌。RAPD显示4个家庭内的菌株间有差异性,TRS-1区PCR指纹图谱显示5个家庭内菌株有株间差异,TRS-2区能鉴定出2个家庭内菌株间有差异。综合各方法共区分出6个家庭内的菌株间有带型差异。结论该研究提示家庭内多发红色毛癣菌病从家外途径感染率高于家内感染。TRS-1区PCR指纹图谱对红色毛癣菌的菌株区分度高于RAPD,更适于红色毛癣菌株间分型。结合多种分子分型方法可最大限度发现不同菌株间的差异。     

Dermatophytes isolated from patients in University Hospital,Kuala Lumpur,Malaysia

A total of 576 dermatophytes were isolated from patients with a variety of skin infections from January 1993 to May 2000. Ten species of dermatophytes were identified: Epidermophyton floccosum (0.7%), Microsporum audouinii (1.1%), M. canis (3.1%), M. gypseum (0.3%), Trichophyton concentricum (3.5%), T. equinum (0.2%), T. mentagrophytes (36.1%), T. rubrum (53.8%), T. verrucosum (0.2) and T. violaceum (1.0%). The body sites most frequently affected by dermatophytes were the buttocks, nails and trunk. Anthropophilic dermatophytes made up 60.1% of the isolates; the most common species was T. rubrum, T. mentagrophytes and M. canis were the two main zoophilic dermatophytes. T. mentagrophytes was isolated from all body sites except the scalp. M. canis was found to be associated with domestic dogs and was not isolated from ethnic Malays. The only geophilic dermatophyte was M. gypseum, an uncommon dermatophyte associated with tinea pedis.     

Culture medium alkalinization by dermatophytes

95 dermatophyte strains (12 of Trichophyton mentagrophytes, 12 of T. tonsurans, 11 of T. rubrum, 12 of T. megninii, 12 of T. violaceum, 2 of T. schoenleinii, 1 of T. soudanense, 12 of M. canis, 8 of Microsporum gypseum, 1 of M. ferrugineum and 12 of Epidermphoyton floccosum). 1 of Aspergillus niger, 1 of A. ochraceus, 1 of Paecilomyces sp., 1 of Penicillium sp. and 1 of Candida albicans were grown in Sabouraud liquid medium for the study of pH variation over 6 weeks at room temperature and after 4 weeks at 37 degrees C. All the dermatophyte strains alkalinized the medium. The highest pH values after 2-3 weeks' development in room temperature were produced by T. mentagrophytes, M. gypseum and M. canis, and the lowest by T. rubrum and T. violaceum. After the 4th week the alkalinizing activity became more marked for T. mentagrophytes and remained stationary for T. violaceum, In the 5th week the values produced by T. tonsurans were higher than those for M. gypseum, and those for E. floccosum and T. megninii were higher than those of M. canis. A similar behaviour was observed for T. rubrum and T. megninii and for M. canis, M. gypseum and M. ferrugineum. There seems to be a relation between the alkalinizing capacity and the rapidity and amount of the growth. At 37 degrees C both alkalinization and range of variation of the pH values of the medium became more noticeable for the strains of each species.     

Antimicrobial activity of Hyptis ovalifolia towards dermatophytes

The essential oil and the aqueous, hexane and methanolic fractions from Hyptis ovalifolia leaves were evaluated for their antifungal activity in vitro against 60 strains of dermatophytes: 10 strains of Microsporum canis, 10 of M. gypseum, 20 of Trichophyton rubrum and 20 of T. mentagrophytes. The extracts inhibited growth of the dermatophytes tested at different concentrations. The most biologically active was the essential oil from the leaves which inhibited 57 isolates (95%) at a concentration of 500 g/ml.     

Strains differentiation of Microsporum canis by RAPD analysis using (GACA)4 and (ACA)5 primers

Molecular analysis of dermatophytes (based on PCR fingerprinting) revealed high clonal differentiation between the genus and species. Microsporum canis (zoophilic dermatophyte, belonging to genus Microsporum), responsible for most cases of tinea capitis in children, tinea corporis in adults and dermatophytoses in cats, is very unique in comparison with other dermatophytes. Results of most molecular studies show that there is no clonal differentiation within M. canis as distinct from other species. The aim of this study was application of (GACA)4 repetitive primer and (ACA)5 primer for typing of M. canis strains isolated from human and animals in Central Poland. Fungal strains: 32 clinical isolates of M. canis, originated from patients from Central Poland; 11 strains isolated from infected cats (6) and dogs (7), reference strains of M. canis (CBS 113480), T rubrum (CBS 120358), T mentagrophytes (CBS 120357) and E. floccosum (CBS 970.95). The genomic DNAs of the strains were used as a template in RAPD reaction. No differentiation was observed for the analyzed M. canis strains using (GACA)4 and (ACA)5 typing.     

Antifungal activities of the essential oils in Syzygium aromaticum (L.) Merr. Et Perry and Leptospermum petersonii Bailey and their constituents against various dermatophytes

This study was carried out in order to investigate the potential of using plant oils derived from Leptospermum petersonii Bailey and Syzygium aromaticum L. Merr. Et Perry as natural antifungal agents. The antifungal effects of essential oils at concentrations of 0.05, 0.1, 0.15, and 0.2 mg/ml on the dermatophytes Microsporum canis (KCTC 6591), Trichophyton mentagrophytes (KCTC 6077), Trichophyton rubrum (KCCM 60443), Epidermophyton floccosum (KCCM 11667), and Microsporum gypseum were evaluated using the agar diffusion method. The major constituents of the active fraction against the dermatophytes were identified by gas chromatography-mass spectrometry and high-performance liquid chromatography analysis. The antifungal activities of S. aromaticum oil (clove oil) against the dermatophytes tested were highest at a concentration of 0.2 mg/ml, with an effectiveness of more than 60%. Hyphal growth was completely inhibited in T. mentagrophytes, T. rubrum, and M. gypseum by treatment with clove oil at a concentration of 0.2 mg/ml. Eugenol was the most effective antifungal constituent of clove oil against the dermatophytes T. mentagrophytes and M. canis. Morphological changes in the hyphae of T. mentagrophytes, such as damage to the cell wall and cell membrane and the expansion of the endoplasmic reticulum, after treatment with 0.11 mg/ml eugenol were observed by transmission electron microscopy (TEM). At a concentration of 0.2 mg/ml, L. petersonii oil (LPO) was more than 90% effective against all of the dermatophytes tested, with the exception of T. rubrum. Geranial was determined to be the most active antifungal constituent of L. petersonii oil. Taken together, the results of this study demonstrate that clove and tea tree oils exhibited significant antifungal activities against the dermatophytes tested in this study.     

In vitro activity of <Emphasis Type="Italic">Penicillium chrysogenum</Emphasis> antifungal protein (PAF) and its combination with fluconazole against different dermatophytes

Strains of five dermatophyte species (Microsporum canis, Microsporum gypseum, Trichophyton mentagrophytes, Trichophyton rubrum and Trichophyton tonsurans) were selected for testing against Penicillium chrysogenum antifungal protein (PAF) and its combination with fluconazole (FCZ). Inhibition of microconidia germination and growth was detected with MICs of PAF ranging from 1.56 to 200 mug ml(-1) when it was used alone, or at constant concentration (100 mug ml(-1)) in combination with FCZ at from 0.25 to 32 mug ml(-1). The MICs for FCZ were found to be between 0.25 and 128 mug ml(-1). PAF caused a fungicidal effect at 200 mug ml(-1) and reduced growth at between 50 and 200 mug ml(-1). Total growth inhibition with fungistatic activity was detected at 64 mug ml(-1) of FCZ for M. gypseum, T. mentagrophytes, and T. tonsurans, and at 32 mug ml(-1) FCZ for M. canis and T. rubrum. PAF and FCZ acted synergistically and/or additively on all of the tested fungi except M. gypseum, where no interactions were detected.     

Study of solar photosensitization processes on dermatophytic fungi

The antifungal activity of solar simulator was evaluated in presence of haematoporphyrin derivative (HPD), methylene blue (MB) and toluidine blue O (TBO) as photosensitizers. Seven dermatophytes were used as test fungi. The solar simulator at fluence rate 400 W/m2 for 30 minutes induced marked inhibition for spore germination of the photosensitized fungi. The rate of inhibition varied according to the fungal species and concentration of the photosensitizer. There was an increase in percentage inhibition of spore germination as the concentration of HPD or MB increased. Complete inhibition for spore germination of Trichophyton. verrucosum, T. mentagrophytes, and Miccrosporum canis was induced when these species were pretreated with 10(-3) M of HPD or MB before irradiation. Epidermophyton floccosum, T. rubrum, M. gypseum and T. violaceum were less sensitive to irradiation when pretreated with HPD or MB. On contrary, the maximum reduction in percentage spore germination was induced at the lowest concentration (10(-7) M) of TBO. The tested dermatophytes were mostly capable of producing different enzymes (keratinase, phosphatases, amylase, lipase). The separate application of radiation or photosensitizer was ineffective or exerted slight inhibition on enzyme production. However, the activity of the enzymes was drastically inhibited when the fungi were irradiated after their treatment with photosensitizer. T. verrucosum and T. mentagrophytes were the most sensitive. In a trail to apply a control measure against dermatomycosis using solar simulator radiation, the results revealed that the radiation was successful in curing the MB-photosensitized guinea pigs, artificially infected with T. verrucosum, T. mentagrophytes or M. canis. The percentage of recovery reached 100% in some treatments.     

Dermatophytes isolated from symptomatic dogs and cats in Tuscany,Italy during a 15-year-period

Between January, 1, 1986 and December, 31, 2000, dermatological specimens from 10.678 animals (7.650 cats and 3.028 dogs) were examined for dermatophytes. All the animals presented clinical signs of ringworm. Two thousand-four hundred fifty-six of the 10.678 (23%) examined animals scored positive for dermatophytes, 566 out of 3.028 canine (18.7%) and 1890 out of 7.650 feline specimens (24.7%). Microsporum canis constituted 83% and 97% of the isolated dermatophytes respectively in dogs and cats, M. gypseum represented 13% and 2.6% and T. mentagrophytes 5.5% and 0.2%. A sexual predisposition for mycotic infections was not observed. The animals with less than 1 year of age were more frequently infected. Canine toy breeds showed a significantly higher (P < 0.001) prevalence of infections by M. canis. Microsporum gypseum was mostly recorded from sporting (hunting) breeds [such as T. mentagrophytes (6.7%)]. Microsporum canis was isolated from long-haired cats with a ratio of 2:1 versus short-haired cats, while M. gypseum and T. mentagrophytes were never recovered from Persian cats. The annual distribution of the infections in dogs showed a significantly higher incidence for M. gypseum in summer versus winter and spring, while the recovery rate of M. canis from cats was very significantly higher in fall and winter than in summer and spring. Trichophyton mentagrophytes did not show a similar seasonal distribution.